Motivational interviews and digital health guidance improve postoperative weight management in obese children

Abstract

BACKGROUND

Childhood obesity is a major public health issue, with obesity rates reaching 20.8% among 14-year-olds and increasing with age. Metabolic and bariatric surgery is the most effective treatment for moderate to severe obesity, but postoperative weight regain and reduced quality of life often occur due to poor lifestyle adherence. Digital health guidance interventions have shown benefits in improving disease understanding and quality of life, yet single interventions have limited effectiveness. Motivational interviewing (MI), a person-centered communication approach, enhances medication adherence and metabolic control. This study integrates MI with digital health guidance to evaluate its impact on lifestyle adherence and weight management in obese children after metabolic and bariatric surgery.

AIM

To explore the impact of MI combined with digital health guidance on lifestyle adherence and weight management in obese children after metabolic and bariatric surgery.

METHODS

A total of 40 obese children who underwent metabolic and bariatric surgery in our hospital from January 2021 to January 2025 were selected and randomly divided into two groups. The control group (20 cases) received one month of digital health education intervention, while the observation group (20 cases) received one month of MI intervention in addition to the control group’s intervention. The lifestyle adherence rate, diet and exercise status, weight control indicators, lipid metabolism indicators, body image and self-esteem scores, and quality of life scores before and after one month of intervention were compared between the two groups.

RESULTS

After one month of intervention, the observation group showed higher overall lifestyle adherence rate, fruit and vegetable intake, moderate-to-vigorous physical activity duration, body image score, Rosenberg Self-Esteem Scale score, high-density lipoprotein cholesterol level, and scores in all dimensions of the 36-Item Short Form Health Survey, while exhibiting lower energy intake, sugary beverage consumption, body weight, body mass index, waist circumference, hip circumference, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels compared to the control group (P < 0.05).

CONCLUSION

The combined intervention of digital health guidance and MI showed preliminary short-term improvements in lifestyle adherence, diet and exercise habits, weight control, lipid metabolism, and quality of life in obese children after metabolic and bariatric surgery over a one-month follow-up period.

Key Words: Motivational interviews; Digital health guidance; Obesity; Lifestyle compliance; Weight loss metabolic surgery; Weight management

Core Tip: This study introduces a combined intervention of motivational interviewing (MI) and digital health guidance for pediatric obesity management. Our findings reveal that integrating MI with digital support significantly enhances lifestyle compliance, dietary and exercise behaviors, weight control, lipid profiles, and quality of life in children after metabolic and bariatric surgery. The MI approach, which focuses on eliciting patient motivation, synergizes with digital monitoring to sustain long-term behavior change, offering a novel and effective model for postoperative care in this vulnerable population.

INTRODUCTION

According to reports, the obesity rate among 14-year-old children can reach 20.8%, with an overweight rate of 17%. Moreover, as age increases, the obesity rate continues to rise. This indicates that childhood obesity has become a significant global public health issue[1]. Currently, metabolic and bariatric surgery is the most effective treatment for moderate to severe obesity and related metabolic diseases. It primarily reconstructs the anatomical structure of the gastrointestinal tract, reduces gastrointestinal volume, and thereby decreases the absorption of nutrients to achieve weight loss. This approach has been widely adopted in clinical practice[2]. However, postoperative patients often experience weight regain and a decline in quality of life due to poor dietary habits, insufficient health awareness, and non-compliance with lifestyle changes[3]. Therefore, implementing appropriate intervention measures for children after metabolic and bariatric surgery is of paramount importance. With the continuous advancement of digital technology, digital health guidance interventions are also being increasingly applied in clinical settings[4]. Plummer et al[5] found that, compared to the control group, digital health interventions achieved more significant effects in improving parents’ understanding of children’s diseases and their satisfaction before and after surgery (95% confidence interval: 1.45-2.87, P < 0.001). Meanwhile, Harbi et al[6] demonstrated that digital health interventions enhanced patients’ quality of life (95% confidence interval: 0.05-0.31, P < 0.05). However, single intervention measures tend to have limited effectiveness. Motivational interviewing (MI), as a person-centered, goal-oriented communication approach, works by eliciting and reinforcing an individual’s reasons for change, thereby increasing their motivation and commitment to behavioral change[7]. Parwati et al[8] noted in their study that MI could improve patients’ medication adherence post-intervention by 4.5 times. Furthermore, Berhe et al[9] showed that MI effectively lowers patients’ blood glucose levels, indicating that MI also yields positive results in clinical interventions. Building on this, the present study integrates MI with digital health guidance to explore its impact on lifestyle adherence and weight management in obese children after metabolic and bariatric surgery, aiming to provide new approaches for clinical intervention.

