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Strategies to enhance effectiveness of individual based nutrition communications

European Journal of Clinical Nutrition volume 59, pages S24–S30 (2005)Cite this article

Abstract

Lifestyle modifications, including dietary and physical activity, are treatments for many chronic health conditions. Therefore, there is continued interest in improving the quantity and quality of nutrition information provided to the patient by the physician. This paper reviews the evidence to support motivational interviewing and other similar strategies for nutrition communications. Limited but positive data were found.

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Acknowledgements

Catherine Sullivan, MPH, RD, LDN, Brody School of Medicine at East Carolina University, for her discussion of uses of electronic medical records in teaching nutrition; Robert Schwartz MD, Department of Pediatrics, Wake Forest University School of Medicine, for his kind review of this manuscript and his discussion of motivational interviewing for overweight children; Emilie Balkman MPH, RD, LDN and Yancey Crawford MPH for their critique of the manuscript.

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Authors and Affiliations

  1. Department of Family Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA

    K M Kolasa

  2. Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA

    K M Kolasa

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  1. K M Kolasa
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Correspondence to K M Kolasa.

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Discussion after Kolasa

Rosser: How much training do you give your residents in motivational interviewing?

Kolasa: Our Family Medicine residents have 2 month-long rotation each year that focus on ambulatory care. During each of those months, they get about 8 h of formal training in behavioral medicine and motivational interviewing. So it will be 16 h in the first, second and third year of residency. The pediatric residents are getting about 10 h training sessions specifically related to weight management. Of course, in university they are doing a lot of this; they are experimenting with everything from a 2-h block to a 16-h block.

Helman: I find it a little hard to imagine that some elements of that will be: ‘may I have your permission to tell you that X and Y’. That does not sound like the family doctors I know. Do you have any sense of which part of the motivational interviews are actually the core that produce the effect, and which parts are the window dressing?

Kolasa: I have been teaching residents for 30 y. I would agree with you that until about the last year and a half they would not have had this approach at all, but they have been very frustrated with the issues of weight; and I think in our country the problem of pediatric obesity is much more severe than anywhere else, and people are very upset about it. So we are looking for other ways to do business than we did before. They do not want to go to the office every day and do nothing but see angry people. And about your question what is real and what is not, we do not know. The few studies in the literature do not tell us what is window dressing and what is core.

Brug: Have you tried to monitor if GPs are indeed applying this technique of motivational interviewing?

Kolasa: We are just getting ready to do some studies on that. Financing medical and graduate medical education is challenging in the US today. As a result, physicians and other health care providers are spending much more time in patient care than they used to. External funding is needed to support practice-based research so it can be completed without putting a burden on busy clinical providers. So, there has not been a great deal of activity in this arena yet. But again, I cannot explain to you how much the pediatric obesity crisis and diagnosis of type II diabetes in children and youth have changed the willingness to experiment and find practice-based solutions to treating and preventing obesity. I hope in a couple of years to be able to answer your question.

Green: What we have to do is convince the editors of the medical journals to allow for a little more space for the description of behavioural interventions. Because this requires a mature description for the readers to know what the operational focus is for any given intervention.

Helman: I think the electrical medical record has a lot of potential if all EMRs would have BMI's in it. Maybe we should talk to the software manufacturers to make sure that the system keeps asking for a BMI value, just as it does for blood pressure.

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Kolasa, K. Strategies to enhance effectiveness of individual based nutrition communications. Eur J Clin Nutr 59 (Suppl 1), S24–S30 (2005). https://doi.org/10.1038/sj.ejcn.1602171

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