Motivational Interviewing & Nutrition
Behavior changes, especially nutrition-related changes, bring challenges. Motivational interviewing--a counseling approach developed by psychologists William Miller, Ph.D., and Stephen Rollnick, Ph.D.--helps patients examine and resolve their ambivalence about behavior change. The goal of MI isn't necessarily to change behavior, but rather to encourage fully informed, deeply contemplated and internally motivated choices. In nutrition-related health settings, dietitians and nutritionists increasingly see MI as a tool in the battle against obesity.
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Patient-Centered
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According to Eileen Britt’s 2003 article, "Motivational Interviewing in Health Settings," MI focuses on what the patient wants, thinks, and feels, with the patient doing most of the talking. The client sets the agenda and comes up with ideas, alternatives and solutions. Rather than attempting to fix a client’s unhealthy eating habits by forceful instruction, the dietitian/nutritionist uses warmth and respect to persuade the patient to want a healthy lifestyle. MI practitioners use open-ended and thought-provoking questions such as, “How will you know it’s time to start eating a more nutritious diet?” These kind of questions, not answered with a simple "yes" or "no," help the patient begin an active thought process rather than passively listening to a flood of information.
Directive
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Britt claims that MI differs from other patient-centered approaches in its directness. With a clear goal of exploring the patient’s ambivalence, practitioners feel the patient will more likely choose to change behavior in the desired direction, and use systematic strategies to achieve this. In explaining and discussing issues such as the negative health consequences of poor food choices and large portion sizes with a dietitian or nutritionist, a patient ideally will use this information as intrinsic motivation to choose healthier foods and consume smaller portions sizes.
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Express Empathy
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By expressing empathy, the interviewer uses reflective listening and shares understanding of the patient’s perspectives of food choices and habits without judging, criticizing or blaming. Non-acceptance will immobilize the change process.
Develop Discrepancy
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According to Janet Treasure’s 2004 article, "Motivational Interviewing," the interviewer must develop a discrepancy between the patient’s most deeply held values and current behavior. For example, the interviewer teases out ways in which the patient's current unhealthy eating habits conflict with her desire to “be good” by eating a nutritious diet.
Roll With Resistance
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In her lecture, "Using Motivational Interviewing Techniques to Facilitate Health-Related Changes" registered dietitian Aida Miles claims that resistance signals the interviewer to respond differently. Rather than responding to the patient’s resistance with confrontation, the interviewer should show understanding, with resistance seen as a natural feeling.
Support Self-Efficacy
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The interviewer should support self-efficacy by enhancing the patient’s confidence in his ability to cope with obstacles to change and to live a healthy and nutritious lifestyle.
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