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A Feasibility Study

Robert P. Schwartz, MD; Robin Hamre, MPH, RD; William H. Dietz, MD, PhD; Richard C. Wasserman, MD, MPH; Eric J. Slora, PhD; Esther F. Myers, PhD, RD; Susan Sullivan, PhD; Helaine Rockett, MS, RD; Kathleen A. Thoma, MA; Gema Dumitru, MD, MPH; Kenneth A. Resnicow, PhD

Arch Pediatr Adolesc Med. 2007;161(5):495-501.

Objective  To determine whether pediatricians and dietitians can implement an office-based obesity prevention program using motivational interviewing as the primary intervention.

Design  Nonrandomized clinical trial. Fifteen pediatricians belonging to Pediatric Research in Office Settings, a national practice-based research network, and 5 registered dietitians were assigned to 1 of 3 groups: (1) control; (2) minimal intervention (pediatrician only); or (3) intensive intervention (pediatrician and registered dietitian).

Setting  Primary care pediatric offices.

Participants  Ninety-one children presenting for well-child care visits met eligibility criteria of being aged 3 to 7 years and having a body mass index (calculated as the weight in kilograms divided by the height in meters squared) at the 85th percentile or greater but lower than the 95th percentile for the age or having a normal weight and a parent with a body mass index of 30 or greater.

Interventions  Pediatricians and registered dietitians in the intervention groups received motivational interviewing training. Parents of children in the minimal intervention group received 1 motivational interviewing session from the physician, and parents of children in the intensive intervention group received 2 motivational interviewing sessions each from the pediatrician and the registered dietitian.

Main Outcome Measure  Change in the body mass index–for-age percentile.

Results  At 6 months' follow-up, there was a decrease of 0.6, 1.9, and 2.6 body mass index percentiles in the control, minimal, and intensive groups, respectively. The differences in body mass index percentile change between the 3 groups were nonsignificant (P = .85). The patient dropout rates were 2 (10%), 13 (32%), and 15 (50%) for the control, minimal, and intensive groups, respectively. Fifteen (94%) of the parents reported that the intervention helped them think about changing their family's eating habits.

Conclusions  Motivational interviewing by pediatricians and dietitians is a promising office-based strategy for preventing childhood obesity. However, additional studies are needed to demonstrate the efficacy of this intervention in practice settings.

Author Affiliations: Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Schwartz); Centers for Disease Control and Prevention, Atlanta, Ga (Ms Hamre and Drs Dietz and Dumitru); University of Vermont College of Medicine, Burlington (Dr Wasserman); Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Ill (Drs Wasserman, Slora, and Sullivan and Ms Thoma); American Dietetic Association, Chicago, Ill (Dr Myers); Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (Ms Rockett); and University of Michigan School of Public Health, Ann Arbor (Dr Resnicow).

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