"Why won't my patients do what's good for them?" Motivational interviewing and treatment adherence

Limited adherence to healthy habits in adults at risk of lifestyle diseases, some of whom become candidates for bariatric surgery, has been paralleled by high rates of nonadherence to postbariatric surgery behavioral recommendations. This is a specific case of the more general problem of nonadherence to medical treatment of chronic conditions. An adequate understanding of the problem of nonadherence requires an understanding of the motivational factors that influence whether persons implement healthy behavior. Motivational interviewing is an empirically supported counseling style for strengthening a person's own motivation and commitment to change. It offers a model for understanding and intervening with nonadherence to behavioral recommendations that emphasizes the role of clinician communication in both increasing and inadvertently decreasing patient motivation. A conceptual account of patient motivation for healthy change, highlighting the centrality of resolution of patient ambivalence through targeted conversation, is illustrated by thought exercises for the reader and supplemented by references to empirical data. Recommendations for changes in clinical practice to improve patient adherence to behavioral recommendations are also offered.