How physicians can support behavioral changes with a motivational interview

April 1, 2021
Nicholas Pennings, DO, FOMA

Nicholas Pennings, DO is board certified in Family Medicine and Obesity Medicine and is a fellow of the Obesity Medicine Association (OMA). He is an associate professor and chair of family medicine at Campbell University School of Osteopathic Medicine (CUSOM) and also serves as the director of the Campbell University Health Center. As a champion for advancing the education of current and future health professionals, particularly as it relates to obesity, Dr. Pennings is an executive director of clinical education for the Obesity Medicine Association. He has also infused obesity education into the medical school curriculum at CUSOM and has developed an online obesity education rotation through the OMA for clinicians in training.

Helping patients take the next step on making healthy choices.

Does this sound familiar? While taking the dietary history of a patient with one or more chronic diseases — for example, obesity and diabetes — you identify that their lifestyle choices and habits are implicated in their health conditions. It turns out that they are consuming large amounts of soda or eating fried foods every day. What they “should do” is obvious. They should stop drinking soda and eating fried foods, develop healthier diet habits and start losing weight. 

What is not so obvious is why this patient is unable to take the next step. You’ve explained the relationship between their choices and their health risks. You’ve made it clear that they need to change their habits or risk serious health complications. You may have provided them with helpful resources, like pamphlets and websites, that lay out healthier diet choices. But nothing you do seems to make a difference. 

This is one of the most common frustrations faced by primary care providers treating a chronic disease like obesity. Unhealthy or risky behaviors have a significant impact on these conditions but helping patients make behavioral changes can be a huge challenge. While many patients want to lose weight, for example, they often have tremendous ambivalence about making actual lifestyle changes. And the unresolved conversations that may ensue between patient and provider do little to build a relationship of trust.

Using a Research-Based Approach for Behavioral Change

One highly effective solution for providers facing these challenges is a patient engagement approach known as motivational interviewing. Research demonstrates that this approach can have a significant and clinically relevant effect in eliciting behavior changes such as smoking cessation, weight loss, decreased alcohol use and physical activity. 

What is motivational interviewing? This is a collaborative style of patient-centered engagement that focuses on identifying the patient's own motivation for change. The practitioner then works with the patient to develop treatment strategies that are aligned with their desired goals and objectives. It benefits patients by centering around their personal wishes, desires and ideas for improving their health. 

By identifying the patient's goals and objectives and eliciting their own ideas for making the necessary changes, a provider can develop treatment plans for which the patient takes a greater sense of ownership and thus is more likely to follow. This involves taking four steps:

1. Identifying the patient’s motivation for change

2. Reinforcing that motivation

3. Developing specific patient-centered goals towards achieving change

4. Providing follow-up and support

How Motivational Interviewing Works

Before implementing the technique in their practice, providers need to understand that motivational interviewing is very different from our usual way of communicating with patients. As health care providers, we are accustomed to telling patients what to do. Motivational interviewing, however, avoids this authoritarian stance. We don’t say, “I am the expert, you are the patient, therefore do what I say.” Acute care situations may require us to make these unilateral decisions but in long-term care and lifestyle change decisions, patients benefit from a greater sense of involvement.

Similarly, motivational interviewing is not about creating motivation in a patient. Instead, we act as detectives to discover the patient’s own motivation for change — for example, losing weight would allow them to join their family on hikes — and then use that motivation to guide the patient towards creating a plan to achieve their personal goals. 

Once learned, motivational interviewing can serve as a powerful tool for primary care providers in treating patients with obesity and overweight. The Obesity Medicine 2021 Virtual Conference, running April 21-25, is providing health care practitioners an opportunity to learn how to use this technique in a session I will be offering titled “Short and Sweet: Utilizing Motivational Interviewing in Primary Care,” on Saturday, April 24.

My goal at the conference will be to provide practical tips and techniques for communicating with patients with obesity by leveraging motivational interviewing. Through the use of common case examples, providers will learn to apply simple motivational interviewing tools that are geared toward busy primary care practices. I hope to help attendees move from theory to practice so that they can integrate some of these skills in their office on the Monday morning following the conference. 

More information on the Obesity Medicine 2021 Virtual Conference and on how to become a member of the Obesity Medicine Association is available here.

Nicholas Pennings, DO is board certified in Family Medicine and Obesity Medicine as well as a fellow of the Obesity Medicine Association. He is an associate professor and chair of family medicine at Campbell University School of Osteopathic Medicine (CUSOM), where he serves as the director of the Campbell University Health Center. An executive director of clinical education for the Obesity Medicine Association, Dr. Pennings is a champion for advancing the education of current and future health professionals. He has co-authored core curriculum for obesity education, developed obesity education content for the Obesity Medicine Association and is researching the relationship between endogenous insulin production, insulin resistance and weight gain.