Childhood Obesity
Conditions
Keywords
Motivational Interviewing, Child and Adolescent Self-Efficacy, Health Behaviours
Brief summary
The investigators studied the effect of motivational interviewing (MI) on self-efficacy, health behaviors, and health outcomes in overweight children and adolescents (ages ranging from 10 to 18 years).
Detailed description
One empirically supported intervention with a large evidence base for improving adult outcomes in behavioral health-related disorders is Motivational Interviewing (MI). MI is strongly rooted in the client-centered therapy of Rogers (1951). Its relational stance emphasizes the importance of understanding the client's internal frame of reference and displaying unconditional positive regard for the client. Motivational interviewing can thus be defined as a client-centered, directive method of therapy for enhancing intrinsic motivation to change by exploring and resolving ambivalence. MI manifests through specific strategies, such as reflective listening, summarization, shared decision making, and agenda setting. Adolescent participants exposed to motivational interviewing in conjunction with usual care (diet and exercise program) are expected to endorse greater self-efficacy, report increased engagement in healthy behaviors, demonstrate a decrease in body weight and report improved psychological outcomes. While motivational interviewing has been shown to increase adults' motivation to make healthy behavior changes, few adolescent studies have demonstrated this effect.
Interventions
BEHAVIORALMotivational Interviewing (Treatment Group)
Motivational interviewing (MI) can be defined as a client-centered, directive method of therapy for enhancing intrinsic motivation to change by exploring and resolving ambivalence (Miller and Rollnick, 2002). MI manifests through specific strategies, such as reflective listening, summarization, shared decision making, and agenda setting.
BEHAVIORALSocial Skills Training (Control Group)
Within the social skills training framework, advice is given to clients and sessions are focused on assigning goals for clients to work towards without specific regard for their readiness to change. The intervention is aimed at finding appropriate ways to navigate typical social situations (e.g., how to negotiate with parents).
Sponsors
The Hospital for Sick Children
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
10 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Obese youth (with Body Mass Index (BMI) ≥ to 85th percentile for age and gender (as classified by the Center for Disease Control)) * ages 10-18 years * attending a local obesity clinic (Healthy Weights clinic) Time of entry into the weight-loss program was controlled for; however, both new and current participants had the option to participate in the study.
Exclusion criteria
* taking medication whose side effects may influence weight gain or weight loss * did not speak English * demonstrated a developmental delay * reported being pregnant and/or reported having an eating disorder
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Weight Efficacy Life-style Questionnaire | Baseline, 6 month follow-up | A self-efficacy instrument, the Weight Efficacy Life-style Questionnaire (WEL; Clark, Abrams, Niaura, Eaton, & Rossi, 1991) was used to measure participants' beliefs about and confidence in their own ability to make a behavior change, specifically their ability to lose weight. The questionnaire yields a total score, with higher scores indicating higher levels of health-related self-efficacy, as well as 5 situational sub-scores (negative emotions, availability, social pressure, physical discomfort, and positive activities). Individuals rate statements on a 10-point scale ranging from 0 (not confident) to 9 (very confident). The WEL is made up of 20 items (4 items per sub-scale) which are summed to obtain a total score, with the lowest total score possible being 0 and the highest 180. Only the total WEL score was used in the study's analyses. The difference in self-efficacy (WEL) change between treatment and control groups from baseline to a 6 month follow-up was examined. |
| Child Dietary Self-Efficacy Scale | Baseline, 6 month follow-up | A second self-efficacy scale, the Child Dietary Self-Efficacy Scale (CDSS; Parcel et al., 1995) was used to measure participants' confidence in their ability to choose lower fat, lower sodium foods. The questionnaire is made up of 20 likert items with 3 response options, including not sure, a little sure, and very sure. Each item asks the participant to indicate how sure he/she is that they would make a healthy choice, for example, How sure are you that you could eat cereal instead of a donut? Individual items are scored -1, 0, or 1 and subsequently summed for a total score, with the lowest possible score a -20 and the highest a 20, whereby higher scores signify higher dietary self efficacy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Physiological Outcomes: BMI | Baseline, 6 month follow-up | The study used a Body Mass Index (BMI) percentile for age as the main indicator of weight-loss. Height and weight was measured by the pediatrician at the treatment site and BMI as well as BMI percentile for age was determined with the use of an age appropriate growth curve chart. |
| Physiological Outcomes: Waist Circumference | Baseline, 6 month follow-up | Measurements of waist circumference, an indirect measure of central adiposity (or fatness), were also obtained. |
| Psychological Well-being | Change over time from Baseline to 6 months (measured monthly) with a 12 months reassessment | Rosenberg Self-Esteem scale, Pediatric Quality of Life Inventory (PEDS QL), Child depression inventory, Adolescent coping (A-COPE) |
Countries
Canada
Participant flow
Recruitment details
Overweight and obese youth (BMI ≥ 85th %ile for age and gender) were eligible to participate and were recruited directly by the primary investigators from the Toronto East General Hospital's Healthy Lifestyles program, comprised of children and adolescents ages 10-18 years who are seeking diet and exercise treatment for their obesity.