MATERIALS AND METHODS

General information

A total of 40 pediatric patients with obesity who underwent metabolic and bariatric surgery at our hospital from January 2021 to January 2025 were selected and randomly divided into an observation group and a control group, with 20 patients in each group. In the observation group, the male-to-female ratio was 10:10; the age range was 13-18 years, with a mean age of (15.68 ± 1.95) years; parental education levels were as follows: Junior high school or below (5 cases), high school/technical college (11 cases), and bachelor’s degree or above (4 cases); Preoperative comorbidities were categorized as none (2 cases), one type (9 cases), and two or more types (9 cases); Preoperative body mass index (BMI) ranged from 35 kg/m² to 49 kg/m², with a mean of (41.98 ± 6.58) kg/m². In the control group, the male-to-female ratio was 11:9; the age range was 14-18 years, with a mean age of (15.90 ± 1.86) years; parental education levels were: Junior high school or below (4 cases), high school/technical college (11 cases), and bachelor’s degree or above (5 cases); preoperative comorbidities were: None (2 cases), one type (11 cases), and two or more types (7 cases); Preoperative BMI ranged from 33 kg/m² to 48 kg/m², with a mean of (40.68 ± 6.90) kg/m². There were no significant differences in the general characteristics between the two groups (P > 0.05), indicating comparability.

Inclusion criteria: (1) Age between 12 years and 18 years; (2) Diagnosed with severe obesity[10] and underwent sleeve gastrectomy; (3) Possessing normal communication and cognitive abilities; and (4) No severe dysfunction of major organs.

Exclusion criteria: (1) Secondary obesity; (2) Suffering from congenital anomalies, autoimmune diseases, infectious diseases, or neoplastic diseases; (3) Having a family history of cardiovascular or cerebrovascular diseases; (4) Significant delays in individual growth and development; (5) Inability to cooperate and complete the procedures of this study for any other reasons; and (6) Postoperative occurrence of severe complications such as anastomotic leakage or acute massive gastrointestinal bleeding.

Indications for metabolic and bariatric surgery: (1) BMI ≥ 35 kg/m² (or 120% of the 95^th percentile, whichever is lower) with at least one of the following clinically significant comorbidities: Obstructive sleep apnea (apnea-hypopnea index > 5), type 2 diabetes mellitus, idiopathic intracranial hypertension, nonalcoholic steatohepatitis, Blount’s disease, slipped capital femoral epiphysis, gastroesophageal reflux disease, or hypertension; or (2) BMI ≥ 40 kg/m² (or 140% of the 95^th percentile, whichever is lower), regardless of comorbidity status[11].

Sample size calculation: The formula n = (UαS/δ)² was used. Based on a pilot study, Uα = 1.96 and S/δ = 3.23, resulting in n = 40[12].

