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Fazla Kilolu ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı

Year 2020, Volume: 10 Issue: 2, 258 - 262, 31.05.2020
https://doi.org/10.33631/duzcesbed.553805

Abstract

Obezite
tüm dünyayı etkileyen ve yetişkinlerde olduğu kadar son zamanlarda adölesan ve
çocukluk çağındaki bireyleri de etkileyen bulaşıcı olmayan kronik bir
hastalıktır. Obezitenin oluşumunda bireylerin sağlık davranışları büyük bir
etkendir. Obezite tedavisini tek boyutta ele almak doğru bir yaklaşım olmayıp
aynı zamanda davranış değişikliği ve kilo yönetimini de kapsamalıdır. Kilo
yönetimi ve davranış değişikliği için kullanılan birçok mevcut yöntem olup
bunlardan biri de motivasyonel görüşmedir. Motivasyonel görüşme danışan
merkezli olup içsel görüyü ve aynı zamanda öz etkililiği de arttıran bir
terapötik girişimdir. Motivasyonel görüşme farklı alanlarda kullanılmakla
birlikte özellikle kilo verme, kilo kontrolü ve yönetimi, kronik hastalıklarda
tedaviye uyum, sigara bırakma tedavisi ve maddenin kötüye kullanımı gibi
davranış değişiminin yapılması gereken konularda kullanılmaktadır. Motivasyonel
görüşmenin obez veya fazla kilolu adölesanlar üstünde davranış değişiminde
etkili olduğu ve istendik yönde olumlu sağlık davranışlarının geliştirildiğini
gösteren araştırmalar mevcuttur. Ancak motivasyonel görüşmenin klinik
etkinliğini ortaya koymak ve kanıt düzeyini yükseltmek için konu ile ilgili
daha fazla çalışmaya gereksinim bulunmaktadır. Bu derlemenin amacı fazla kilolu
ve obez adölesanlarda motivasyonel görüşme tekniği kullanımının bireyler
üstündeki etkilerini ortaya koymaktır.