Pre-assignment details
Individuals were excluded if they: 1) were taking medication whose side effects may influence weight gain or weight loss, 2) did not speak English, 3) had a known developmental delay, and 4) reported being pregnant and/or having an active eating disorder.
Participants by arm
| Arm | Count |
|---|---|
| Treatment Group (Motivational Interviewing) The treatment group received Motivational Interviewing (MI), which is a client-centered, directive method of therapy aimed at enhancing a client's intrinsic motivation to change by exploring and resolving ambivalence.
MI utilizes strategies to guide the patient, as opposed to offering advice or focusing on accomplishing specific goals. For example, using reflective listening and shared decision making are common within the MI approach.
Six individual MI sessions, approximately 30 minutes in length each, were provided by a trained clinical psychology doctoral student. | 20 |
| Control (Social Skills Training) The control group received social skills training in place of Motivational Interviewing (MI). The social skills training was provided by a therapist who was not trained in MI to avoid cross-contamination.
The social skills training provided was a standardized and manualized treatment, developed and validated for children and adolescents. As part of this training, the interventionist offered advice and clients were assigned specific tasks to work on. No consideration of clients' readiness to change was made in this group. | 20 |
| Total | 40 |
Baseline characteristics
| Characteristic | Control (Social Skills Training) | Treatment Group (Motivational Interviewing) | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 20 Participants | 20 Participants | 40 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 13.7 years STANDARD_DEVIATION 1.7 | 14.1 years STANDARD_DEVIATION 1.8 | 13.9 years STANDARD_DEVIATION 1.7 |
| Region of Enrollment Canada | 20 participants | 20 participants | 40 participants |
| Sex: Female, Male Female | 9 Participants | 14 Participants | 23 Participants |
| Sex: Female, Male Male | 11 Participants | 6 Participants | 17 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 20 | 0 / 20 |
| serious Total, serious adverse events | 0 / 20 | 0 / 20 |
Outcome results
Primary
Child Dietary Self-Efficacy Scale
A second self-efficacy scale, the Child Dietary Self-Efficacy Scale (CDSS; Parcel et al., 1995) was used to measure participants' confidence in their ability to choose lower fat, lower sodium foods. The questionnaire is made up of 20 likert items with 3 response options, including not sure, a little sure, and very sure. Each item asks the participant to indicate how sure he/she is that they would make a healthy choice, for example, How sure are you that you could eat cereal instead of a donut? Individual items are scored -1, 0, or 1 and subsequently summed for a total score, with the lowest possible score a -20 and the highest a 20, whereby higher scores signify higher dietary self efficacy.
Time frame: Baseline, 6 month follow-up
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control Group | Child Dietary Self-Efficacy Scale | Baseline CDSS | 9.35 scores on a scale | Standard Deviation 3.28 |
| Control Group | Child Dietary Self-Efficacy Scale | Follow-up CDSS | 8.59 scores on a scale | Standard Deviation 3.26 |
| Motivational Interviewing Group | Child Dietary Self-Efficacy Scale | Baseline CDSS | 9.42 scores on a scale | Standard Deviation 4.53 |
| Motivational Interviewing Group | Child Dietary Self-Efficacy Scale | Follow-up CDSS | 8.55 scores on a scale | Standard Deviation 4.5 |
Comparison: Based on previous research , baseline CDSS means were expected between 5 - 6.5 with a SD of 3 - 4. It was hypothesized that an attributable effect of 1.5 would be detected.~Published results comprise baseline and follow-up means and standard deviations for both the MI and control group (reported above), as well as the absolute attributable effect of intervention (i.e., the difference in self-efficacy \[CDSS\] change between the treatment and control groups from baseline to a 6 month follow-up).p-value: 0.8895% CI: [-2.301, 2.668]Regression, Linear
Primary
Weight Efficacy Life-style Questionnaire
A self-efficacy instrument, the Weight Efficacy Life-style Questionnaire (WEL; Clark, Abrams, Niaura, Eaton, & Rossi, 1991) was used to measure participants' beliefs about and confidence in their own ability to make a behavior change, specifically their ability to lose weight. The questionnaire yields a total score, with higher scores indicating higher levels of health-related self-efficacy, as well as 5 situational sub-scores (negative emotions, availability, social pressure, physical discomfort, and positive activities). Individuals rate statements on a 10-point scale ranging from 0 (not confident) to 9 (very confident). The WEL is made up of 20 items (4 items per sub-scale) which are summed to obtain a total score, with the lowest total score possible being 0 and the highest 180. Only the total WEL score was used in the study's analyses. The difference in self-efficacy (WEL) change between treatment and control groups from baseline to a 6 month follow-up was examined.
