I learned many interesting ideas about MI at the Motivational Interviewing Network of Trainers (MINT) conference I attended in September. Dr. Bill Miller, one of the founders of MI gave a keynote address on MI and Social Justice.
In this talk he spoke of volition, as defined in www.dictionary.com, “…the act of willing, choosing, or resolving, or a choice or decision made by the will”. Miller stated that volition is only one aspect of the process of change, and clinicians working with others to foster change in behavior must consider the environment and context in which people live.
In my work helping people change dietary behavior, this is a key element. People may want to change, but not have the resources including money, time and skill to shop for and prepare the foods that are best for them. Perhaps there aren’t grocery stores nearby, or they have very limited time due to family and job demands. The social environment in which people live is also key. If everyone around you is eating high fat, high sugar, high salt foods, you are much more likely to do so as well. It can be very difficult to be the only one changing food habits in a family or community.
This happens in particular with teens who want to either lose weight or stop gaining weight. When I suggest more fruits and veggies, it might not be possible if the person who buys food for the family isn’t buying them. School meals are often low in fruits and veggies, and the one available might not be what students really like. One teen told me, “It’s just not cool to walk down the hall at school eating an apple when everyone else has Coke and chips.”
Another obstacle to changing eating habits is lack of knowledge about how to prepare “healthy” foods. If you’ve never had butternut squash for example, and have no idea how to prepare and cook it, my telling you to eat it is useless. We need to offer help and support to people with limited knowledge of fruits and veggies to teach them simple skills in the kitchen.
What do you think?
