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Anthropometric outcomes of a motivational interviewing school-based randomized trial involving adolescents with overweight

Abstract

Motivational interviewing (MI) is an effective method to promote weight loss that can be delivered by non-mental health providers. The aim of this study was to evaluate whether MI was superior to conventional counseling to improve the anthropometric outcomes of adolescents with obesity/overweight. It was a controlled cluster randomized trial with parallel design in a school setting. The study included two groups: Motivational Interviewing Group (MIG) and control group (Conventional Intervention Group, CIG). Students participated in three face-to-face 30-min interviews, 3 months apart. Outcomes were BMI z-score, abdominal circumference, percentages of fat mass and muscle mass, and blood pressure. Sessions were coded with the Motivational Interviewing Treatment Integrity (MITI) manual. Mixed repeated-measures ANOVAs were used to assess the group versus time interaction. Effect sizes were calculated for each ANOVA with eta-squared measures (η2). Eighty-three adolescents finished the protocol. While MIG participants showed a significant improvement in all anthropometric scores at 6 months, CIG participants showed an unfavorable change in those variables.

Conclusion: Our results provide additional evidence of the short-term usefulness of a school-based MI intervention on anthropometric outcomes of adolescents with obesity/overweight, demonstrating that pediatricians can play an important role in the prevention and management of pediatric obesity.

Trial registration: The study is called IMAGINE and is registered in Clinicaltrials.gov with the number NCT02745795.

What is Known:
Although MI has been recognized as an effective counseling style for behavioral change in weight loss, there are few reports about the anthropometric outcomes of interventions with adolescents being treated for obesity/overweight.
Our study showed significant positive changes in anthropometric variables (BMI z-score, abdominal circumference, percentage of fat mass, percentage of muscular mass, systolic and diastolic blood pressure) after only three face-to-face sessions over 6 months.
What is New:
MI delivered by non-mental health providers in a school setting seems to have short-term usefulness in a program aiming the treatment of obese/overweight adolescents.

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Abbreviations

BMI:

Body mass index

CIG:

Conventional Intervention Group

MI:

Motivational interviewing

MIG:

Motivational Interviewing Group

MITI:

Motivational Interviewing Treatment Integrity

PE:

Physical education

SD:

Standard deviation

WHO:

World Health Organization

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Acknowledgements

The authors thank the teachers of the schools involved in the study (Alfredo dos Reis Silveira High School, José Afonso High School, Manuel Cargaleiro High School, Amora High School, Terras de Larus Basic 2/3 School, Fernão Mendes Pinto High School, Emídio Navarro High School, Professor Ruy Luís Gomes High School), the Seixal and Almada Municipalities, the associations Independente Futebol Clube Torrense and Sociedade Recreativa União Pragalense, and the Holon Pharmacy Group®.

The study was not funded by any grant but the Portuguese Municipalities of Seixal and Almada, where the study took place, partially funded the physical activities for the participants. Dieticians from Holon Pharmacy Group® gave free dietetic counseling, which did not involve any selling of dietetic products in the pharmacies. Neither the municipalities nor the above mentioned pharmacy group had any role in the study protocol or in any decisions related to the study.

Funding

This study was not funded by any grant, but the municipalities where the study took place (Seixal and Almada, Portugal) partially funded the physical activities for the participants. Additionally, pharmacies from Group Holon® gave free dietetic counseling, without selling any dietetic products. Neither the municipalities nor the pharmacies had any influence on the study protocol or on the analysis of results. Authors do not have any financial relationship with the organizations that sponsored the research.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Silvia Freira: (1) conception and design of the study, acquisition of data, and analysis and interpretation of data, (2) drafting the article, and (3) final approval of the version to be submitted

Marina Serra Lemos: (1) conception and design of the study and analysis and interpretation of data, (2) revising the article critically for important intellectual content, and (3) final approval of the version to be submitted

Helena Fonseca: (1) analysis and interpretation of data, (2) revising the article critically for important intellectual content, and (3) final approval of the version to be submitted

Geoffrey Williams: (1) analysis and interpretation of data, (2) revising the article critically for important intellectual content, and (3) final approval of the version to be submitted

Marta Ribeiro: (1) conception and design of the study and acquisition of data, (2) revising the article critically for important intellectual content, and (3) final approval of the version to be submitted

Fernanda Pena: (1) conception and design of the study and acquisition of data, (2) revising the article critically for important intellectual content, and (3) final approval of the version to be submitted

Maria do Céu Machado: (1) conception and design of the study and analysis and interpretation of data, (2) revising the article critically for important intellectual content, and (3) final approval of the version to be submitted

Correspondence to Silvia Freira.

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Conflict of interest

The authors declare that they have no conflict of interest.

Study registry

The Study is called IMAGINE and is registered at Clinicaltrials.gov database with the number NCT02745795.

Ethical approval

Approval to conduct the study was granted by the local research ethics committees (equivalent to a Human Subjects Review Boards). The study is called IMAGINE and is registered in Clinicaltrials.gov with the number NCT02745795. The full trial protocol can be accessed at the repositorium of the University which supervised the study (University of Lisbon). The students who agreed to participate provided written assent and their parents/guardians were asked to sign an informed consent, which was obtained from all individual participants included in the study. All procedures performed in this study involving human participants were in accordance with the institutional and/or national research committee and with the Code of Ethics of the World Medical Association (1964 Helsinki Declaration) and its later amendments or comparable ethical standards for experiments involving humans and with uniform requirements for manuscripts Submitted to Biomedical Journals.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Mario Bianchetti

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Freira, S., Lemos, M.S., Fonseca, H. et al. Anthropometric outcomes of a motivational interviewing school-based randomized trial involving adolescents with overweight. Eur J Pediatr 177, 1121–1130 (2018). https://doi.org/10.1007/s00431-018-3158-2

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Keywords

  • Pediatric obesity
  • School health services
  • Motivational interviewing
  • Body mass index
  • Body composition
  • Blood pressure