Time frame: Baseline, 6 month follow-up
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control Group | Weight Efficacy Life-style Questionnaire | Baseline WEL | 120.70 scores on a scale | Standard Deviation 29.32 |
| Control Group | Weight Efficacy Life-style Questionnaire | Follow-up WEL | 139.88 scores on a scale | Standard Deviation 19.88 |
| Motivational Interviewing Group | Weight Efficacy Life-style Questionnaire | Baseline WEL | 128.80 scores on a scale | Standard Deviation 27.24 |
| Motivational Interviewing Group | Weight Efficacy Life-style Questionnaire | Follow-up WEL | 136.40 scores on a scale | Standard Deviation 26.77 |
Comparison: Published results comprise baseline and follow-up means and standard deviations for both the MI and control group (reported above), as well as the absolute attributable effect of intervention (i.e., the difference in self-efficacy \[WEL\] change between the treatment and control groups from baseline to a 6 month follow-up).p-value: 0.2495% CI: [-5.871, 23.103]Regression, Linear
Secondary
Physiological Outcomes: BMI
The study used a Body Mass Index (BMI) percentile for age as the main indicator of weight-loss. Height and weight was measured by the pediatrician at the treatment site and BMI as well as BMI percentile for age was determined with the use of an age appropriate growth curve chart.
Time frame: Baseline, 6 month follow-up
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control Group | Physiological Outcomes: BMI | Baseline BMI | 2.64 z-score | Standard Deviation 0.73 |
| Control Group | Physiological Outcomes: BMI | Follow-up BMI | 2.41 z-score | Standard Deviation 0.78 |
| Motivational Interviewing Group | Physiological Outcomes: BMI | Baseline BMI | 2.51 z-score | Standard Deviation 0.47 |
| Motivational Interviewing Group | Physiological Outcomes: BMI | Follow-up BMI | 2.46 z-score | Standard Deviation 0.47 |
Comparison: Results published comprise baseline and follow-up BMI z-score means and standard deviations for both the MI and control groups (reported above), as well as the attributable effect of intervention (i.e., the difference in BMI change between the treatment and control groups from baseline to a 6-month follow-up)p-value: 0.56Regression, Linear
Secondary
Physiological Outcomes: Waist Circumference
Measurements of waist circumference, an indirect measure of central adiposity (or fatness), were also obtained.
Time frame: Baseline, 6 month follow-up
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control Group | Physiological Outcomes: Waist Circumference | Baseline Waist Circumference | 95.7 cm | Standard Deviation 11.4 |
| Control Group | Physiological Outcomes: Waist Circumference | Follow-up Waist Circumference | 93.6 cm | Standard Deviation 10.9 |
| Motivational Interviewing Group | Physiological Outcomes: Waist Circumference | Baseline Waist Circumference | 92.8 cm | Standard Deviation 6.6 |
| Motivational Interviewing Group | Physiological Outcomes: Waist Circumference | Follow-up Waist Circumference | 94.35 cm | Standard Deviation 7.5 |
Comparison: Results published comprise baseline and follow-up means and standard deviations for both the MI and control group (reported above), as well as the attributable effect of intervention (i.e., the difference in waist circumference change between the treatment and control groups from baseline to a 6-month follow-up).p-value: 0.09Regression, Linear
Secondary
Psychological Well-being
Rosenberg Self-Esteem scale, Pediatric Quality of Life Inventory (PEDS QL), Child depression inventory, Adolescent coping (A-COPE)
Time frame: Change over time from Baseline to 6 months (measured monthly) with a 12 months reassessment