References

  • 1. Digital.nhs.uk [Internet]. England: Health and Social Care Information Centre, Inc; c2015 [Updated: 2019 January 8; Cited: 2019 April 4]. Available from: http://www.hscic.gov.uk/catalogue/PUB16988/obesphys-acti-diet-eng-2015.pdf.
  • 2. Verma S, Hussain ME. Obesity and diabetes: An update. Diabetology & Metabolic Syndrome. 2017; 11(1): 73-9.
  • 3. Who.int [Internet]. Switzerland: WHO Document Production Services, Inc; c2000 [Updated: 2009 August 3; Cited: 2019 April 1]. Available from: https://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/.
  • 4. Who.int [Internet]. Switzerland: WHO Document Production Services, Inc; c2015 [Updated: 2018 February 17; Cited: 2019 April 4]. Available from:https://www.who.int/dietphysicalactivity/childhood/en/.
  • 5. Amiri P, Kazemian E, Mansouri-Tehrani MM, Khalili A, Amouzegar A. Does motivational interviewing improve the weight management process in adolescents? Protocol for a systematic review and meta-analysis. Systematic reviews. 2018; 7(1): 178-85.
  • 6. Who.int [Internet]. Switzerland: WHO Data Analaysis Services, Inc; c1975 [Updated: 2017 September 29; Cited: 2019 April 4]. Available from:http://apps.who.int/gho/data/view.main.BMIPLUS2C10-19v?lang=en.
  • 7. Esen İ, Ökdemir D. Çocukluk çağı obezitesi: Tanım, etiyoloji ve klinik değerlendirme. Fırat Tıp Dergisi. 2018; 23 (Supp): 92-9.
  • 8. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: Causes and consequences. Journal of Family Medicine Primary Care. 2015; 4(2): 187-92.
  • 9. Borrelli B, Tooley EM, Scott-Sheldon LAJ. Motivational interviewing for parent-child health interventions: a systematic review and meta-analysis. Pediatrics Dentistry. 2015; 37(3): 254-65.
  • 10. West DS, Gorin AA, Subak LL, Foster G, Bragg C, Hecht J,et al. A motivation-focused weight loss maintenance program is an effective alternative to a skill-based approach. International Journal of Obesıty. 2011; 35(2): 259-69.
  • 11. Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight again. Obesity Reviews. 2005; 6(1): 67-85.
  • 12. Teixeira PJ, Going SB, Sardinha LB, Lohman TG. A review of psychological pre-treatment predictors of weight control. Obesity Reviews. 2005; 6(1): 43-65.
  • 13. Arabacı Z, Doğru A, Yıldırım J. Kronik hastalıklarda transteoretik modele dayandırılarak motivasyonel görüşme tekniğinin kullanılması. Sağlık Akademisi Kastamonu. 2018; 3(2): 50-61.
  • 14. Taylor RW, Brown D, Dawson AM, Hazar J, Cox A, Rose EA, et al. Motivational Interviewing for screening and feedback and encouraging lifestyle change to reduce relative weight in 4-8 year old children: design of the MinT Study. BMC Public Health. 2010; 10(1): 271-81.
  • 15. Freira S, Lemos MS, Fonseca H, Williams G, Ribeiro M, Pena F, et al. Anthropometric out comes of a motivational interviewing school-based randomized trial involving adolescents with overweight. European Journal of Pediatrics. 2018; 177(7): 1121-30.
  • 16. Miller WR, Rollnick S. Motivational interviewing: Helping people change. 3rd ed. New York: Guilford Press; 2013.
  • 17. Christie D, Channon S. The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in pediatric and adult populations: a clinical review. Diabetes, Obesity and Metabolism. 2014; 16(5): 381-7.
  • 18. Espinoza PG, San Carlos NG, Rojas DN, Rioseco RC. Es efectiva la entre vista motivational individual en la malnutrición porexceso? Una revisión sistemática de la literatura. Atención Primaria. 2018; 51(9): 548-61.
  • 19. Chien WT, Mui JH, Cheung EF, Gray R. Effects of motivational interviewing based adherence therapy for schizophrenia spectrum disorders: a randomized controlled trial. Trials. 2015; 16(1): 270-83.
  • 20. Lundah B, Moleni T, Burke BL, Butters R, Tollefson D, Butler C, et al. Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials. Patient Education Counselling. 2013; 93(2): 157-68.
  • 21. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbel TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obesity Reviews. 2011; 12(9): 709-23.
  • 22. Rubak S, Sandbæk A, Lauritzen T, Christensen B. Motivational interviewing: A systematic review and meta-analysis. British Journal of General Practice. 2005; 55(513): 305-12.
  • 23. Taşçı S, Özdemir H. Motivasyonel görüşme tekniği ve hemşirelikte kullanımı. Erciyes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2013; 1(1): 41-7.
  • 24. Miller WR, Rollnick S. Motivational interviewing: Preparing people to change addictive behavior. New York: The Guildford Press; 2002.
  • 25. Walpole B, Dettmer E, Morrongiello BA, McCrindle BW, Hamilton J. Motivational interviewing to enhance self-efficacy and promote weight loss in overweight and obese adolescents: a randomized controlled trial. Journal of Pediatric Psychology. 2013; 38(9): 944-53.
  • 26. Naar-King S. Motivational interviewing in adolescent treatment. Canadian Journal of Psychiatry. 2011; 56(1): 651-7.
  • 27. Gayes LA, Steele RG. A meta-analysis of motivational interviewing interventions for pediatric health behavior change. Journal of Consulting Clinical Psychology. 2014; 82(3): 521-35.
  • 28. Flattum C, Friend S, Neumark-Sztainer D, Story M. Motivational interviewing as a component of a school-based obesity prevention program for adolescent girls. Journal of the American Dietetic Association. 2009; 109(1): 91-4.
  • 29. Ball GDC, Mackenzie-Rife KA, Newton MS, Alloway CA, Slack JM, Plotnikoff RC, et al. One-on-one lifestyle coaching form an aging adolescent obesity: Findings from a pilot, randomized controlled trial in a real-world, clinical setting. Paediatrics & Child Health. 2011; 16(6): 345-50.
  • 30. Brennan L. Does motivational interviewing improve retention or outcome in cognitive behavior therapy for overweight and obese adolescents?. Obesıty Research Clinical Practice. 2016; 10(4): 481-6.
  • 31. Chahal N, Rush J, Manlhiot C, Boydell KM, Jelen A, McCrindle BW. Dyslipidemia management in overweight or obese adolescents: A mixed-methods clinical trial of motivational interviewing. SAGE Open Medicine. 2017; 5(1): 1-15.
  • 32. Walpole B,Dettmer E, Morrongiello B, McCrindle B, Hamilton J. Motivational interviewing as an intervention to increase adolescent self-efficacy and promote weight loss: Methodology and design. BMC Public Health. 2011; 11(1): 459-67.
  • 33. Tripp SB, Perry JT, Romney S, Blood-Siegfried J. Providers as weight coaches: using practice guides and motivational interview to treat obesity in the pediatric office. Journal of Pediatric Nursing. 2011; 26(5): 474-9.
  • 34. Kelishadi R, Malekahmadi M, Hashemipour M, Soghrati M, Soghrati M, Mirmoghtadaee P, et al. Can a trial of motivational lifestyle counseling be effective for controlling childhood obesity and the associated cardiometabolic risk factors? Pediatrics & Neonatology. 2012; 53(2): 90-7.
  • 35. Taveras EM, Gortmaker SL, Hohman KH, Horan CM, Kleinman KP, Mitchell K, et al. Randomized controlled trial to improve primary care to prevent and manage childhood obesity: The high five for kids study. Archives of Pediatrics & Adolescent Medicine. 2011; 165(8): 714-22.
  • 36. MacDonell K, Brogan K, Naar-King S, Ellis D, Marshall S. A pilot study of motivational interviewing targeting weight-related behaviors in overweight or obese African American adolescents. Journal of Adolescent Health. 2012; 50(2): 201-3.
  • 37. Flattum C, Friend S, Neumark-Sztainer D, Story M. Motivational interviewing as a component of a school-based obesity prevention program for adolescent girls. Journal of American Dietetic Association. 2009; 109(1): 91-4.
  • 38. Neumark-Sztainer DR, Friend SE, Flattum CF, Hannan PJ, Story MT, Bauer KW, et al. New moves-preventing weight-related problems in adolescent girls a group-randomized study. American Journal of Preventive Medicine. 2010; 39(5): 421-32.
  • 39. Davis JN, Gyllenhammer LE, Vanni AA, Meija M, Tung A, Schroeder ET, et al. Startup circuit training program reduce metabolic risk in Latino adolescents. Medicine and Science Sports and Exercise. 2011; 43(11): 2195-203.