Methods

Control group (received digital health education intervention): A multidisciplinary team was established, consisting of pediatric metabolic surgeons, clinical dietitians, rehabilitation specialists, and senior nurses. The team underwent training and assessment. Based on a big data platform, the core management needs for post-discharge care of the children were identified and selected. A digital network platform was designed and developed, incorporating educational health videos, exercise guidance videos, a dedicated column on the hospital’s official WeChat account, and the hospital’s official website. The platform was also used to record and track the children’s health data after discharge. Vital parameters such as body temperature, heart rate, and blood pressure were continuously monitored using smart detection devices and the platform. Before discharge, a designated staff member provided guidance to both the children and their parents on using the digital network platform, ensuring they could log in and access the learning resources. The intervention plan was as follows: (1) Health education and self-management: Two weeks after surgery, the children’s knowledge regarding dietary improvements, exercise implementation, and self-monitoring was assessed. Deficiencies were addressed through various online channels, with home visits arranged when necessary. Daily communication, psychological support, and regular reminders were integrated to emphasize the importance of medication adherence and follow-up visits, thereby enhancing treatment confidence and compliance; (2) Exercise program design: Each child was provided with a pedometer. Tailored exercise plans were developed based on the child’s age, interests, and physical fitness. Initially, daily moderate-intensity activities such as 60 minutes of aerobic exercise and strength training were prescribed. The exercise volume was gradually increased to ensure a minimum of 10000 steps per day, while avoiding excessive fatigue; (3) Dietary management: Dietitians formulated individualized dietary plans for the children based on their resting metabolic rates. The total daily caloric intake was set between 1200 kcal and 1600 kcal, with a macronutrient distribution of 15% protein, 55% carbohydrates, and 30% fat. The caloric ratio for breakfast, lunch, and dinner was 25%:50%:25%. Prior to the intervention, comprehensive explanations were provided regarding obesity risks, dietary adjustment principles, and precautions to secure family understanding and cooperation; and (4) Functional recovery and activities of daily living training: Children were guided via instructional videos to gradually engage in limb joint activities, balance exercises, and walking. The intensity of these activities was adjusted according to each child’s tolerance. Concurrently, guidance was provided on self-care abilities such as eating independently and dressing. The entire process was managed through the digital platform. Continuous communication was maintained using features such as check-in records, system feedback, and online question and answer. Implementation quality and child safety were ensured through methods including data verification, regular case discussions, and established emergency reporting procedures.

Intervention group (receiving digital health education with MI): In addition to the control group’s intervention, MI was implemented by psychological counselors. The interview content primarily focused on identifying areas requiring adjustment, reasons for adjustment, and methods of adjustment. Cognitive-behavioral adjustment strategies were employed to identify and analyze potential difficulties and obstacles in the weight loss process, thereby developing preventive strategies and methods to overcome these challenges. Based on adolescents’ psychological characteristics, the influencing factors affecting their participation in exercise-based weight loss were thoroughly explored, and external environmental influences were comprehensively considered to formulate personalized, easily implementable goals. The intervention lasted for one month and consisted of three stages: The initial stage spanned one week, involving weekly face-to-face sessions lasting 30 minutes to 50 minutes to establish a mutually trusting and equal counseling relationship, assess the children’s willingness to change, and jointly develop weight management strategies. Entering the second stage in the third week, sessions were conducted biweekly to monitor the progress of the weight loss plan, provide targeted advice and support, and strengthen participants’ determination to continue implementation. Finally, during the consolidation period in the fourth week, biweekly telephone follow-ups lasting approximately 10 minutes to 15 minutes were arranged to actively acknowledge their efforts and motivation for change, thereby ensuring the long-term sustainability of the weight loss outcomes. Before the MI session, a psychological counselor conducted a 15-20 minutes individual interview with the primary caregiver (at least one parent) of each child to assess their understanding of postoperative management, willingness to support the child, and their own psychological status. The results of this interview served as an important reference for developing the weight loss plan. Throughout the MI intervention, parents were fully involved. Specifically, at least one parent of each child attended every face-to-face MI session, and a dedicated component of the session was designed to explore parents’ supportive attitudes toward the child’s weight loss and potential difficulties they might face. During the intervention period, the parent participation rate was 90.00%.

