Motivational Interviewing and Weight Bias

motivational interviewing (MI)

a collaborative, person-centered form of guiding to elicit and strengthen motivation for change

core principle of MI

collaborative and patient-centered. people are more likely to change when they discover their own reasons for change (dig deep to find their true motivators)

4 key elements

partnership, acceptance, compassion, evocation

partnership

collaborative relationship, not expert-patient dynamic

acceptance

showing genuine care and respect for the person

compassion

actively promoting the person’s welfare and well-being

evocation

drawing out the person’s own motivations and ideas

OARS

open ended questions, affirmations, reflective listening, summaries

OARS: open ended questions

“what concerns you most about your current activity level?”

OARS: affirmations

“You’ve made some really positive changes already”

OARS: reflective listening

“It sounds like you’re feeling fruterated with…”

OARS: summaries

pulling together key points and motivations expressed

MI in PA counseling

explore person’s own reasons for wanting to be more active

ask about past positive experiences with movement (find something they enjoy. the more fun it is, the more they will stick with it)

identify barriers without judgement (time is a big one)

support self-efficacy: “what makes you confident you could try this?”

avoid the “righting reflex” (telling people what they should do)

bias

develops from all your interactions. what you see on TV, social media, what your friends think, what your family thinks. doesn’t mean you have a hatred for a group of people. usually it is unconscious

most common weight bias

skinny is best

implicit bias

unconscious attitudes and stereotypes (most common)

explicit bias

conscious prejudices and discrimination

weight bias

negative attitudes toward people based on body size

confirmation bias

seeking info that confirms existing beliefs (looking past info that proves you wrong)

impact of bias

can affect quality of care, patient trust, and health outcomes

stats

weight bias is prevalent among healthcare providers. can lead to delayed medical care and avoidance of healthcare. associated with increased stress, depression, and unhealthy behaviors

common assumptions about weight

it is a “lack of willpower” or “personal failure”

oversimplifying complex health conditions

assuming all health problems are weight-related

barriers created from weight stigma

fear of judgement in gyms or public spaces (especially if you are overweight)

negative past experiences with exercise (bad gym teacher)

shame and low self-esteem

avoidance of healthcare settings (if they experience bias, feel like they are getting ignored by focusing solely on obesity)

reduced motivation to engage in healthy behaviors

result of barriers of weight stigma

can actually decrease PA and worsen health outcomes

recognizing disparities

access to safe rec facilities varies by community

economic barriers to gym memberships, equipment, programs

cultural differences in activity preferences and norms

accessibility challenges for PWD

time constraints due to work/family responsibilities

strategies to create an inclusive environment

use person-first language

offer diverse activity options that accommodate different abilities

consider cultural preferences and traditions

address environmental barriers (cost, transportation, safety)

focus on health behaviors rather than weight loss alone

self reflection questions for MI

what assumptions am I making about this person?

how might my biases affect our interaction?

what are this person’s strengths and past successes?

how can I support their autonomy and choices?

listen for and reflect the person’s own motivations, not what you think they should want

try: what role would you like PA to play in your life?

instead of: you need to lose weight and exercise more

focus on

behaviors, feelings, and goals rather than appearance or weight

weight as an indicator

not good indicator of health. muscle outweighs fat

applications

ask about preferred activities and past positive experiences

explore barriers without making assumptions

celebrate small changes and efforts

address weight bias in yourself and colleagues

advocate for inclusive facilities and programs

consider social determinants of health in your recommendations

how does MI help

with weight, smoking, diet, excessively playing video games, etc.