Motivational Interviewing for Behaviour Modification

Obesity is a complex, chronic disease and there is so much more to addressing it than simply eating less or following a diet. If you are tired of focusing on restrictive eating patterns, consider trying behavioural modification techniques for weight management. Two methods a person can use to create effective and lasting behavioural changes are motivational interviewing (MI), explained below, and cognitive behavioural therapy (CBT), which focuses on using your own thoughts and behaviour to help you through a situation, rather than focusing on changing the circumstances that are usually beyond your control.

This is about learning new skills, not about ramping up willpower. Others who are not living with obesity might also find learning these techniques helpful in other areas of their lives.

When applying these methods for weight loss, the goal and focus is most often on overall health instead of the numbers on a scale. Research has shown¹ that even small and modest reductions in weight can have positive benefits on improving health, which is very encouraging. Registered dietitians and other healthcare professionals (e.g., doctors, physiotherapists, counsellors) can all acquire extra training in motivational interviewing techniques.

Motivational Interviewing

Motivational interviewing is a person-centred and goal-directed approach that works toward increasing a person’s motivation for change.² This involves counselling to help improve self-efficacy, which is a person’s belief in their capacity to execute behaviours necessary to produce specific performance attainments.³ This is all done in the context of a positive provider-patient relationship, which is so important for this technique to work. Those who are living with obesity might be less likely to seek out help and continue with treatment sessions if they feel judged, or if their provider doesn’t understand the complexity of obesity. Unfortunately, obesity stigma can still happen among healthcare professionals today.

The core principles in MI are as follows: express empathy, support self-efficacy, roll with resistance (not opposing someone who is resistant to change), and develop discrepancy. These principles involve asking open-ended questions, affirming the person’s perspective, reflecting on what one has heard to ensure understanding, and summarizing the shared understanding to set specific goals.² It is also important for practitioners to discuss relapse prevention and strategies around this and avoid offering unsolicited advice.

The healthcare provider and patient create realistic and measurable goals together, which results in a patient-directed plan. Healthcare professionals trained in MI can increase a person’s awareness of the need or desire to change by highlighting the discrepancy between a current behaviour and a desired behaviour.

Here are ten examples of questions used in MI to help increase awareness, support autonomy, build confidence, and stimulate the desire for change:

Can you tell me more about how your life would look different if you lost weight?
What are the benefits to staying the same/not changing?
What are you currently doing that is helping you lose weight?
What would you have to give up to make this a priority?
What do you value in life?
On a scale of 1 to 10, how confident do you feel about making these changes?
What made you choose that number?
Are you able to connect how having a balanced snack in the afternoon helps prevent you from feeling too hungry by the time dinner comes?
Would you like to hear more ideas about how other clients have found ways to make that same change?
Can you walk me through how you plan to make this goal happen?

Research in Adults

A systematic review and meta-analysis published in Australia in 20181 looked at the combined effect of motivational interviewing and cognitive behavioural therapy in community-based adults who were overweight or living with obesity on the following lifestyle mediators: physical activity, diet, and body composition. They analyzed 10 randomized controlled trials (RCTs) and concluded that MI and CBT can lead to modest improvements in physical activity and body composition, and that even small increases in physical activity and minor changes in body composition can deliver beneficial health outcomes. Adults who completed at least five or more sessions experienced these positive effects. The optimal treatment number was unclear, but what was clear was that the more treatments the better. They recommended a combined approach of MI together with CBT to achieve these modest but meaningful results. In terms of diet, there was not enough information collected in the RCTs to come to any conclusion in this review.

Research in Parents Guiding Children

Healthcare providers will also use motivational interviewing as a strategy to modify health behaviour in children struggling with weight management. A randomized controlled trial published in the US in 2015⁴ looked at the effects of MI and dietary counselling for pediatric care in the primary care setting. Primary care providers practiced MI with the parents of children 2-8 years old, with content emphasizing child choice in making behaviour change. The follow-up period was two years, and the final data involved results from a total of 457 children. The researchers found that the children from whom the parents had received MI counselling from both a primary care provider and a registered dietitian had a statistically significant reduction in body mass index percentile over the two years when compared to the group who received standard care.

Conclusion

Behavioural modification techniques can help create significant and beneficial changes in adults and children who are looking to improve their weight management. The more motivational interviewing sessions an individual completes the better, with at least five sessions being ideal to achieve results.1 Cognitive behavioural therapy, which is proven to help in irritable bowel syndrome, can also be helpful in obesity and is worth exploring. I have seen the positive effects of these techniques in my own practice, as have other healthcare professionals.

There are a variety of workshops available offering MI and licensed CBT for emotional eating that help to create lasting changes. Ask your doctor or a registered dietitian for a referral.

It’s important to find a healthcare provider that is a good fit for you; some offer a short, complimentary phone call to learn more about them and the services they provide. I strongly encourage anyone who is interested in seeking out these services to take advantage of this option and make calls to different healthcare practitioners before deciding.