By: Reuben R., Lagniappe Wellness Dietetic Intern
The world of dietetics is constantly evolving. Newly emerging research on how nutrients impact our bodies and health is constantly scrutinized and the efficacy of new diets regularly discussed. Macronutrient ratios, meal timing, food composition, weight cycling, meat or meatless, organic or GMO—all topics endlessly discussed to find an eating pattern which will achieve maximum health for our patients, clients, and communities. What is not frequently discussed, however, is how we communicate and form relationships with our patients and how it impacts their health and lifestyle.
As a community of experts, if we could develop the best diet, complete with a comprehensive list of micronutrients and food properties, it would mean nothing if we could not communicate the idea with the public and would have no value if we could not develop meaningful and impactful relationships with patients. An analysis published in the International Journal of Preventive Medicine found that self-body perception, self-motivation, and behavioral improvements were key drivers in helping people lose weight and keep it off.1 In other words, successful weight loss had more to do with factors related to intrapersonal skills and abilities than a specific methodology of eating. Yet, our conversations in dietetics still revolve almost entirely around the latter. Much to the detriment of our profession—and to the health of our patients—not enough time has been spent on creating effective methods of empowering clients.
This reality is playing out in front of us now. We know more about food, nutrition, and its impact on human physiology than ever before, yet more Americans are obese and suffering from largely preventable chronic diseases such as cardiovascular disease and type 2 diabetes.2 The problem that we face now as a profession is not a lack of information, but rather, barriers to implementation.
One possible method to help us close this gap is Motivational Interviewing (MI). Originally pioneered by William Miller in the 1980s to help individuals break the cycle of substance abuse, motivational interviewing takes a patient centered approach with an eye toward facilitating behavior change. Research from the early 1980s showed that, “therapist empathy during treatment predicted a surprising two-thirds of the variance in client drinking 6 months later” and that the “alcoholism counselors’ client-centered interpersonal functioning accounted for a substantial proportion of variance in the relapse…of assigned clients.” Findings such as these combined with collaboration with other colleagues in his field led Miller to develop a framework for what eventually came to be called Motivational Interviewing.3
Behind the technical aspects of implementing Motivational Interviewing lies the spirit of MI—the foundational tenets that the other portions of the technique are built upon. The Motivational Interviewing Network of Trainers outlines the spirit of MI as follows:
MI is practiced with an underlying spirit or way of being with people:
o Partnership. MI is a collaborative process. The MI practitioner is an expert in helping people change; people are the experts of their own lives.
o Evocation. People have within themselves resources and skills needed for change. MI draws out the person’s priorities, values, and wisdom to explore reasons for change and support success.
o Acceptance. The MI practitioner takes a nonjudgmental stance, seeks to understand the person’s perspectives and experiences, expresses empathy, highlights strengths, and respects a person’s right to make informed choices about changing or not changing.
o Compassion. The MI practitioner actively promotes and prioritizes clients’ welfare and wellbeing in a selfless manner. 4
Stemming from this “way of being with people” flows the processes and core skills utilized to help evoke patient centered change.
Over 1,000 peer-review articles have been published exploring the impact of Motivational Interviewing.5 In its original arena of helping to treat substance abuse, research points to higher retention rates in treatment as well as close to double to the rates of abstinence from alcohol or drugs compared to controls in some studies. Additionally, MI was even more effective when combined with other treatments or interventions.3 This may be attributed to the fact that Motivational Interviewing is really more “a method of communication rather than intervention, sometimes used on its own or combined with other treatment approaches.” 4 Although substance abuse and poor dietary patterns produce different consequences for patients, interventions for both have the same underlying goal in mind—changes in behavior designed to improve patient outcomes. This lies directly within the main strength of motivational interviewing, something which makes it a prime candidate to be co-opted into dietetics professional practice. The synergistic effect of MI when combined with other interventions means that dietetics professionals can combine the core concepts of MI with other validated tools like nutrition education to help empower and improve patient outcomes.
Although not as widely studied in the discipline of nutrition when compared to other areas, studies that have investigated MI on nutrition-related diseases and topics have found that it can help lower HgA1c in type 2 diabetics (see table), increase weight loss compared to controls, and assist in improving health related lifestyle factors such as exercise.6, 7, 5
Nutrition professionals need to continue to explore how Motivational Interviewing can improve our ability to reach patients. Beyond that, we need to understand that our relational skills are as important as our technical ones and need to be evaluated, refined, and tested with the same eagerness. We need to take time to understand and explore emerging research on communication methods and techniques and how they can apply to our practice. Dietetics is more than nutrition—it is a field centered around the good of the patient and as such, it is our responsibility to capitalize on any tool available that will make us more effective practitioners and lead patients to happier and healthier outcomes.
Gupta, H. Barriers to and facilitators of long term weight loss maintenance in adult UK people: A thematic analysis. Int J Prev Med. 2014 Dec; 5(12). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336981/ Published December 2014.
About Chronic Diseases. Center for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/about/index.htm. Last updated July 21, 2022. Accessed December 2022.
Rose, G. Miller, W. Toward a theory of motivational interviewing. Am Psychol. 2009 September ; 64(6): 527–537. doi:10.1037/a0016830. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759607/pdf/nihms146933.pdf
Understanding motivational interviewing. Motivational Interviewing Network of Trainers. https://motivationalinterviewing.org/understanding-motivational-interviewing. Accessed December 2022
What is motivational interviewing. USDHHS. https://eclkc.ohs.acf.hhs.gov/mental-health/article/what-motivational-interviewing#:~:text=Q%3A%20What%20is%20the%20evidence,studies%20 published%20on%20 motivational%20 interviewing. Last updated September 22, 2022. Accessed December 2022.
Berhe, K. Gebru, H. Kaysay, H. et. al. Effect of motivational interviewing intervention on HbA1C and depression in people with type 2 diabetes mellitus (systematic review and meta-analysis). PLoS One. 2020; 15(10): e0240839. Published online 2020 Oct 23. doi: 10.1371/journal.pone.0240839. Published
Welch, G. Rose, G. Ernest, D. Motivational nterviewing and iabetes: What is it, how is it used, and does it work?Diabetes Spectr 2006;19(1):5–11