News Flash: Listening and Motivation Don’t Cure Obesity

Motivational interviewing (MI) is a foundational tool for obesity care. In this setting, it is all about listening, understanding, and bolstering a patient’s motivation in seeking care for obesity. But what should we make of the revelation about it last week in the Annals of Internal Medicine? A study found that it doesn’t, by itself, yield better weight loss outcomes.

The authors of the systematic review and meta-analysis that produced this finding are blunt. In fact, they say maybe it’s not worth the effort:

“There is no evidence that MI increases effectiveness of BWMPs [behavioral weight management programs] in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs.”

Many Ways to Interpret

This analysis is a wondrous thing because we see people filling it up with whatever meaning they like. One very straightforward take comes in an editorial by Sandra Wittleder and Melanie Jay:

“Strengthening motivation through MI is insufficient for weight management because obesity is a disease with a complex etiology, including multilevel factors that are outside the patient’s control.”

To be clear, if a clinician thinks motivation is the secret sauce for weight loss, they’re fooling themselves. Because motivation is no different for someone with obesity than it is for someone with cancer. It takes a lot to manage a chronic disease. Willpower can be helpful, but it doesn’t make it go away.

So if this finding underscores that fact, it’s a good thing.

On the other hand, using this as an excuse to drop the pretense of listening to patients and caring about their motivations would be a mistake. In their conclusions, the authors of this study do make it sound that way.

The Indispensable Value of Listening and Support

Obesity is not a disease of errant behavior. But for many people, behavioral strategies can be essential for coping with it. So clinical care that centers upon listening to people with obesity, understanding their motivation, and supporting them is indeed important. Health coach Gabrielle Fundaro sums it up quite well:

“The article stated that MI had an effect, albeit a small one. But the purpose of MI isn’t to make people change, so that’s not surprising. I will still continue to practice active listening, accurate empathy, supporting the autonomy and self-efficacy of clients.”

Click here for the study, here for the editorial, and here for further reporting.

The Talk, painting by Camille Pissarro / WikiArt

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April 4, 2022