Motivational Interviewing (MI) in Clinical Nutrition

Marilyn Rabin August 31, 2023 Dietitian

Registered dietitians, like other health professionals, must support their clients in adopting and maintaining new behaviours and eating habits. Motivational interviewing is a very useful and effective technique to that end.

Evoking change – the groundwork

The groundwork for evoking change is embedded in a meaningful conversation. More than 40 years ago, William Miller and Stephen Rollnick began developing a way of engaging with vulnerable people to enhance their autonomy that has evolved into what is now known as motivational interviewing (MI). Their recent book, entitled “Motivational Interviewing, Helping People Change and Grow”, along with one thousand eight hundred and counting published trials have demonstrated that “simply telling others what to do is usually not enough to motivate them to do it; you get better outcomes if you put less pressure on people to change.” Just as the way we eat is as important as what we eat, the way we speak is as important as what we say. At the core of MI is the spirit (partnership, acceptance, compassion, empowerment) along with an ability to navigate ambivalence (the struggle between the willingness to change and the reasons to sustain the behaviour). MI is not a panacea but is beneficial for people who are given the opportunity to chart their own trajectory. It is considered a component of best practices in translating and applying nutritional psychiatry and assuring nutrition literacy.

Navigating towards the Mediterranean diet

The Mediterranean dietary pattern, for example, promotes cardiometabolic health and is achievable. Guiding an individual toward improving nutrient density rather than restricting calories offers the opportunity to explore foods that enhance diet quality over time. This is the hallmark of the Mediterranean dietary pattern – it embraces all foods and is compatible with other scientifically endorsed food guides. The practitioner can determine what their client knows, what they are willing to do and how confident they are to fulfil their own objectives. The important debriefing component reviews how the discussion went and what can be added or deleted for future meetings. This can be a convenient segue to address critical food-medication interactions and the advantages of pertinent goals of reducing caffeine, alcohol, and highly processed foods.

Food security

Food security is an extremely sensitive topic especially at this time in our lives. It is described as the consistent and assured access to and availability of safe sufficient food to support nutritional adequacy and a healthy life. It is deemed a right for all humans by the United Nations. Regrettably, many people for a variety of reasons, do not always have regular access to nutritious foods in recommended quantities. While there are some obvious solutions (food banks, lower costing foods such as grains, legumes, frozen, canned, dried fruit and vegetables, and foods priced lower when short-dated), this delicate topic can be discussed by first affirming the person’s ability to cope with this severe circumstance. Asking what steps the person is taking to acquire food and prepare meals is part of the planning stage. Some additional key concepts of motivational interviewing include: supporting autonomy and the person’s world view, directing, following, and guiding.

In summary

In summary, motivational interviewing may be valuable in numerous nutrition care settings as a way of “guiding a conversation that engages people by looking together at their experiences, strengths, values, skills and goals”. When examining ways to encourage food choices and eating habits that are realistic, accessible, and achievable, incorporating motivational interviewing may lead to desired outcomes.

Sources

Rollnick, Miller and Butler. Motivational Interviewing in Healthcare, Helping Patients Change Behavior. 2nd edition. 2023. The Guilford Press. Prologue Page 1; Part 1, Introduction to Motivational Interviewing, Page 5.

Khalil M et al. The potential of the Mediterranean Diet to improve mitochondrial function in experimental models of obesity and metabolic syndrome. Nutrients. 2022;14, 3112-3143. https://doi.org/10.3390/nu14153112.

Hoffman, Richard. Implementing the Mediterranean Diet. Nutrition in Practice and Public Health. 2023. John Wiley & Sons Ltd. Preface, Page vii.
Canadian Food Guide https://food-guide.canada.ca/en/

Tripodi E et al. Prevalence of food insecurity in community-dwelling people living with severe mental illness. Nutrition & Dietetics. Journal of Dietitians of Australia. 2022;79:374-379.

Frey J and Hall A. 2021. Motivational interviewing for mental health clinicians – A toolkit for skills enhancement. PESI Publishing. Chapter 1: MI with People Experiencing Mental Health Issues, Page 8.

Miller, William R. and Rollnick, Stephen. Motivational Interviewing, Helping People Change and Grow. 4th edition. 2023. The Guilford Press.

Author

Marilyn Rabin

Marilyn is an active member of the ODNQ – Ordre des diététistes nutritionnistes du Québec, Dietitians of Canada, and the American Academy of Nutrition and Dietetics, with a vast experience. She worked the better part of her career at the Douglas mental health university institute in Montreal, Canada, as their community out-patient dietitian-nutritionist. More recently, she has been volunteering her expertise to COMPEER - an organization promoting mental wellness. Marilyn is also an active member of MINT – Motivational Interviewing Network of Trainers, which involves the sharing of expertise using skills that help people find their own path to empowering change and success.