Applying MI to Obesity Conceptual and Pragmatic Issues

There are several aspects of obesity counseling that pose unique challenges for the MI counselor. First, for pediatric obesity, depending on the age of the patient, the intervention may occur directly with the parent(s), directly with the child, or both. There is some evidence that older obese children do not benefit from the involvement of their parents, whereas parent involvement may be beneficial for younger children (46). However, it is not known at what ages youth and parents should be seen alone versus together. For both youth and adults, the practitioner needs to understand that obesity is not a behavior per se. Therefore, a key task for clinicians is to work with patients to identify what behaviors contribute to their own or their child's weight status and use agenda setting strategies to determine which behaviors they feel are most amenable to intervention (Table 1).

Although MI has been established as a useful method for helping individuals overcome resistance and clarify motivation, it is important to note that additional strategies, such as behavior therapy or cognitive behavioral therapy, may be needed once an individual decides to attempt behavior change. There is an MI-consistent means for delivering treatment and at this stage of care, MI should perhaps be conceived as a platform for treatment delivery rather than the primary treatment modality; as background rather than foreground.

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