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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 motivational 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 counter change talk (CCT; amotivational statements against change and commitment). Method Thirty-seven Black adolescents with obesity received a single Motivational Interviewing session targeting weight-related behaviors. The video-recorded, transcribed sessions were coded using the MY-SCOPE 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 adolescent 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. Conclusion 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 statements.

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In order to reduce the incidence of obesity and hypertension in this minority population, dietary intervention should begin at adolescence or even earlier. DASH diet would be beneficial for this population.