by Jan Kavookjian, PhD, MBA, FAPhA, FADCES, Associate Professor of Health Outcomes Research and Policy, Auburn University, National DPP Lifestyle Coach, and incoming (2021) ADCES President-Elect; Kameron B. Suire, ACSM-EP, MS, PhD Candidate in Department of Kinesiology, Auburn University
Overweight and obesity are prevalent conditions in the U.S. and world and contribute significantly to risks for diabetes and associated cardiometabolic conditions. Diabetes care and education specialists practicing within diabetes self-management education and support (DSMES) programs and/or National Diabetes Prevention Programs (DPPs) have a focus in facilitating goal setting for lifestyle change and self-management behaviors for those with or at risk for type 2 diabetes.
Self-management behaviors like healthy eating and being active are keys to general type 2 diabetes prevention and treatment, as well as to weight loss specifically. Because overweight and obesity are known to bring negative and costly outcomes for the person with or at risk for diabetes, the practitioner/practice setting, and for the healthcare system, addressing weight loss is an area of high focus and is a central objective in National DPP and DSMES endeavors.
Talking about weight loss can be an anxiety-producing conversation for both the person carrying extra weight and for the diabetes care and education specialist trying to find a comfortable way to bring the sensitive topic up. Often, we are unsure of how to approach the topic in a way that will help the individual’s decision-making about setting goals and engaging in weight reducing behaviors.
Conversations on weight loss are most effectively initiated and facilitated by mindfully attending to the use of:
- Nonjudgmental strengths-based language and non-stigmatizing words.
- A person-centered approach and communication skills set known as motivational interviewing.
What is motivational interviewing?
Motivational interviewing (MI), which originated from successful impact in the counseling and addictions fields in the early 1980s, emerged in health behavior interventions for chronic disease management/prevention in the early 1990s.
MI is known as a person-centered approach and communication skills set that facilitates the individual’s own internal motivation and decision-making for change on a target behavior by interviewing the person using the MI relational and technical dimensions. These include approaching with a caring, non-judgmental, collaborative and empowering relational demeanor while using the technical skills of active listening, empathic responding, self-efficacy support, eliciting of the person’s ideas/goals/knowledge before giving ideas or advice, autonomy supporting strategies like permission asking, open-ended questions and agenda-setting, among others. The combined efforts across these dimensions have been shown to help individuals resolve their ambivalence or resistance to change a target behavior.
How does motivational interviewing impact weight loss?
MI has a vast evidence base across varied target behaviors, conditions, populations, settings and practitioner types. In looking at the impact of a strategy on weight loss, well-conducted systematic reviews can help summarize evidence reported across studies and can bring a state-of-the-science contribution to the evidence base.
For the impact of MI on weight loss, last month two rigorous systematic reviews of randomized controlled trials (RCTs) emerged in the literature, reporting impact of MI on weight loss in overweight children and adult women. The systematic review by Suire, Kavookjian, and Wadsworth in the journal, Pediatrics, examined impact of MI on overweight children (via parental intervention) and the systematic review/meta-analysis by Suire, Kavookjian, Feiss, and Wadsworth in International Journal of Behavioral Medicine reviewed RCTs of MI impact on weight loss in adult women.
Both reviews used the modified Cochrane method of systematic review to explore and report evidence and gaps in the literature among published RCTs. In the review focused on weight loss in overweight young children via MI intervention with their parents, four of the seven retained studies that met the review’s inclusion criteria demonstrated significant decreases in weight and/or BMI in addition to improvements in related outcomes (healthy eating targets and physical activity) when compared to usual care.
Studies that showed a statistically significant impact from MI had three things in common:
Higher frequency of MI sessions.
Evaluation of recordings of sessions for MI fidelity.
- Utilization of practitioners fully trained in MI.
In the second publication, a review and meta-analysis of RCTs focused on weight loss in adult women, the nine studies that measured weight reported several key findings. These include:
On average, the MI groups lost about 3 pounds more than the control groups. Studies measuring BMI demonstrated that on average, six MI groups lost about 1.22 kg/m2 more than the control groups.
A higher number of MI sessions as well as longer session length were methods used in studies showing statistically significant impact.
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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