MI was delivered by two psychological counselors certified as National Level II Psychological Counselors. Both received 24 hours of MI-specific training (including didactic lectures, role-playing, and case discussions) and passed a competency assessment before participating in the study. During the intervention period, every MI session was audio-recorded, and 20% of the recordings were randomly selected and coded by an independent psychological counselor using the MI Treatment Integrity Code, Version 4 (MITI 4)[13]. Key indicators were as follows: Global scores (empathy and collaboration dimensions) were 4.0 ± 0.6; The reflection-to-question ratio (R:Q) was 1.1 ± 0.3; And the open question-to-closed question ratio (OQ:CQ) was 1.8 ± 0.5. All scores met the MITI 4 competency thresholds (global scores ≥ 3.5, R:Q ≥ 1, OQ:CQ ≥ 1). Biweekly case supervision meetings were held to review recordings and provide feedback to ensure MI fidelity.

Observation indicators

Assess the patients’ adherence to lifestyle modifications, which includes four aspects: Reasonable diet structure, regular weekly exercise, periodic weight monitoring, and maintaining a positive and happy mood. Adherence is defined as follows: “Full adherence” if all four aspects are fully implemented; “Non-adherence” if any one aspect is not implemented; and “partial adherence” if some aspects are implemented but not all.

Evaluate the patients before the intervention and one month after the intervention using the Short Form 36 Health Survey[14]. This scale covers eight domains: Physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). Each domain includes 2 questions to 10 questions, totaling 36 items. The score for each domain ranges from 0 to 100, with higher scores indicating a better quality of life. The Cronbach’s α coefficient for this scale is 0.791.

Measure weight, hip circumference, waist circumference, and height before the intervention and one month after using the X-SCAN PLUS II Body Composition Analyzer (Beijing Hongtaisheng Health Technology Co., Ltd.). BMI = weight (kg)/height² (m²).

The BODY-Q scale[15] was used to assess the body image of the children before the intervention and one month after the intervention. This scale consists of 10 items and employs a 5-point Likert scale. The total score ranges from 0 to 100, with higher scores indicating a more positive body image. The Cronbach’s α coefficient for this scale is 0.926.

The Rosenberg Self-Esteem Scale (RSES)[16] was used as the assessment tool to measure the self-esteem level of the children before the intervention and one month after the intervention. This scale consists of 10 items and uses a 4-point Likert scale. The total score ranges from 10 to 40, with higher scores indicating a higher level of self-esteem. The Cronbach’s α coefficient for this scale is 0.87.

Before the intervention and one month after the intervention, a 5 mL venous blood sample was collected from each child and tested using a fully automated biochemical analyzer (Manufacturer: Hitachi, Japan; Model: Lst008as). Total cholesterol (TC) was measured using the enzymatic colorimetric method, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured using the direct clearance method, and triglycerides (TG) were measured using the enzymatic colorimetric method.

Statistical analysis

Statistical analysis was performed using SPSS 27.0. For continuous variables, the Shapiro-Wilk test was first applied. Continuous variables that followed a normal distribution are presented as the mean ± SD and were analyzed using the t-test. Categorical data are expressed as n (%) and were analyzed using the χ² test or Fisher’s exact test, with a significance level of P < 0.05.

RESULTS

Comparison of lifestyle adherence

The total adherence rate in the intervention group (95.00%) was higher than that in the control group (P < 0.05), as shown in Table 1.

Table 1 Comparison of lifestyle adherence, n (%).

Group	Complete adherence	Partial adherence	Non-adherence	Total adherence rate
Intervention group (n = 20)	14 (70.00)	5 (25.00)	1 (5.00)	19 (95.00)
Control group (n = 20)	8 (40.00)	3 (15.00)	9 (45.00)	14 (70.00)
χ2 value				8.536
P value				0.014

Comparison of diet and exercise

The intervention group had lower daily energy intake (1436.55 ± 101.16) kcal/day and lower consumption of sugar-sweetened beverages (0.84 ± 0.46) servings/day compared to the control group, while daily fruit and vegetable intake (2.89 ± 1.25) servings/day and the proportion of time spent on moderate or higher intensity exercise 13.72% ± 5.22% were higher in the intervention group than in the control group (P < 0.05), as shown in Table 2.

