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August 28, 2023

Motivational Interviewing for Obesity Treatment

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Image of a doctor taken from over the shoulder of a patient wearing a red shirt. The doctor is wearing a white coat with a blue shirt and has a stethoscope around their neck. They are speaking to the patient. The white OMA logo sits in the top right corner of the image.

Using Motivational Interviewing for Obesity Treatment

In the treatment of the disease of obesity, where conventional approaches often fall short of achieving lasting outcomes, a fresh perspective emerges through the application of motivational interviewing. In recent years, the paradigm of obesity treatment has shifted from a one-size-fits-all model to one that embraces the complexities of individual behavior, motivation, and readiness to change. Motivational interviewing, a collaborative and person-centered communication style, has gained prominence as an effective tool in fostering intrinsic motivation and facilitating sustainable lifestyle modifications.

Motivational interviewing is a patient-centered counseling technique that incorporates listening, interpersonal skills, and support to bring a patient from ambivalence to behavioral change. The patient is in control of the process and is allowed to explore their true intentions along with the inner conflicts involved in achieving the desired outcome. This article delves into the transformative potential of motivational interviewing within the realm of obesity treatment, exploring its principles, techniques, and empirical evidence that underscores its role in guiding individuals toward meaningful, long-term health improvements.

Incentives and Weight Loss Behavior

Change is hard. Anyone on a quest to make better lifestyle choices can attest to this. It is much easier to go with the flow than to withstand resistance. For example, at a dinner meeting, most attendees will succumb to the added calories from the breadbasket to the sugary desserts because it is easier to indulge than to resist. For this reason, the question of how to incite internal motivation in order to reach a goal has been applied in the weight loss industry for years. Many weight loss programs have found that incentives help to influence inner motivation. Corporate wellness programs use incentives ranging from prizes to cash deposits in health spending accounts to motivate employees to obtain a healthy weight, and multiple weight loss programs use gifts such as keychains, praise, and stickers once a weight milestone is achieved. The problem with incentives is that although they may work for some, they do not work for all. In addition, awards lose appeal over time. Many have found that the instant gratification of indulgence outweighs the patience and planning required to earn the incentive, negating the entire purpose of the incentive program or plan.

Motivational Interviewing in Obesity Treatment

So, what really motivates people to change? Is it the external nudges from the healthcare provider reminding the patient that they have excess weight to lose or a supportive community providing encouragement and accountability? Motivational interviewing teaches that although external influences incite inspiration, only the patient’s intrinsic strength creates sustainable motivation. In motivational interviewing, the five components include pre-contemplation, contemplation, preparation, action, and maintenance. The role of the provider is to understand each stage and provide patience, compassion, and guidance along the journey. It is important to gauge the patient’s level of commitment and aid in acknowledging responsibilities, readiness, and the steps taken to execute each goal. Calling out inconsistencies between the patient’s words, choices, and actions will only serve to enhance this process. In weight management, patients often feel that they have lost control, especially when their attempts are unsuccessful. Providers can restore this loss of control and empower patients by echoing their internal conversations and analyzing deep-rooted ambitions.

Motivational interviewing involves asking open-ended questions that encourage individuals to explore their thoughts, feelings, and motivations related to behavior change. Here are some sample questions that can be used during motivational interviewing sessions for obesity treatment.

Exploring Ambivalence:

  • “What are some of the reasons you might want to make changes to your eating habits?”
  • “What are some things you enjoy about your current lifestyle, even though you’re considering making changes?”

Eliciting Importance and Values:

  • “What would be the benefits of achieving a healthier weight for you?”
  • “How does your weight impact your day-to-day life and your future goals?”

Considering Pros and Cons:

  • “What are the positive aspects of losing weight or making healthier food choices?”
  • “Are there any concerns or challenges you foresee in making these changes?”

Exploring Readiness for Change:

  • “On a scale of 1 to 10, how confident are you in your ability to make changes to your eating habits?”
  • “What factors would make you more ready to take action towards weight management?”

Identifying Goals:

  • “What specific changes in your eating habits would you like to work on?”
  • “Where would you like to see yourself in terms of weight and health in the next few months?”

Exploring Confidence and Self-Efficacy:

  • “What strategies have you used successfully in the past to overcome challenges?”
  • “How do you think you could handle situations where you’re tempted to make unhealthy food choices?”

Support Systems and Resources:

  • “Who in your life could provide support or encouragement as you work towards your goals?”
  • “Are there any community resources or tools that could assist you in your weight management journey?”

Remember, the key to motivational interviewing is to listen actively, respond empathetically, and guide the conversation based on the individual’s responses. These questions serve as a starting point, but the flow of the conversation will depend on the person’s unique experiences and motivations.

How to Learn Motivational Interviewing

The motivational interviewing approach to obesity treatment, rooted in empathy, collaboration, and personalized exploration, has illuminated a path toward sustainable and meaningful weight management. By acknowledging the intricate interplay of individual motivations, barriers, and aspirations, motivational interviewing fosters a shift from imposed directives to self-determined journeys. With each empathetic question asked and every reflective statement offered, we inch closer to a future where obesity treatment embodies both science and heart, leading individuals toward a healthier and more fulfilled existence. The provider that is best able to leverage the patient’s strengths through promoting introspective autonomy will be most successful in cultivating the patient’s self-actualization and goal achievement.

To learn more patient care techniques, read “How to Manage the Social Stigma of Obesity in a Clinical Setting” or listen to our podcast episode on behavioral interventions in lifestyle change.

Article written by:

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Melody Covington, MD