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→ A look at MI and obesity by CIPC Director, Dan Mullin
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Part 2 of Obesity in Primary Care
Motivational Interviewing and Weight Loss
If you know the programs of the Center for Integrated Primary Care, you know that we are champions of Motivational Interviewing. We run acclaimed intensive training in MI twice a year online and sponsor MI-related special events. We use MI in our practices as primary care behavioral health providers.
So it is logical to ask if Motivational Interviewing can be an effective intervention for patients struggling with issues of weight and obesity. As with any chronic health condition, MI can be helpful, but it is not a cure. The question to ask is, “What is the target?” If one is working in primary care with a patient who is obese, the goal is not weight loss but rather building a commitment to change. The goal ought to be eliciting and strengthening the patient’s own reasons for engaging in an intensive, multicomponent behavioral intervention.
Eating and Lifestyle are complex and personal
Like alcoholism or addiction, it may not be realistic to expect that success will equal total prohibition and unwavering self-control. Eating and lifestyle are just as complex. We eat to live and so “control” can be quite relative and personal.
It is also helpful to be clear about how active we should expect that patients can become. Imagine a continuum of activity from sedentary to active to fit. It may be realistic to move a patient from sedentary to active. It may also be possible move an active patient to fit. But expecting all sedentary patients to become fit may be unrealistic. It is not a patient-centered approach.
Engagement or meeting the guidelines?
In a recently published article, “Effects of physical activity goal attainment on engagement and outcomes in the National Diabetes Prevention Program” the authors find that the NDPP recommendation of 150 minutes of weekly physical activity may be linked to high attrition rates in the program. If individuals are overwhelmed by the prospect of reaching 150 minutes of weekly activity, they assume they have failed and drop out of participation. It may be more important to encourage continued engagement. Supporting individuals in their journey toward readiness to change is consistent with the spirit of motivational interviewing.
“Moreover, it may be beneficial to place greater emphasis on setting personalized physical activity goals…This is consistent with a systematic review of necessary intervention components for diabetes prevention that found evidence supporting motivational interviewing and individualized tailoring of recommendations, rather than prescriptive guidance"
As the article demonstrates and as we have seen in our practice, offering a patient-centered approach to change and goal setting can help motivate individuals to seek the professional help they need to begin improving their health and well-being.
