Testimony of a Minor

Motivational Interviewing Flunks a Test with Pediatricians

Motivational interviewing is a respected tool for helping people who are seeking care for obesity. It’s  all about listening  to and supporting a person’s motivations wanting medical obesity care. But yet again, we are learning that motivation is not the magic answer for overcoming obesity. This time, in Pediatrics, Ken Resnicow and colleagues have published a cluster-randomized test of motivational interviewing in a real-world setting with pediatricians and came to a very simple conclusion. It didn’t work, as the authors clearly explain:

“There was no overall benefit of the intervention and, contrary to expectations, youth in the intervention arm gained more weight, based on percent of the distance from the 95th percentile than matched youth from UC practices. The absolute excess weight gain among intervention relative to UC youth was small, approximately 0.5 BMI units and 1 kg over 2 years.”

So  motivational interviewing clearly flunked this test of effectiveness for obesity in the real world of practicing pediatricians.

The Need for Humility

Dean David Allison of the Indiana University School of Public Health praised the researchers for plainly reporting that an intervention they expected would help, actually made things worse:

“If ever there was a demonstration of the need for intellectual humility and the importance of evidence in obesity intervention research, this is it.

“A top team of experts conducted a large, theory-based, well-designed, and seemingly well-executed rigorous randomized controlled trial.

“Kudos to the authors for their straightforward reporting.”

“The next time someone opines that ‘it is obvious’ that we need to … [fill in their favorite intervention] … and that doing so must surely work, remind them of this study.”

Presumptions About Motivation

We’ve seen this result before. A recent systematic review and meta-analysis of motivational interviewing in overweight and obesity found no evidence for a beneficial effect. As we wrote at the time, this does not prove that motivational interviewing is a bad idea. Listening to a patient’s motivation for seeking care is almost always a good idea.

But this does tell us that deeply held beliefs (i.e. bias) about the importance of motivation for overcoming obesity might be clouding our judgment in delivering care for this chronic disease. We would never presume that motivation is the key for putting cancer into remission.

In obesity, though, this presumption is common. That’s because we implicitly blame patients for their condition despite the fact that physiology can be the overwhelming factor.

Yet again we see that assumptions can make us seem like foolish asses.

Click here for the study and here for a companion editorial. For further perspective, click here, here, and here.

Testimony of a Minor, painting by Honore Daumier / WikiArt

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February 2, 2024

One Response to “Motivational Interviewing Flunks a Test with Pediatricians”

  1. February 02, 2024 at 10:53 am, Valerie M. O'Hara said:

    Thank you Ted. This highlights the sometimes subtle (other times not so subtle) presumption that if a patient with obesity – via MI – could voluntarily engage in ILT change, the disease of obesity would resolve. This approach highlights the bias and lack of understanding of the complex pathophysiology at the homeostatic level of this disease. It seeps into what providers are “saying” to continue to consider MI, which is helpful in learning to listen and hear your patients history, as an actual treatment is false. It is a means to helping determine what treatment(s) will best treat the disease process for this specific and unique individual and how to overcome barriers as a team.