Using Motivational Interviewing to Engage Patients, Assess Where They are in Stages of Behavioral Change

A Message from Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania. Dr. Still is also a board member of the Obesity Action Coalition, Tampa, Florida.

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Dear Readers,
Welcome to the November issue of Bariatric Times. This month we feature an article titled, “Talking to Patients About Bariatric Surgery: Guiding Meaningful Conversations and Evoking Commitment to Change,” by Gretchen E. Ames, PhD, ABPP; Matthew M. Clark, PhD, ABPP; Karen B. Grothe, PhD, ABPP; and Maria L. Collozo-Clavell, MD. The authors discuss motivational interviewing (MI), which they define as a person-centered guiding method of communication between healthcare provider and patient that elicits and strengthens the patient’s own reasons and motivation for change.[1] I think that all healthcare providers working with patients with obesity (e.g., surgeons, obesity medicine specialists, nurses, psychologists, dietitians) might find benefits in using this technique.

I had heard about MI and then saw Robert F. Kushner, MD, MS, FACP, Professor of Medicine at Northwestern University Feinberg School of Medicine in Chicago, Illinois, put it in action with obesity management. During a presentation, he introduced the fundamental processes of MI: open-ended questions, affirmations, reflections, and summaries. He then showed a video that illustrated all of the techniques being employed in a conversation with a patient all within 15 minutes. You could see from his presentation that MI could be done to quickly and effectively engage patients.

By asking open-ended questions and supporting the patient to think and talk things through, MI brings the conversation back to the patient. Instead of just telling a patient to eat well and exercise more, providers using MI might ask a patient how he or she could fit exercise into his or her schedule. After the patient gives an answer, such as “I could fit in more exercise by taking my dog on longer walks,” the provider then repeats and summarizes what the patient said and comes up with a plan.

MI is a technique that requires practice as it takes time to refine skills. I find that providers who practice MI seem to have better patient rapport and engagement, which I think is important when treating patients with obesity. Weight is a sensitive subject, and I think a lot of healthcare providers struggle just to bring up it up. Sometimes I ask the patient simply, “Can we talk about your weight?” This goes a long way in starting the conversation.

One important consideration when learning MI is the need to assess where the patient is in their behavioral change. Not every patient will be ready and willing to commit to a change, such as weight loss medications or surgery, and it is important for providers to realize that. We need to meet patients wherever they are in their level of engagement. That is why asking a patient if it is OK to talk about their weight today is important. They may want to at some point, but not at that encounter.

Since learning MI, I have gotten better at employing the technique but realize there is always more to learn. We can always try to communicate better with our patients and meet them wherever they are in their stages of change.

As ObesityWeek 2015 is fast approaching, I am looking forward to an unbelievable week of education, camaraderie, and socializing! The program Committee has put together another fantastic educational and social agenda for all attendees. I believe the conference has come a long way since the ASMBS and TOS combined meetings to start “ObesityWeek” in 2013. Since then, we have seen a real melding of the two societies in the curriculum and networking. Attendees have an opportunity to educate themselves outside of their specialty, which is a great thing.

Lastly, I would like to congratulate my friend Dr. Raul Rosenthal on his appointment of ASMBS President. Raul, you will do a fantastic job, and I am glad to be along for the ride! It is a well-deserved honor, and we all expect great things to come.

Sincerely,
Christopher Still, DO, FACN, FACP

References
1.    Miller WR, Rollnick, S. Motivational Interviewing: Helping People Change. Third Edition. New York: The Guilford Press, 2013.

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Category: Editorial Message, Past Articles