Motivational Interviewing and weightloss

Obesity has been evidence linked as a significant risk factor for cardiovascular disease, diabetes, cancer, chronic diseases, sleep apnea and depression. Weight loss can significantly reduce the risk of developing up to 18 health conditions linked to obesity. Not only does obesity impact the quality of life of the individual, it puts a strain on health care systems. According a NHS report 10,660 hospital admissions in 2017/18 were directly attributable to obesity and 29% of adults classified as obese. Despite the obvious health benefits of weight loss, many healthcare professionals are still unable to persuade their patients to lose weight.

Resistance to change often stems from ambivalence, which leads to procrastination. The individual might have contradictory ideas about losing weight (not wanting to give up their sugary Cola, yet at the same time not wanting to be diabetic) which leads them to not making any changes to their diet.

Healthcare professionals are traditionally trained to promote change by being the expert, distilling information and giving instructions in order that the patient will make the necessary changes.  This might work for patients who are unaware of the impact their weight has on their health, but many patients are completely aware of the reasons why they should lose weight, yet they are ambivalent about making the required dietary changes. In these cases Motivational Interviewing “MI” can be used to elicit change.

MI is an empathetic and collaborative counselling style that elicits and strengthens motivation for change in a person. The aim is to get the person to overcome their ambivalence, examine their options and eventually talk themselves into changing. 

Sapadin and Maguir identified six procrastinator styles:

Procrastination StyleExamples within a weight-loss setting
The perfectionist delays a task because they might not achieve their own high standards.Delays starting a diet because they may not reach their goal weight at all. Or if the goal weigh is reached, they think they may not be able to sustain it.  
The dreamer has unrealistic or grandiose ideas.Wants to reach goal weight within 1 week, or a middle-aged person who wants to be the same weight they were as a teenager.  
The worrier fears things will go wrong and feels overwhelmed.Delays starting the diet because the lifestyle change seems too big of an adjustment. May also feel as if family members or doctors are pressuring them to lose weight.
The crisis-maker likes leaving things until the situation is so bad that someone else has to step in, or they hope the situation will resolve itself if they leave it long enough.  Delays starting a diet until they are unable to find clothes in their size, or lives in the hope that their doctor will prescribe a miracle cure.
The defier will go against instructions or good advice because they don’t like to be told what to do.  Will not go on a diet unless the idea is their own.
The over-doer stays busy with unnecessary tasks and avoids spending time on important issues.Spends time researching various diets and may even start a diet, but loses interest and starts researching other diets.  

Studies have shown that MI is an effective coaching style to eliciting change in patients that lead to a reduction in body weight. A meta-analysis of 11 published studies published in Obesity Reviews, showed that motivational interviewing was associated with a significant reduction in body weight (- 1.47kg) compared to those in the control group.

Healthcare professional however need to be taught MI techniques. The American Academy of Paediatricts launched a free app called “Change Talk: Childhood Obesity” which health care providers can use to learn MI techniques. The app simulates a virtual practice environment in which the health care provider assume the role of a pediatrician and decide what to say to a mother and her son about his weight. The app was launched after paediatricians and dietitians who used MI to counsel parents about their child’s weight, were successful in reducing the children’s BMI by 3.1 more points than comparison children over a 2-year period. 

The key to MI’s success is that the coach or healthcare provider do not portray themselves as the expert, giving orders to the patient and expecting the patient to immediately comply. Instead the healthcare professional displays empathy and patience and assumes that the person with the problem (the patient) is the one who holds the answer to solving the problem.

Stephen Rollnick sets out the four general principles, or RULEs of MI, for practitioners as follows (7):

  • Resist the urge to change the person’s mind by giving instructions, dumping information on them or portraying yourself as the expert.
  • Understand that it’s their reason for change, not yours, that will elicit a change in behaviour. Also understand that change will happen when they feel ready, not when you think they should be ready.
  • Listen to what they are saying. They need to know they are being understood. The individual is the one who holds the key to solving their weight problem.
  • Empower them to understand that they have the power to change their behaviour.

To quote Stephen Rollnick, strategies for use of MI in healthcare “is a shift in approach that is at the same time both fundamental and simple: instead of badgering patients to change their ways, you briefly connect or come alongside, and help them to do this for themselves.”

When patients are shown that they in fact are capable of change and can reduce their weight on their own terms, they feel empowered.  As an added benefit, an empowered patient lifts the responsibility from health care professionals to solve every problem because the patient is able to self-motivate and make the required changes.

*This blog post is based on the assignment I completed for Module 7 of my Integrated Resilience & Wellness Coaching studies. Citations were included in the submitted assignment.*