The Use of Motivational Interview Technique in Overweight and Obese Adolescents

Year 2020, Volume: 10 Issue: 2, 258 - 262, 31.05.2020
https://doi.org/10.33631/duzcesbed.553805

Abstract

Obesity is a
chronic disease that affects the whole world and is not contagious, affecting
adults as well as recently adolescent and childhood individuals. Obesity is a
major factor in the formation of individual’s health behaviors. Treating
obesity in one dimension is not the right approach, but should also include
behavior change and weight management. There are many available methods for
weight management and behavior change, one of which is motivational
interviewing. Motivational interviewing is a therapeutic initiative that is
client-centered and increases inner vision as well as self-efficacy.
Motivational interviewing is used in different areas, but is particularly used
in the areas of weight loss, weight control and management, adaptation to
treatment in chronic diseases, smoking cessation therapy, and substance abuse.
There are studies that show that motivational interviewing is effective in
changing behavior on obese or overweight adolescents and that positive health
behaviors are developed in the desired direction. However, further studies are
needed to demonstrate the clinical efficacy of motivational interviewing and to
raise the level of evidence. The aim of this review is to demonstrate the
effects of motivational interviewing technique on individuals in overweight and
obese adolescents.

References

  • 1. Digital.nhs.uk [Internet]. England: Health and Social Care Information Centre, Inc; c2015 [Updated: 2019 January 8; Cited: 2019 April 4]. Available from: http://www.hscic.gov.uk/catalogue/PUB16988/obesphys-acti-diet-eng-2015.pdf.
  • 2. Verma S, Hussain ME. Obesity and diabetes: An update. Diabetology & Metabolic Syndrome. 2017; 11(1): 73-9.
  • 3. Who.int [Internet]. Switzerland: WHO Document Production Services, Inc; c2000 [Updated: 2009 August 3; Cited: 2019 April 1]. Available from: https://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/.
  • 4. Who.int [Internet]. Switzerland: WHO Document Production Services, Inc; c2015 [Updated: 2018 February 17; Cited: 2019 April 4]. Available from:https://www.who.int/dietphysicalactivity/childhood/en/.
  • 5. Amiri P, Kazemian E, Mansouri-Tehrani MM, Khalili A, Amouzegar A. Does motivational interviewing improve the weight management process in adolescents? Protocol for a systematic review and meta-analysis. Systematic reviews. 2018; 7(1): 178-85.
  • 6. Who.int [Internet]. Switzerland: WHO Data Analaysis Services, Inc; c1975 [Updated: 2017 September 29; Cited: 2019 April 4]. Available from:http://apps.who.int/gho/data/view.main.BMIPLUS2C10-19v?lang=en.
  • 7. Esen İ, Ökdemir D. Çocukluk çağı obezitesi: Tanım, etiyoloji ve klinik değerlendirme. Fırat Tıp Dergisi. 2018; 23 (Supp): 92-9.
  • 8. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: Causes and consequences. Journal of Family Medicine Primary Care. 2015; 4(2): 187-92.
  • 9. Borrelli B, Tooley EM, Scott-Sheldon LAJ. Motivational interviewing for parent-child health interventions: a systematic review and meta-analysis. Pediatrics Dentistry. 2015; 37(3): 254-65.
  • 10. West DS, Gorin AA, Subak LL, Foster G, Bragg C, Hecht J,et al. A motivation-focused weight loss maintenance program is an effective alternative to a skill-based approach. International Journal of Obesıty. 2011; 35(2): 259-69.
  • 11. Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight again. Obesity Reviews. 2005; 6(1): 67-85.
  • 12. Teixeira PJ, Going SB, Sardinha LB, Lohman TG. A review of psychological pre-treatment predictors of weight control. Obesity Reviews. 2005; 6(1): 43-65.
  • 13. Arabacı Z, Doğru A, Yıldırım J. Kronik hastalıklarda transteoretik modele dayandırılarak motivasyonel görüşme tekniğinin kullanılması. Sağlık Akademisi Kastamonu. 2018; 3(2): 50-61.
  • 14. Taylor RW, Brown D, Dawson AM, Hazar J, Cox A, Rose EA, et al. Motivational Interviewing for screening and feedback and encouraging lifestyle change to reduce relative weight in 4-8 year old children: design of the MinT Study. BMC Public Health. 2010; 10(1): 271-81.
  • 15. Freira S, Lemos MS, Fonseca H, Williams G, Ribeiro M, Pena F, et al. Anthropometric out comes of a motivational interviewing school-based randomized trial involving adolescents with overweight. European Journal of Pediatrics. 2018; 177(7): 1121-30.
  • 16. Miller WR, Rollnick S. Motivational interviewing: Helping people change. 3rd ed. New York: Guilford Press; 2013.
  • 17. Christie D, Channon S. The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in pediatric and adult populations: a clinical review. Diabetes, Obesity and Metabolism. 2014; 16(5): 381-7.
