ABSTRACT
BACKGROUND AND OBJECTIVE: Few studies have tested the impact of motivational interviewing (MI) delivered by primary care providers on pediatric obesity. This study tested the efficacy of MI delivered by providers and registered dietitians (RDs) to parents of overweight children aged 2 through 8. METHODS: Forty-two practices from the Pediatric Research in Office Settings Network of the American Academy of Pediatrics were randomly assigned to 1 of 3 groups. Group 1 (usual care) measured BMI percentile at baseline and 1- and 2-year follow-up. Group 2 (provider only) delivered 4 MI counseling sessions to parents of the index child over 2 years. Group 3 (provider + RD) delivered 4 provider MI sessions plus 6 MI sessions from a RD. The primary outcome was child BMI percentile at 2-year follow up. RESULTS: At 2-year follow-up, the adjusted BMI percentile was 90.3, 88.1, and 87.1 for groups 1, 2, and 3, respectively. The group 3 mean was significantly (P = .02) lower than group 1. Mean changes from baseline in BMI percentile were 1.8, 3.8, and 4.9 across groups 1, 2, and 3. CONCLUSIONS: MI delivered by providers and RDs (group 3) resulted in statistically significant reductions in BMI percentile. Research is needed to determine the clinical significance and persistence of the BMI effects observed. How the intervention can be brought to scale (in particular, how to train physicians to use MI effectively and how best to train RDs and integrate them into primary care settings) also merits future research.
Subject(s)
Counseling , Diet, Reducing/psychology , Feeding Behavior/psychology , Motivational Interviewing , Nutritionists , Pediatric Obesity/therapy , Primary Health Care , Body Mass Index , Child , Child, Preschool , Combined Modality Therapy , Cooperative Behavior , Female , Follow-Up Studies , Humans , Interdisciplinary Communication , Male , Motivation , Parents/education , Parents/psychology , Pediatric Obesity/psychology , United StatesABSTRACT
Pediatricians can help adolescents with attention-deficit/hyperactivity disorder prepare to enter post-high school training and the workforce. In this article peer-reviewed studies and other resources for informing patients of the issues ahead are identified. We discuss preventive counseling, including long-term monitoring, adherence to treatment, driving, tobacco, alcohol, and other drug usage, career planning, and intimacy. The current status of insurance coverage for young adults and federal programs to assist students with attention-deficit/hyperactivity disorder are reviewed also. Consideration is given for applying for precollege testing and college accommodations and traveling abroad with medications. Pediatricians and young adults are directed to Web-based and other self-management information and tools.
