IHBLT and Motivational Interviewing: Tools for Healthcare Providers Treating Childhood Obesity

What Is IHBLT and How to Use It to Treat Childhood Obesity 

Intensive Health Behavior and Lifestyle Treatment (IHBLT) is one of the most effective, evidence-based approaches for treating pediatric obesity. Recommended by the American Academy of Pediatrics, IHBLT focuses on helping children and families adopt healthier eating, physical activity, and behavioral habits through frequent, structured support ideally 26 or more hours over 3 to 12 months. 

Pediatric healthcare providers use IHBLT by partnering with families to set achievable goals, track progress, and deliver consistent guidance tailored to the child’s age, health status, and home environment. These programs are often delivered in a team-based setting that may include dietitians, psychologists, and health coaches. Even when full IHBLT programs aren’t available, pediatricians can apply key elements, like motivational interviewing and SMART goal setting, during routine visits to make meaningful progress toward better health. And thanks to federal guidelines, many of these services may be covered by insurance, making them more accessible. 

Weight Conversations: Start with Permission and Empathy 

Talking about weight can feel uncomfortable for both the provider and the family. But avoiding the conversation doesn’t help anyone. When approached respectfully and with consent, it can be empowering.

Before discussing the child’s weight, ask permission:

“I have some concerns about your child’s weight. Is that something you’re open to talking about today?”

If the answer is no, pivot to other health topics like physical activity or eating patterns. The goal is to meet families where they are and build trust over time.

Tailoring the Conversation: Parent vs. Child 

These discussions look different depending on who’s in the room:

• With parents: Ask who should or shouldn’t be involved in the conversation. Emphasize that healthy changes should include the whole family, not just one child. Framing it this way helps everyone feel included and supported.
• With children: Avoid focusing on weight as a number. Talk about behaviors, energy, goals, and how healthy habits can help them feel better or become stronger athletes. Kids often care more about performance, confidence, and fun rather than pounds or percentiles.

Use Weight-Inclusive, Person-First Language 

Language matters. Avoid stigmatizing terms like “obese child” or “normal weight child.” Use person-first and neutral phrasing.

• DO: “Child with obesity” or “child with a healthy weight”
• DON’T: “Obese child”, “Overweight child”, or even “fat”

Recognize children for behaviors and efforts, not labels. Celebrate small wins:

“I see you brought your water bottle today. You're already working on hydration, great job! What’s one more thing you can try this week?”

Children also mirror what they hear adults say about themselves. Encourage parents to be a positive role model in their own language around food, body, and health.
Parents can also learn how to talk to their child about body weight in a safe and healthy way.

Motivational Interviewing: A Powerful Tool

Set SMART Goals for the Whole Family

Help the family set SMART goals: Specific, Measurable, Achievable, Relevant, and Time-bound.

Example:

Instead of recommending to “eat healthier,” try “add a vegetable to dinner three nights this week.”

Involving the entire family in setting goals creates shared participation and increases success. Help families break down big goals into small, realistic steps, and always celebrate progress.

Every family is different. Consider:

• Time constraints
• Financial limitations
• Food access (including what kids eat at school or outside the home)
• Cultural preferences
• Parenting structures and sibling dynamics

Ask open questions like:

• “What’s most important to your family right now?”
• “What feels doable this week?”

Listening first helps tailor the plan to the family, making the family far more likely to succeed.

Build Systems that Support Families

You don’t need a perfect system to make a difference. Start with small, consistent, compassionate steps.

Families want to feel supported, not judged. When you focus on behavior, health, and connection, not just weight, you create a safe space for real, lasting change.

Even if your clinic doesn’t have a full IHBLT program, you can still make a big difference by:

• Training staff on respectful, weight-inclusive care and language
• Using Electronic Health Record alerts and billing codes to prompt interventions
• Connecting families to community resources
• Creating partnerships with dietitians, social workers, or wellness programs
• Download the Greaux Healthy Childhood Obesity Treatment Toolkit

Remember: the goal isn’t to send patients walking out with a handout and hope. It’s to walk alongside them, connecting care inside the clinic with their lives outside it.