  • 18. Espinoza PG, San Carlos NG, Rojas DN, Rioseco RC. Es efectiva la entre vista motivational individual en la malnutrición porexceso? Una revisión sistemática de la literatura. Atención Primaria. 2018; 51(9): 548-61.
  • 19. Chien WT, Mui JH, Cheung EF, Gray R. Effects of motivational interviewing based adherence therapy for schizophrenia spectrum disorders: a randomized controlled trial. Trials. 2015; 16(1): 270-83.
  • 20. Lundah B, Moleni T, Burke BL, Butters R, Tollefson D, Butler C, et al. Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials. Patient Education Counselling. 2013; 93(2): 157-68.
  • 21. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbel TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obesity Reviews. 2011; 12(9): 709-23.
  • 22. Rubak S, Sandbæk A, Lauritzen T, Christensen B. Motivational interviewing: A systematic review and meta-analysis. British Journal of General Practice. 2005; 55(513): 305-12.
  • 23. Taşçı S, Özdemir H. Motivasyonel görüşme tekniği ve hemşirelikte kullanımı. Erciyes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2013; 1(1): 41-7.
  • 24. Miller WR, Rollnick S. Motivational interviewing: Preparing people to change addictive behavior. New York: The Guildford Press; 2002.
  • 25. Walpole B, Dettmer E, Morrongiello BA, McCrindle BW, Hamilton J. Motivational interviewing to enhance self-efficacy and promote weight loss in overweight and obese adolescents: a randomized controlled trial. Journal of Pediatric Psychology. 2013; 38(9): 944-53.
  • 26. Naar-King S. Motivational interviewing in adolescent treatment. Canadian Journal of Psychiatry. 2011; 56(1): 651-7.
  • 27. Gayes LA, Steele RG. A meta-analysis of motivational interviewing interventions for pediatric health behavior change. Journal of Consulting Clinical Psychology. 2014; 82(3): 521-35.
  • 28. Flattum C, Friend S, Neumark-Sztainer D, Story M. Motivational interviewing as a component of a school-based obesity prevention program for adolescent girls. Journal of the American Dietetic Association. 2009; 109(1): 91-4.
  • 29. Ball GDC, Mackenzie-Rife KA, Newton MS, Alloway CA, Slack JM, Plotnikoff RC, et al. One-on-one lifestyle coaching form an aging adolescent obesity: Findings from a pilot, randomized controlled trial in a real-world, clinical setting. Paediatrics & Child Health. 2011; 16(6): 345-50.
  • 30. Brennan L. Does motivational interviewing improve retention or outcome in cognitive behavior therapy for overweight and obese adolescents?. Obesıty Research Clinical Practice. 2016; 10(4): 481-6.
  • 31. Chahal N, Rush J, Manlhiot C, Boydell KM, Jelen A, McCrindle BW. Dyslipidemia management in overweight or obese adolescents: A mixed-methods clinical trial of motivational interviewing. SAGE Open Medicine. 2017; 5(1): 1-15.
  • 32. Walpole B,Dettmer E, Morrongiello B, McCrindle B, Hamilton J. Motivational interviewing as an intervention to increase adolescent self-efficacy and promote weight loss: Methodology and design. BMC Public Health. 2011; 11(1): 459-67.
  • 33. Tripp SB, Perry JT, Romney S, Blood-Siegfried J. Providers as weight coaches: using practice guides and motivational interview to treat obesity in the pediatric office. Journal of Pediatric Nursing. 2011; 26(5): 474-9.
  • 34. Kelishadi R, Malekahmadi M, Hashemipour M, Soghrati M, Soghrati M, Mirmoghtadaee P, et al. Can a trial of motivational lifestyle counseling be effective for controlling childhood obesity and the associated cardiometabolic risk factors? Pediatrics & Neonatology. 2012; 53(2): 90-7.
  • 35. Taveras EM, Gortmaker SL, Hohman KH, Horan CM, Kleinman KP, Mitchell K, et al. Randomized controlled trial to improve primary care to prevent and manage childhood obesity: The high five for kids study. Archives of Pediatrics & Adolescent Medicine. 2011; 165(8): 714-22.
  • 36. MacDonell K, Brogan K, Naar-King S, Ellis D, Marshall S. A pilot study of motivational interviewing targeting weight-related behaviors in overweight or obese African American adolescents. Journal of Adolescent Health. 2012; 50(2): 201-3.
  • 37. Flattum C, Friend S, Neumark-Sztainer D, Story M. Motivational interviewing as a component of a school-based obesity prevention program for adolescent girls. Journal of American Dietetic Association. 2009; 109(1): 91-4.
  • 38. Neumark-Sztainer DR, Friend SE, Flattum CF, Hannan PJ, Story MT, Bauer KW, et al. New moves-preventing weight-related problems in adolescent girls a group-randomized study. American Journal of Preventive Medicine. 2010; 39(5): 421-32.
  • 39. Davis JN, Gyllenhammer LE, Vanni AA, Meija M, Tung A, Schroeder ET, et al. Startup circuit training program reduce metabolic risk in Latino adolescents. Medicine and Science Sports and Exercise. 2011; 43(11): 2195-203.
There are 39 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Reviews
Authors

