Addendum: Assessing Readiness to Change

The "stages of change," developed by Prochaska and DiClemente, provide a framework to conceptualize the process for how people change by categorizing the stages through which people progress when contemplating a behavior change. Because the stages of change are sometimes mentioned with MI, a brief description is provided here. Motivational interviewing can facilitate and/or support change during any of the stages; however, many feel that it is most helpful for those in the precontemplation and contemplation phases, where ambivalence plays the greatest role.

Confidence Ruler

The confidence ruler is another MI tool. It is best used after the patient has expressed interest in making a change in a specific area, perhaps through a decisional balance exercise followed by the clinician's summary. The clinician then asks the patient to rate on a scale of 1-10 how important making the change is to the patient, with 1 being "not at all" and 10 being "very important." Whatever the patient response is, the clinician should commend the patient for his or her answer and then ask why the patient did not choose a lower number.

Brief Background

Motivational interviewing was developed by William Miller and Stephen Rollnick for use in addictive behavior counseling and has been used effectively since the early 1990s. Miller and Rollnick describe MI as “a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with nondirective counseling, it is more focused and goal-directed.

Motivational Interviewing

By: Stephen Pont, MD, MPH, FAAP
Assistant Professor of Pediatrics
Medical Director, Texas Center for the Prevention & Treatment of Childhood Obesity
Medical Director, Austin ISD Student Health Services
UT Southwestern, Austin - Department of Pediatrics / UT Austin - Department of Advertising
Dell Children's Medical Center of Central Texas
On Twitter: @DrStephenPont

Perspectives for the Future

As this toolkit is incorporated into individual clinics to evaluate and treat pediatric obesity, clinicians should realize that for some children, the onset of obesity occurred years earlier. This section gives an overview of the possible factors that may have contributed to patients’ obesity in their early years. Also, some suggestions are offered to help prevent obesity in the early years, a critical step in the battle against childhood obesity.

Treatment Overview

Pediatric practitioners should approach the discussion of childhood obesity with sensitivity and a nonjudgmental tone toward parents and patients.  Practitioners must minimize embarrassment, harm to self-esteem, and stigmatization, and, instead, be supportive when discussing the issue with patients. Even though the clinical terms "overweight" and "obese" are recommended for documentation and clinical risk assessment, the use of different words should be considered in the dialogue with patients and families.


1.   Binns HJ, Ariza AJ. Guidelines help clinicians identify fisk factors for overweight in children. Pediatr Ann. 2004;33(1):19-22.

2.   Kleinman RE. American Academy of Pediatrics. Pediatric Nutrition Handbook. Elk Grove Village, IL: American Academy of Pediatics; 2004:466.

3.   Kleinman RE. American Academy of Pediatrics. Pediatric Nutrition Handbook. Elk Grove Village, IL: American Academy of Pediatrics; 2004:568-569.


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