Rates of overweight and obesity in pediatric populations are reaching crisis levels, with African American adolescents at highest risk. Although effective weight loss strategies (e.g., monitoring of food intake and activity level, environmental control to reduce cues to eat unhealthy foods, goal setting) are well known, attempts to construct effective behavioral weight loss interventions for African American adolescents with obesity (AAAO) have largely failed. A primary barrier to success has been motivation to engage in the weight loss strategies critical for success. Therefore, successful weight loss treatment requires that treatment providers be able to motivate families to make the challenging behavioral changes necessary for sustained weight loss. Patient-provider communication is the primary treatment strategy that treatment providers, in any setting, use with their patients. Although patient-provider communication is recognized as a key clinical skill, there are few guidelines to help treatment providers communicate effectively with patients. Motivational Interviewing (MI) is an evidence-based communication strategy that uses client-centered, directive methods for enhancing intrinsic motivation and self-efficacy. MI provides a framework to study the relationship between provider communication and patient outcomes. Originally developed to treat adult substance abusers, MI has been widely adapted to the treatment of other behavioral health problems including obesity and poor dietary practices and is now included the expert recommendations for pediatric obesity prevention and treatment. In addition, MI has been successfully utilized in diverse populations in the U.S. and around the world. Despite the application of MI to multiple behavioral problems, the mechanisms by which MI elicits behavior change are less clear, particularly in pediatric and minority populations. In other words, it is unclear which components of MI are most important for health care providers working with African American adolescents and caregivers to elicit behavior change. Identifying the key components of MI in eliciting behavioral changes would enable the development of targeted health communication training designed to maximize African American adolescents'and caregivers'motivation for weight loss. The proposed study will use data from a parent clinical trial that is part of an NIH-funded obesity center grant (U01 HL097889) at Wayne State University providing family-based weight loss interventions to AAAOs and their primary caregivers. A newly developed code scheme will be used to conduct a secondary analysis of 184 weight loss treatment sessions from the parent clinical trial. The goals of this research are to (1) identify provider communication behaviors that predict motivation and intention for behavior change among AAAOs and their caregivers and (2) to link provider communication behaviors to changes in the health behavior of AAAOs and their caregivers, such as changes in diet, fitness, body fat composition and weight, through changes in their motivation and intention for behavior change.

Public Health Relevance

As the rates of obesity reach crisis levels, particularly among minority populations, there is an increasing need to identify effective behavioral weight loss interventions for African American adolescents with obesity (AAAO). Previous research has suggested that motivation to enact the behavioral lifestyle changes necessary for successful weight loss is a significant barrier;thus, providing treatment providers with the communication skills necessary to motivate families to make these challenging behavioral changes is one strategy to increase adherence to weight loss recommendations. The proposed study will examine 184 weight loss sessions with AAAO and their caregivers to identify the key components of patient-provider communication linked to weight loss outcomes.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Exploratory/Developmental Grants (R21)
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Psychosocial Risk and Disease Prevention Study Section (PRDP)
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Kuczmarski, Robert J
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Wayne State University
Schools of Medicine
United States
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Carcone, April Idalski; Jacques-Tiura, Angela J; Brogan Hartlieb, Kathryn E et al. (2016) Effective Patient-Provider Communication in Pediatric Obesity. Pediatr Clin North Am 63:525-38