Table 2 Comparison of diet and exercise, mean ± SD.

Group	Energy (kcal/day)	Sugar-sweetened beverages (servings/day)	Fruits and vegetables (servings/day)	Moderate or higher intensity exercise time (%)
Intervention group (n = 20)	1436.55 ± 101.16	0.84 ± 0.46	2.89 ± 1.25	13.72 ± 5.22
Control group (n = 20)	1567.59 ± 121.57	1.25 ± 0.49	2.11 ± 1.03	10.48 ± 4.53
t value	3.706	2.731	2.187	2.092
P value	0.001	0.010	0.035	0.043

Comparison of weight control indicators

After the intervention, the intervention group showed significantly lower values compared to the control group in weight (61.05 ± 6.71) kg, BMI (24.28 ± 2.19) kg/m², waist circumference (75.05 ± 5.32) cm, and hip circumference (95.45 ± 3.26) cm (P < 0.05), as shown in Table 3.

Table 3 Comparison of weight control indicators, mean ± SD.

Group	Weight (kg)		BMI (kg/m2)		Waist circumference (cm)		Hip circumference (cm)
	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention
Intervention group (n = 20)	66.05 ± 9.20	61.05 ± 6.71	26.30 ± 2.30	24.28 ± 2.19	79.10 ± 6.85	75.05 ± 5.32	98.01 ± 5.02	95.45 ± 3.26
Control group (n = 20)	66.10 ± 9.11	65.37 ± 6.62	26.25 ± 2.29	25.80 ± 2.18	79.23 ± 6.93	78.73 ± 5.41	98.20 ± 5.03	97.68 ± 3.15
t value	0.017	2.051	0.068	2.200	0.060	2.174	0.120	2.199
P value	0.986	0.047	0.946	0.034	0.953	0.036	0.905	0.034

BMI: Body mass index.

Comparison of blood lipid metabolism indicators

After the intervention, the TC (4.11 ± 0.58) mmol/L, TG (1.02 ± 0.38) mmol/L, and LDL-C (2.58 ± 0.34) mmol/L levels in the observation group were significantly lower than those in the control group, while the HDL-C (1.65 ± 0.49) mmol/L level was higher than that in the control group (P < 0.05; Table 4).

Table 4 Comparison of blood lipid metabolism indicators, mean ± SD.

Group	TC		TG		HDL-C		LDL-C
	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention
Intervention group (n = 20)	4.55 ± 0.59	4.11 ± 0.58	1.69 ± 0.39	1.02 ± 0.38	1.68 ± 0.53	1.65 ± 0.49	2.97 ± 0.19	2.58 ± 0.34
Control group (n = 20)	4.62 ± 0.79	4.42 ± 0.30	1.71 ± 0.30	1.36 ± 0.60	1.65 ± 0.48	1.36 ± 0.38	3.02 ± 0.48	2.95 ± 0.57
t value	0.274	2.192	2.264	2.161	0.185	2.113	0.436	2.491
P value	0.785	0.035	0.794	0.037	0.855	0.041	0.665	0.017

TC: Total cholesterol; TG: Triglycerides; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol.

Comparison of body image and self-esteem

After the intervention, the body image score and the RSES score in the observation group were significantly higher than those in the control group (P < 0.05), as shown in Figure 1.

Figure 1 Comparison of body image and self-esteem. ^aP < 0.05 compared with the control group. RSES: Rosenberg Self-Esteem Scale.

Comparison of quality of life

After the intervention, the scores in the observation group were significantly higher than those in the control group across all domains: GH, PF, RE points, SF points, BP points, VT points, RP points, and MH points (all P < 0.05), as shown in Figure 2.

Figure 2 Comparison of quality of life. ^aP < 0.05 compared with the control group. GH: General health; PF: Physical functioning; RP: Role physical; RE: Role emotional; SF: Social functioning; BP: Bodily pain; VT: Vitality; MH: Mental health.

