Motivational interviewing to enhance self-efficacy and promote weight loss in overweight and obese adolescents: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of Motivational Interviewing (MI) as an intervention for promoting self-efficacy and weight loss in a sample of overweight and obese youth. METHODS: /Design 40 participants (aged 10-18 years) were randomly assigned to control (social skills training) or treatment (MI) group. Both groups received individual therapy (~30 min/month) in addition to usual care of diet/exercise counseling. Pre- and post- (at 6 months follow-up) variables included measures of self-efficacy and anthropometrics. RESULTS: Although significant between-group differences were not found, individuals in the MI group attended more sessions. Overall, participants in both groups showed significant increases in self-efficacy and a trend of decreased body mass index z-scores. CONCLUSIONS: Health benefits from participation in individual therapy may have been accrued; however, specific benefits attributable to MI were limited. Findings suggest that more than one type of counseling intervention (i.e., MI and social skills training) may be beneficial when providing integrative treatment for obese youth.

Motivational interviewing as an intervention to increase adolescent self-efficacy and promote weight loss: methodology and design.

BACKGROUND: Childhood obesity is associated with serious physiological and psychological consequences including type 2 diabetes, higher rates of depression and low self-esteem. With the population of overweight and obese youth increasing, appropriate interventions are needed that speak to the issue of readiness to change and motivation to maintain adherence to healthy behavior changes. Motivational Interviewing (MI) is a method of therapy found to resolve ambivalence, enhance intrinsic motivation and promote confidence in a person's ability to make behavior changes. While MI has shown promise in the adult obesity literature as effecting positive lifestyle change, little is known about the effectiveness of MI with overweight and obese youth. This study aims to: 1) demonstrate that MI is an effective intervention for increasing a person's self-efficacy; 2) demonstrate that exposure to MI will facilitate healthy behavior changes; 3) explore psychological changes related to participation in MI and 4) compare physiological and anthropometric outcomes before and after intervention. METHODS/DESIGN: The current investigation is a prospective study conducted with ongoing participants who regularly attend an outpatient pediatric care center for weight-loss. Overweight youth (BMI > 85th %ile) between the ages of 10 and 18 who meet eligibility criteria will be recruited. Participants will be randomly assigned to a control group (social skills training) or a treatment group (MI). Participants will meet with the therapist for approximately 30 minutes prior to seeing the dietician, over the course of 6 months. Participants will also undergo a full day assessment at the beginning and end of psychology intervention to evaluate body fat, and metabolic risk (screening for diabetes, high cholesterol, high blood pressure and fitness level). The paper and pencil portions of the assessments as well as the clinical testing will occur at baseline and at the conclusion of the intervention (6 months) with a repeat assessment 6 months following the completion of the intervention. DISCUSSION: Results from this study are expected to enhance our understanding of the efficacy of MI with children and adolescents who are overweight or obese.

Brief report: Young children's risk of unintentional injury: a comparison of mothers' and fathers' supervision beliefs and reported practices.

OBJECTIVE: There is increasing interest in understanding how parent supervision influences young children's risk of injury, but nearly all of this research has been conducted with mothers. The present study compared first-time mothers' and fathers' supervisory beliefs and reported practices, and related these scores to parental reports of their child's history of injuries. METHODS: Mothers and fathers of children 2-5 years each independently completed a telephone interview and previously validated questionnaires about their supervisory beliefs and practices and their child's history of injuries. RESULTS: Mothers and fathers provided similar reports of their child's injuries (minor, medically attended) and scored similarly on various supervision indices. Despite these similarities, the way mothers' and fathers' supervision indices related to children's injury history scores differed. Children's frequency of minor and medically attended injuries was predicted from maternal supervisory scores but not from paternal scores. CONCLUSIONS: Maternal supervision has more impact on children's risk of injury than paternal supervision, possibly because mothers spend more time with children than fathers.

Understanding children's injury-risk behavior: wearing safety gear can lead to increased risk taking.

The present study examined whether school-age children show risk compensation and engage in greater risk taking when wearing safety gear compared to when not doing so when running an obstacle course containing hazards that could lead to physical injury. Because sensation seeking has been shown to influence risk taking, this child attribute was also assessed and related to risk compensation. Children 7-12 years of age were videotaped navigating the obstacle course twice, once wearing safety gear and once without safety gear, with reverse directions used to minimize possible practice effects. The time it took the child to run through the course and the number of reckless behaviors (e.g., falls, trips, bumping into things) that the child made while running the course were compared for the gear and no-gear conditions. Results indicated that children went more quickly and behaved more recklessly when wearing safety gear than when not wearing gear, providing evidence of risk compensation. Moreover, those high in sensation seeking showed greater risk compensation compared with other children. Implications for childhood injury prevention are discussed.