Sonay Bilgin 0000-0003-2229-3820

Hasan Evcimen 0000-0003-4352-101X

Publication Date May 31, 2020
Submission Date April 15, 2019
Published in Issue Year 2020 Volume: 10 Issue: 2

Cite

APA Bilgin, S., & Evcimen, H. (2020). Fazla Kilolu ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 10(2), 258-262. https://doi.org/10.33631/duzcesbed.553805
AMA Bilgin S, Evcimen H. Fazla Kilolu ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı. J DU Health Sci Inst. May 2020;10(2):258-262. doi:10.33631/duzcesbed.553805
Chicago Bilgin, Sonay, and Hasan Evcimen. “Fazla Kilolu Ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10, no. 2 (May 2020): 258-62. https://doi.org/10.33631/duzcesbed.553805.
EndNote Bilgin S, Evcimen H (May 1, 2020) Fazla Kilolu ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10 2 258–262.
IEEE S. Bilgin and H. Evcimen, “Fazla Kilolu ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı”, J DU Health Sci Inst, vol. 10, no. 2, pp. 258–262, 2020, doi: 10.33631/duzcesbed.553805.
ISNAD Bilgin, Sonay - Evcimen, Hasan. “Fazla Kilolu Ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10/2 (May 2020), 258-262. https://doi.org/10.33631/duzcesbed.553805.
JAMA Bilgin S, Evcimen H. Fazla Kilolu ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı. J DU Health Sci Inst. 2020;10:258–262.
MLA Bilgin, Sonay and Hasan Evcimen. “Fazla Kilolu Ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, vol. 10, no. 2, 2020, pp. 258-62, doi:10.33631/duzcesbed.553805.
Vancouver Bilgin S, Evcimen H. Fazla Kilolu ve Obez Adölesanlarda Motivasyonel Görüşme Tekniğinin Kullanımı. J DU Health Sci Inst. 2020;10(2):258-62.