DISCUSSION

Obesity not only predisposes children to obesity-related health issues such as type 2 diabetes, hypertension, and metabolic syndrome, but also leads to problems like depression and low self-esteem, ultimately resulting in social isolation and significantly reducing their quality of life[17,18]. Bariatric and metabolic surgery, as an effective treatment for obesity and associated chronic metabolic diseases, can markedly improve patients’ weight and metabolic disorders such as dyslipidemia and type 2 diabetes postoperatively[19]. However, some patients still experience weight regain and deterioration in metabolic health and physical function due to poor adherence to postoperative lifestyle modifications, which significantly exacerbates MH issues such as anxiety[20]. Adolescents and children, especially those with obesity, are in a developmental stage with limited self-control and are highly susceptible to external influences, making it challenging for them to maintain weight control after surgery and leading to weight recurrence[21]. Therefore, targeted interventions focusing on lifestyle adherence and weight management are crucial for children with obesity following bariatric and metabolic surgery. Relevant studies have shown that both digital health guidance and MI demonstrate favorable clinical intervention outcomes. Hence, this study designed a prospective randomized controlled trial to explore the impact of a combined intervention approach utilizing both methods on lifestyle adherence and weight management in children with obesity after bariatric and metabolic surgery.

The results of this study indicate that the observation group had lower energy intake and consumption of sugar-sweetened beverages compared to the control group, while their intake of fruits and vegetables and time spent in moderate-to-vigorous physical activity were higher. This demonstrates that the intervention combining digital health guidance with MI can significantly improve the dietary and exercise habits of children with obesity. The primary reasons for this improvement may be as follows: First, the diet plans developed by dietitians based on the resting metabolic rate of the children, along with the digital platform’s function of automatically calculating calorie intake and issuing alerts for excess consumption, enabled precise control of caloric intake after bariatric and metabolic surgery. Health education further helped the children understand clearly that bariatric surgery alone does not guarantee long-term weight control, and that only by establishing and maintaining a healthy lifestyle can they achieve sustained and stable weight management. This understanding fundamentally strengthened their determination to change their behaviors. Through MI, goals such as replacing sugar-sweetened beverages with water and consuming fruits and vegetables daily were set, which enhanced the children’s intrinsic motivation. Simultaneously, the digital management platform allowed children to log their physical activity. The system provided feedback on their exercise performance rankings and rewarded them with electronic badges, points, and other incentives upon achieving goals. Additionally, members could challenge each other and share achievements, significantly boosting the children’s engagement[22]. MI engages with the children in a warm and sincere manner, actively listening to their experiences of weight bias and uncomfortable social situations prior to undergoing bariatric and metabolic surgery. By expressing understanding and acceptance, MI creates a trusting environment where children feel psychologically safe, encouraging them to continuously modify their behaviors, increase physical activity, and providing supportive feedback when their efforts are recognized. This approach enhances behavioral consistency in the children. When children struggle to maintain their exercise routines, MI guides them in developing strategies to overcome difficulties and adjust their plans through psychological interventions. This trains the children to adopt a positive attitude toward setbacks, enabling them to continuously overcome obstacles and increase their exercise intensity and training duration[23]. Furthermore, the significant reduction in energy and sugar-sweetened beverage intake observed in the intervention group decreased the substrate available for the liver to convert excess carbohydrates into TG. Additionally, moderate-to-vigorous intensity exercise not only upregulates the activity of lipoprotein lipase in skeletal muscle and adipose tissue, accelerating the breakdown and clearance of lipoproteins such as chylomicrons in the bloodstream and thereby lowering TG levels, but also enhances the liver’s synthesis of apolipoprotein A-I, promoting HDL-C production. The increased intake of fruits and vegetables accelerates the binding of dietary fiber to bile acids in the intestines, promoting their excretion. This, in turn, stimulates the liver to continuously consume cholesterol for bile acid synthesis, thereby reducing TC and LDL-C levels. Thus, the combined intervention of digital health guidance and MI synergistically promotes the development of healthy lifestyle behaviors in children with obesity, reduces body weight, and improves lipid metabolism[24].

