Motivational interviewing is missing in action

Extract
Introduction
Chronic disease (CD), such as diabetes, hypertension, and cardiovascular conditions, remains the leading causes of morbidity and mortality in the USA. Many of these conditions are preventable, with primary risk factors including physical inactivity, poor nutrition, tobacco use, and excessive alcohol consumption [1]. The cost of CD to the American medical system is enormous, exceeding $1 trillion annually [1]. Beyond financial implications, chronic conditions are also strongly associated with reduced quality of life.
Management of CD requires not only evidence-based medical interventions but also effective engagement with patients, whose daily behaviors (i.e. diet, medication adherence, and physical activity) directly influence their health outcomes. While physicians are increasingly attentive to social determinants of health (SDOH), many lack a structured approach for increasing patient motivation. Motivational interviewing (MI), an evidence-based technique originally developed in addiction medicine, provides a framework for addressing ambivalence and supporting patient-driven change [2, 3]. Yet, despite its documented efficacy, MI remains underutilized in practice. The current shortcomings in CD management stem not from the lack of effective treatments, but in part, from insufficient strategies to engage patients in a meaningful way.