Study findings cast doubt on childhood obesity intervention
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Key takeaways:
- A new study casts doubt on the efficacy of an AAP-recommended obesity intervention method.
- Researchers found no overall benefit of the motivational interviewing method.
Motivational interviewing, a weight loss intervention recommended by the AAP, showed no benefit reducing childhood obesity during a recent study, according to research published in Pediatrics.
“Pediatric obesity rates in the United States remain at an all-time high,” the authors of the study wrote, noting that the upward trend accelerated during the COVID-19 pandemic, with a higher prevalence among non-Hispanic Black and Mexican American youth, as well as youth from low-income and low-education households.
“Pediatric clinicians and registered dietitians can play important and complementary roles in preventing and treating childhood obesity,” they wrote. “Motivational interviewing (MI) is a patient-centered communication style that has been used by pediatric and adult health care professionals to address a wide range of conditions and behaviors, including nutrition and physical activity.”
The AAP recommended MI in new obesity guidelines published last year. According to the authors of the new article, at least two prior studies using a similar intervention yielded mixed effects.
The researchers randomly assigned 18 pediatric primary care practices to use either the Brief Motivational Interviewing to Reduce Body Mass Index intervention or usual care for childhood obesity from 2017 through 2021.
The intervention had four components: in-person and telehealth MI counseling by pediatric clinicians, telephone MI counseling sessions from a registered dietitian, text message reminders and tailored motivational messages and a study portal for parents, pediatricians and dieticians.
The researchers enrolled 1,120 children aged 3 to 11 with a BMI value greater than or equal to the 85th percentile for their age and sex — 280 children in the intervention group and 840 in the control group. The main outcome was BMI as a percent of the 95th percentile for children of the same age and sex.
Results favored the control group, with youth in the intervention arm showing a greater relative increase in their percent of the 95th percentile, according to the researchers. Children in the intervention arm actually gained more weight than children receiving usual care.
The researchers said various methodologic and cultural factors, coupled with the COVID-19 pandemic, may have contributed to the lack of improvement in the weight status of participating children, and that the model used “needs reconfiguration.”
“The required dose to achieve weight effects may be unattainable in our current health care delivery system,” they wrote. “Further, the use of dietitians and pediatricians may need to be reconsidered. It may be beneficial to include other health care professionals who are primarily trained in behavioral change counseling and motivation, perhaps providing them with nutrition counseling skills or perhaps engaging dieticians only once or twice during the intervention.”
The study was accompanied by a commentary authored by Laura Rolke, PhD, and Michelle J. White, MD, MPH, both of the Duke University School of Medicine, who noted that it reflected the “urgent need for child obesity interventions that target the structural factors which contribute to child obesity including socioeconomic, built environment and food policies.”
“Although pandemics are (we hope) rare, the social, environmental, and economic factors that lead to child obesity are ubiquitous,” they wrote. “Interventions focused on individual or family behavior change alone are unlikely to overcome them. Moreover, such interventions may place too much onus on the caregiver to initiate and maintain behavior change against a powerful current of adverse factors.”
References:
Resnicow K, et al. Pediatrics. 2023;doi:10.1542/peds.2023-062462.
Rolke L, et al. Pediatrics. 2023;doi:10.1542/peds.2023-064453.
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