Motivational Interviewing: The Evidence

As previously mentioned, MI is successful for promoting behaviour change in

substance use disorders [23]. The meta-analysis performed by Rubak et al
observed MI to have a significant effect on body mass index, total blood
cholesterol, systolic blood pressure and blood alcohol concentration [24].
Studies by West et al [25] and Carels et al observed the addition of MI to weight
loss programmes resulted in greater weight loss and adherence in obese
individuals[26]. Limbers et al state that although results seem favourable, more
research it required to establish the effectiveness of motivational interviewing
in obesity[27].

Emerging Role of Physiotherapists in Obesity

The activity in obesity, as it is likely to be more beneficial in encouraging

lasting lifestyle changes than simply educating individuals about the health
risks of obesity and instructing them to exercise.

Cognitive Behavioural Therapy (CBT) in the Management of

Obesity

Cognitive behavioural therapy (CBT) has frequently been used over the past
20 years and has been found to be effective in improving adherence in this
population[28].
These strategies have features which distinguish them from other forms of
psychological treatment.
Herning et al (2005) state that CBT posits that thoughts or cognitions
(interpretations) mediate behavior.
The 3 fundamental propositions of CBT are:

1. Cognitions affect behaviour (self-regulation)

2. Cognitions (interpretations) may be monitored and altered
3. Behaviour change may be produced through cognitive change (self-
regulation).

By incorporating concepts of CBT into their fitness practice, physical

therapists can help obese patients see the connection between their thoughts
about exercise and their behavior.
In a review of CBT strategies to increase adherence in patients with obesity
Dalle Grave et al provide a guide with steps to follow [28].
 CBT Strategies to initially engage in physical activity:

 The first step is to educate patients about the benefit of exercising and the
need to increase the level of physical activity for long-term weight control.

 The next step is to create a “pros and cons to change” table. Patients should
be asked to evaluate their reasons for and against adopting an active lifestyle.
It is advised to begin by asking patients to list the cons of changing