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Background: Physicians are encouraged to counsel overweight and obese patients to lose weight., Purpose: It was examined whether discussing weight and use of motivational interviewing techniques (e.g., collaborating, reflective listening) while discussing weight predicted weight loss 3 months after the encounter., Methods: Forty primary care physicians and 461 of their overweight or obese patient visits were audio recorded between December 2006 and June 2008. Patient actual weight at the encounter and 3 months after the encounter (n=426); whether weight was discussed; physicians' use of motivational interviewing techniques; and patient, physician, and visit covariates (e.g., race, age, specialty) were assessed. This was an observational study and data were analyzed in April 2009., Results: No differences in weight loss were found between patients whose physicians discussed weight or did not. Patients whose physicians used motivational interviewing-consistent techniques during weight-related discussions lost weight 3 months post-encounter; those whose physician used motivational interviewing-inconsistent techniques gained or maintained weight. The estimated difference in weight change between patients whose physician had a higher global motivational interviewing-Spirit score (e.g., collaborated with patient) and those whose physician had a lower score was 1.6 kg (95% CI=-2.9, -0.3, p=0.02). The same was true for patients whose physician used reflective statements: 0.9 kg (95% CI=-1.8, -0.1, p=0.03). Similarly, patients whose physicians expressed only motivational interviewing-consistent behaviors had a difference in weight change of 1.1 kg (95% CI=-2.3, 0.1, p=0.07) compared to those whose physician expressed only motivational interviewing-inconsistent behaviors (e.g., judging, confronting)., Conclusions: In this observational study, use of motivational interviewing techniques during weight loss discussions predicted patient weight loss., (Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Pregnancy may contribute to overweight and obesity., Purpose: The primary objective of Active Mothers Postpartum was to promote a reduction in BMI through 24-months postpartum via sustainable lifestyle changes., Design: Behavioral intervention RCT to enhance postpartum weight loss., Setting/participants: A total of 450 overweight or obese women, enrolled 6-weeks postpartum, were recruited through obstetrics clinics and community posters in the Durham NC area., Intervention: Intervention participants were offered eight healthy-eating classes, ten physical-activity classes, and six telephone-counseling sessions over 9 months., Main Outcome Measures: Changes from baseline (6-weeks postpartum) to 1-month post-intervention (12-months postpartum) in: (1) diet (caloric intake, calories from fat, intake of certain foods); (2) physical activity (self-reported physical activity, television time); and (3) weight (collected 2004-2007, analyzed 2007-2008)., Results: Mean weight loss was 0.90 kg (+/-5.1 kg) in the intervention group and 0.36 kg (+/-4.9 kg) in the control group; this difference was not significant. There were also no significant group differences in improvement of diet or increased physical activity. In secondary analyses, there was a positive bivariate relationship between classes attended and weight loss (p=0.01)., Conclusions: There were no significant differences among the arms in diet, physical activity, or weight change. Home-based interventions via mail, telephone, or Internet/e-mail may be more feasible and successful in this population. The postpartum period is an important phase in women's lives with regard to weight retention, but engaging them during this busy period remains a challenge., Trial Registration: NCT00212251.

Background: This study examines whether adding nicotine replacement therapy (NRT) to cognitive-behavioral therapy (CBT) for pregnant smokers increases rates of smoking cessation., Methods: An open-label randomized trial (Baby Steps, n=181) of CBT-only versus CBT+NRT (choice of patch, gum, or lozenge; 1:2 randomization) was used. Data were collected from 2003 through 2005; analyses were conducted in 2006 and 2007. Outcomes were biochemically validated self-reported smoking status at 7 weeks post-randomization, 38 weeks gestation, and 3 months postpartum., Results: Women in the CBT+NRT arm were almost three times more likely than women in the CBT-only arm to have biochemically validated cessation at both pregnancy time points (after 7 weeks: 24% vs 8%, p=0.02; at 38 weeks gestation: 18% vs 7%, p=0.04), but not at 3 months postpartum (20% vs 14%, p=0.55). Recruitment was suspended early by an Independent Data and Safety Monitoring Board when an interim analysis found a higher rate of negative birth outcomes in the CBT+NRT arm than in the CBT-only arm. In the final analysis, the difference between the arms in rate of negative birth outcomes was 0.09 (p=0.26), when adjusted for previous history of preterm birth., Conclusions: The addition of NRT to CBT promoted smoking cessation in pregnant women. This effect did not persist postpartum. More data are needed to determine safety parameters and to confirm the efficacy of NRT use during pregnancy.

Background: Concerns about weight gain have been a commonly cited barrier to cessation among white, affluent, female populations, but less is known about this relationship among minority smokers and those with low incomes. Although smoking cessation is strongly encouraged for this population, it often leads to weight gain. Cultural differences in weight standards and the high prevalence of weight-related health conditions (e.g., hypertension and diabetes) may influence concerns about smoking cessation-related weight gain., Methods: A secondary analysis of low-income African-American smokers (n=367) from a randomized intervention trial was conducted to explore the association of weight concerns with comorbidities and smoking cessation., Results: Less than one quarter of participants were considered concerned about weight, defined as having high general concern about weight and high expectation of post-cessation weight gain. Those for whom weight gain could be riskiest--obese participants--were least concerned about gaining weight. Further, weight concerns were not associated with successful smoking cessation, quit attempts, confidence in quitting, or desire or readiness to quit., Conclusions: Because post-cessation weight gain may be a serious health threat for this population, but weight gain was not a concern for these smokers, smoking-cessation interventions for low-income African-American smokers may need to incorporate weight-gain education and prevention.