Copyright ª Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Original Article Provider Communication Behaviors that Predict Motivation to Change in Black Adolescents with Obesity April Idalski Carcone, PhD, MSW,* Sylvie Naar-King, PhD,* Kathryn E. Brogan, PhD, RD,* Terrance Albrecht, PhD,† Ellen Barton, PhD,‡ Tanina Foster, MA,† Tim Martin, PhD,§ Sharon Marshall, MD\ ABSTRACT: Objective: The goal of this research was to identify communication behaviors used by weight loss counselors that mostly strongly predicted black adolescents’ motivational statements. Three types of moti- vational statements were of interest: change talk (CT; statements describing their own desires, abilities, reasons, and need for adhering to weight loss recommendations), commitment language (CML; statements about their intentions or plans for adhering), and counterchange talk (CCT; amotivational statements against change and commitment). Methods: Thirty-seven black adolescents with obesity received a single motiva- tional interviewing session targeting weight-related behaviors. The video-recorded transcribed sessions were coded using the Minority Youth Sequential Coding for Observing Process Exchanges generating a sequential chain of communication. Data were then subjected to sequential analysis to determine causal relationships between counselor and adolescent communication. Results: Asking open-ended questions to elicit adoles- cent CT and emphasizing adolescents’ autonomy most often led to CT. Open-ended questions to elicit CML, reflecting adolescent CML, and emphasizing autonomy most often led to CML. In contrast, open-ended questions to elicit CCT, reflecting CCT, reflecting ambivalence, and neutral open-ended questions about the target behavior led to CCT. Conclusions: This study provides clinicians with insight into the most effective way to communicate with black adolescents with obesity about weight loss. Specifically, reflective statements and open questions focusing on their own desires, abilities, reasons, need, and commitment to weight loss recommendations are more likely to increase motivational statements, whereas other types of reflections and questions may be counterproductive. Finally, because adolescents have a strong need for autonomous decision making, emphasizing their autonomy may be particularly effective in evoking motivational state- ments. (J Dev Behav Pediatr 34:599–608, 2013) Index terms: patient-provider communication, adolescents, obesity. Rates of pediatric obesity have steadily risen over the past 30 years, particularly among minority children. 1 To illustrate, rates of overweight ($85th percentile body mass index [BMI]) black children (6–11 year olds) in- creased 5-fold (4–20%) from 1971 to 2002 compared with a 3-fold increase (4–13%) among white children. 1 Current estimates suggest that this disparity has persisted and is growing. In 2009 to 2010, 41.2% of black adoles- cents (12–19-year-olds) were overweight versus 30.0% of white adolescents. Despite widespread knowledge of these rates and the disparity among ethnic groups, few interventions to treat obesity have targeted this high-risk group. Most clinical trials have focused on white and/or suburban samples, and when minorities have participated, they have been at high risk for dropout. 2 Community weight loss programs have demonstrated similar results. 3 In general, ethnic minority youth underutilize services, 4,5 terminate treatment pre- maturely, 6–8 attend fewer sessions, 9 and realize fewer clinical benefits. 10 The few studies focusing on minority youth have not shown sustainable weight loss. 11–14 While there are likely many possible explanations for why interventions targeting black adolescents with obe- sity were unsuccessful, poor adherence to treatment rec- ommendations is an important factor. Poor adherence with behavioral intervention components, such as moni- toring food intake or activity level, has been repeatedly shown to predict poor outcomes in pediatric weight loss clinical trials 15,16 and among black adolescents with obesity specifically. Germann et al 17 demonstrated signif- icantly greater weight loss among black adolescents in From the *Pediatric Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI; †Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; ‡Department of English, Wayne State University, Detroit, MI; §Department of Psychology, Kennesaw State University, Kennesaw, GA; \Department of Pediat- rics, Wayne State University School of Medicine, Detroit, MI. Received December 2012; accepted May 2013. Disclosure: The authors declare no conflict of interest. This research was funded by NHLBI (1U01HL097889-01 Naar-King & Jen, PIs) and the Karmanos Cancer Institute Behavioral and Field Research Core (P30CAP30CA022453-23 Bepler, PI). Address for reprints: April Idalski Carcone, PhD, MSW, Pediatric Prevention Re- search Center, Department of Pediatrics, Wayne State University School of Medicine, 4707 St. Antoine, Suite W534 Bin, 502, Detroit, MI 48201; e-mail: acarcone@med.wayne.edu. Copyright Ó 2013 Lippincott Williams & Wilkins Vol. 34, No. 8, October 2013 www.jdbp.org | 599