Background:
Motivational interviewing (MI) is potentially useful in management of overweight and obesity, but staff training and increased delivery time are barriers, and its effectiveness independent of other behavioral components is unclear.
Purpose:
To assess the independent contribution of MI as part of a behavioral weight management program (BWMP) in controlling weight and improving psychological well-being.
Data Sources:
6 electronic databases and 2 trial registries, searched from database inception through 24 September 2021.
Study Selection:
Randomized controlled trials in adults or adolescents aimed at weight loss or maintenance and comparing programs incorporating MI versus interventions without MI.
Data Extraction:
Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included weight, anxiety, depression, quality of life, and other aspects of psychological well-being. Pooled mean differences or standardized mean differences were obtained using random- and fixed-effects meta-analyses.
Data Synthesis:
Forty-six studies involving 11 077 participants, predominantly with obesity, were included. At 6 months, BWMPs using MI were more effective than no/minimal intervention (−0.88 [95% CI, −1.27 to −0.48] kg; I2 = 0%) but were not statistically significantly more effective than lower-intensity (−0.88 [CI, −2.39 to 0.62] kg; I2 = 55.8%) or similar-intensity (−1.36 [CI, −2.80 to 0.07] kg; I2 = 18.8%) BWMPs. At 1 year, data were too sparse to pool comparisons with no/minimal intervention, but MI did not produce statistically significantly greater weight change compared with lower-intensity (−1.16 [CI, −2.49 to 0.17] kg; I2 = 88.7%) or similar-intensity (−0.18 [CI, −2.40 to 2.04] kg; I2 = 72.7%) BWMPs without MI. Studies with 18-month follow-up were also sparse; MI did not produce statistically significant benefit in any of the comparator categories. There was no evidence of subgroup differences based on study, participant, or intervention characteristics. Too few studies assessed effects on psychological well-being to pool, but data did not suggest that MI was independently effective.
Limitations:
High statistical heterogeneity among studies, largely unexplained by sensitivity and subgroup analyses; stratification by comparator intensity and follow-up duration resulted in pooling of few studies.
Conclusion:
There is no evidence that MI increases effectiveness of BWMPs in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs.
Primary Funding Source:
National Institute for Health Research Biomedical Research Centre. (PROSPERO: CRD42020177259)
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Author, Article, and Disclosure Information
Affiliations:
Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.).
Acknowledgment: The authors thank Nia Wyn Roberts, MSc Econ, University of Oxford, for creating and running the searches.
Financial Support: By the National Institute for Health Research Biomedical Research Centre.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3128.
Reproducible Research Statement: Study protocol: Available at www.crd.york.ac.uk/prospero/display_record.php?RecordID=177259. Statistical code and data set: Available from Ms. Michalopoulou (e-mail, moscho.
Corresponding Author: Moscho Michalopoulou, MSc, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; e-mail, moscho.
Author Contributions: Conception and design: P. Aveyard, A.E. Ferrey, G. Harmer, S.A. Jebb.
Analysis and interpretation of the data: P. Aveyard, A.E. Ferrey, G. Harmer, S.A. Jebb, M. Michalopoulou.
Drafting of the article: P. Aveyard, A.E. Ferrey, M. Michalopoulou.
Critical revision for important intellectual content: P. Aveyard, A.E. Ferrey, L. Goddard, G. Harmer, S.A. Jebb, M. Kebbe, M. Michalopoulou, A. Theodoulou.
Final approval of the article: P. Aveyard, A.E. Ferrey, L. Goddard, G. Harmer, S.A. Jebb, M. Kebbe, M. Michalopoulou, A. Theodoulou.
Statistical expertise: P. Aveyard.
Obtaining of funding: P. Aveyard, S.A. Jebb.
Administrative, technical, or logistic support: L. Goddard, G. Harmer, M. Kebbe, M. Michalopoulou, A. Theodoulou.
Collection and assembly of data: P. Aveyard, A.E. Ferrey, L. Goddard, G. Harmer, M. Kebbe, M. Michalopoulou, A. Theodoulou.
This article was published at Annals.org on 29 March 2022.
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