[2600.29] Can Brief Motivational Interviewing in Practice Reduce Child Body Mass Index? Results of a 2-Year Randomized Controlled Trial

K. Resnicow, A. Bocian, D. Harris, R. Schwartz, L. Snetselaar, E. Myers, J. Gotlieb, S. Woolford, R. Wasserman. University of Michigan, Ann Arbor, MI; Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, IL; Wake Forest University, Winston-Salem, NC; University of Iowa, Iowa City, IA; Academy of Nutrition and Dietetics, Chicago, IL; University of Vermont, Burlington, VT.

BACKGROUND: Primary care interventions to address pediatric obesity have had limited success. It is unclear whether Motivational Interviewing (MI) is an effective tool in practice to reduce BMI percentile of overweight and obese children.
OBJECTIVE: Assess the impact of brief MI counseling on child BMI percentile over a 2-year period.
DESIGN/METHODS: Data were collected as part of a 2-year national randomized controlled trial in 41 PROS practices to test use of MI vs usual care among children ages 2-8 with BMI percentiles from 85th-97th. The 3-arm design included a usual care group (G1) (n=10 practices; n=198 parent/child dyads); MI delivered by pediatricians (PED; G2) (n=16; n=212); or MI delivered by PED plus registered dietitians (RD; G3) (n=15; n=235). After 2 years, 70.6% patients were retained; 457 included in analysis.
PED in both intervention arms and RD were trained in MI prior to patient enrollment. Over 2 years, G2 delivered up to 4 MI visits and G3 up to 10 MI visits (4 PED and 6 RD visits). Data were analyzed using mixed effects regression controlling for cluster randomization effects and baseline covariates.
RESULTS: All groups, including usual care, showed a decline in BMI percentile at Year 2 (overall group effect, p = 0.049). Post-hoc contrasts showed the G3 (MI delivered by PED/RD) mean was significantly (p =.02) lower than G1 (usual care). Results using differences in BMI percentile showed a similar pattern. The net difference between G1 and G3 was 3.1 BMI percentile units.

Year 2 BMI Percentile and BMI Percentile Change by Study Group
GroupNPost-intervention (Year 2) BMI Percentile^ (SE)BMI Percentile Difference#^ (SE)
G1 Usual Care15890.3§ (0.94)1.8(0.98)
G2 Pedatricians14588.1 (0.94)3.8 (0.96)
G3 Pedatricians & Dietitians15487.1§ (0.92)4.9(0.99)
§¶ Groups with matching superscript sig. differ p < .05; # Subtracting post-intervention BMI percentile from baseline BMI percentile. ^ Adjusted for age, race, sex, baseline BMI, household income, parent BMI, provider age, practice effects (clustering)

CONCLUSIONS: This is the first large-scale U.S. primary care RCT to demonstrate significant reductions in BMI using MI. MI delivered by both RD and PED was superior to that delivered by PED alone, however BMI reductions for PED alone at fewer visits are encouraging. MI can be a powerful tool to address child obesity in primary care.


Session: Presidential Plenary: 2014 AAP Presidential Plenary & Annual Silverman Lecture (12:30 PM - 4:30 PM)
Date/Time: Sunday, May 4, 2014 - 3:10 PM
Room: West Ballroom B - Vancouver Convention Centre
Course Code: 2600


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