After the intervention, the observation group showed higher scores in both body image and RSES compared to the control group. This indicates that the combined intervention of digital health guidance and MI can enhance satisfaction with body image and self-esteem levels in children with obesity. The primary reasons for this improvement may include the following: Children can more intuitively observe the significant reductions in their weight, waist circumference, and other indicators through the digital platform, which allows them to experience a sense of progress and success, thereby increasing their self-efficacy. Additionally, improvements in physical fitness and weight enhance their confidence and ability to participate in group activities, thereby reducing social anxiety and significantly raising their body image scores. MI, by engaging with children in a warm and sincere manner, actively listens to their experiences of weight bias and uncomfortable social situations from their past lives. By expressing understanding and acceptance, MI creates a trusting environment where children feel psychologically safe, encouraging them to continuously modify their behaviors, increase physical activity, and providing supportive feedback when their efforts are recognized. Building on effective communication, MI helps children identify and resolve ambivalent feelings that may arise during postoperative recovery and weight management, encouraging active participation in the analysis and reflection of their individualized intervention plans. This effectively motivates them to pursue health goals, promotes the re-recognition and affirmation of their self-worth, and thereby significantly enhances their self-esteem levels[25].

After the intervention, the observation group showed significantly higher scores than the control group in GH, PF, RE, SF, BP, VT, RP, and MH. This indicates that the combined intervention of digital health guidance and MI can comprehensively improve the quality of life of children with obesity after metabolic and bariatric surgery. Possible reasons for this improvement include: Significant weight loss and other changes observed in the intervention group may alleviate obesity-related musculoskeletal pain and enhance the children’s ability to engage in daily activities. Regular exercise habits and improved physical stamina also help children feel less fatigued during physical education classes. Additionally, improved sleep quality and cardiovascular function, combined with a healthier diet that stabilizes blood glucose and lipid levels, further contribute to the children feeling more energetic in their daily lives, thereby significantly improving their physiological and behavioral function-related scores. MI fosters a collaborative spirit by jointly exploring and implementing practical solutions without focusing on blame. It engages with children non-judgmentally based on their current circumstances and affirms their problem-solving abilities through an accepting approach. MI prioritizes the child’s best interests over the clinician’s authority in directing change, demonstrating compassion. It also encourages children to express their ideas and opinions about solutions rather than instructing them on what to do, thereby stimulating their intrinsic motivation. This enhances the children’s self-efficacy, improves body image and self-esteem, directly alleviates negative emotions such as anxiety and depression, and promotes MH. The reduction in psychological distress also enables the children to better concentrate in class and become more willing to engage with friends during learning and social activities, thereby significantly improving their MH status. These comprehensive improvements further enhance the children’s overall health scores and SF scores[26,27]. A study by Mohanty et al[28] indicated that lifestyle adherence among obese patients receiving digital monitoring interventions was 60%, significantly lower than the 90% observed in this study. This further highlights that the innovative intervention model in this study, which combines MI with digital health guidance, effectively addresses the limitations of single-intervention approaches through structured and interactive support, deepens behavioral cognition, enhances intrinsic motivation, and synergistically promotes improved lifestyle adherence in children with obesity after metabolic and bariatric surgery. However, this study was a single-center trial with a small sample size and a short follow-up period, including only children who underwent sleeve gastrectomy and excluding those with growth and developmental delays or inability to cooperate. Therefore, the findings can only be generalized to cooperatively participating obese children without developmental delays. Although the parent participation rate was 90.00%, two parents did not fully participate in MI, and family-level variables were not controlled for. Future studies should quantify parental involvement, include high-risk populations, expand the range of surgical procedures, and conduct multi-center, large-sample, long-term follow-up studies for further validation.

CONCLUSION

In summary, over a one-month intervention period, the combination of digital health guidance and MI demonstrated preliminary short-term efficacy in improving lifestyle adherence, dietary and exercise habits, weight control, lipid metabolism, and quality of life in obese children following metabolic and bariatric surgery.