Motivational interviewing for parents of young children

Telling parents that their young child is overweight: The role of motivational interviewing

Written by Associate Professor Rachael Taylor, Associate Investigator with COMPaRE-PHC and Karitane Fellow in Early Childhood Obesity at the Edgar National Centre for Diabetes and Obesity Research, University of Otago.

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Although one-third of young New Zealand children are overweight or obese, around two-thirds of parents have no idea this is the case¹. Most health professionals are also reluctant to broach the topic with parents because they are worried it may adversely affect the doctor-patient relationship, or feel they don’t have the resources to help the families make effective changes². However, although early intervention may offer a greater chance of success³, it won’t happen if parents do not perceive there is an issue⁴.

We decided to test whether motivational interviewing (MI) was a good way of informing parents that their child was overweight. MI is a way of working with people to make a change that comes from within – by emphasising their autonomy to change⁵ and increasing their self-determined (motivation from within the person rather than because of outside influences)⁶.

1093 children attended a comprehensive screening appointment of which 271 (25%) were identified as overweight or obese⁷. Parents of overweight children received feedback about their weight status using a traffic light resource delivered using either MI or usual care. Two weeks later parents were re-interviewed to assess their understanding of the feedback process and how they found it, any changes they had made to family lifestyles, and whether they wanted to participate in a two-year intervention⁸. We found:

1. MI and usual care were just as effective at encouraging parents to participate in a family-based weight intervention
2. A single session of MI increased short-term parental self-determined motivation to promote healthy lifestyles in their child
3. MI did not offer advantages over usual care for feedback of weight status given the extensive training required to perform MI well
4. Feedback did not appear to result in harm but how parents talk to their child about weight screening is important
5. A simple traffic light approach to discuss weight was well received by parents (80% indicated a favourable response)
6. Parents do want to know about their child’s weight, as long as the information is delivered in a sensitive manner

 References

1. Lundahl A, Kidwell KM. Nelson TD. Parental underestimates of child weight: a meta-analysis. Pediatrics 2014;online February 2:DOI: 10.1542/peds.2013-690.
2. Banks J, Sheild JPH. Sharp D. Barriers engaging families and GPs in childhood weight management strategies. British Journal of General Practice 2011;61:e492-e7.
3. Flynn MAT, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, et al. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with "best practice" recommendations. Obes Rev 2006;7:7-65.
4. Doolen J, Alpert PR. Miller SK. Parental disconnect between perceived and actual weight status of children: a metasynthesis of the current research. Journal of the American Academy of Nurse Practitioners 2009;21:160-6.
5. Miller WR. Rollnick S, Motivational interviewing: Preparing people for change. 2nd ed. Guildford Press. 2002, New York, NY.
6. Ryan RM. Deci EL, An overview of self-determination theory: An organismic-dialectical perspective, in Handbook of self-determination research, Deci EL and Ryan RM, Editors. 2002, University of Rochester Press: Rochester, NY. p. 3-33.
7. Taylor RW, Brown D, Dawson AM, Haszard J, Cox A, Rose EA, et al. Motivational interviewing for screening and feedback and encouraging lifestyle changes to reduce relative weight in 4-8 year old children: design of the MInT study. BMC Pub Health 2010;10:271-83.
8. Dawson AM, Brown DA, Cox A, Williams SM, Treacy L, Haszard JJ, et al. Using motivational interviewing for weight feedback to parents of young children. Journal of Paediatrics and Child Health 2014;Article first published online: 12 MAR 2014:DOI: 10.1111/jpc.12518.

The research discussed here was funded by the Health Research Council of New Zealand