Although the primary care setting offers an innovative option for weight loss interventions, there is minimal research examining this type of intervention with low-income minority women. Further, there is a lack of research on the long-term effects of these programs. The purpose of this investigation was to examine the weight loss maintenance of low-income African-American women participating in a primary care weight management intervention. A randomized controlled trial was conducted with overweight and obese women (N = 144) enrolled at two primary care clinics. Women received a 6-month tailored weight loss intervention delivered by their primary care physician and completed follow-up assessments 9, 12, and 18 months following randomization. The weight loss maintenance of the tailored intervention was compared to a standard care comparison group. The weight loss of intervention participants (−1.52 ± 3.72 kg) was significantly greater than that of standard care participants (0.61 ± 3.37 kg) at month 9 (P = 0.01). However, there was no difference between the groups at the 12-month or 18-month follow-ups. Participants receiving a tailored weight loss intervention from their physician were able to maintain their modest weight loss up to 3-6 months following treatment. Women demonstrated weight regain at the 18-month follow-up assessment, suggesting that more intensive follow-up in the primary care setting may be needed to obtain successful long-term weight loss maintenance.

Examined the reliability, construct, and concurrent validity of the Parenting Scale (PS), a brief instrument designed to measure dysfunctional parenting practices for parents of young children. In Study 1, 183 primarily African American mothers and their Head Start children completed the PS. The PS, which consists of 3 subscales--Laxness, Overreactivity, and Verbosity--was subjected to confirmatory factor analysis (CFA). Neither the original 3-factor structure, nor a 2-factor structure consisting of the original Laxness and Overreactivity factors, fit the data. A subsequent exploratory factor analysis yielded a 2-factor solution that was generally consistent with the Overreactivity and Laxness subscales identified by Arnold, O'Leary, Wolff, and Acker (1993). The 2-factor CFA solution was replicated with a sample of 216 similar mothers, and the 5-item Overreactivity and Laxness subscales retained internal consistencies above .70. Analysis of the convergent validity of the modified PS and its 2 subscales revealed moderate associations with measures of permissiveness, authoritarianism, involvement, and limit setting. Scores on the PS were not correlated significantly with measures of social desirability, maternal education level, or parent report of internalizing behavior problems. Concurrent validity evidence was obtained by correlating the PS with measures of parenting satisfaction and support, parenting stress, maternal depression, and measures of externalizing child behavior problems.

The purpose of this qualitative study was to explore perceptions and beliefs about body size, weight, and weight loss among obese African American women in order to form a design of weight loss intervention with this target population. Six focus groups were conducted at a community health clinic. Participants were predominantly middle-aged with a mean Body Mass Index of 40.3 +/- 9.2 kg/m(2). Findings suggest that participants (a) believe that people can be attractive and healthy at larger sizes; (b) still feel dissatisfied with their weight and self-conscious about their bodies; (c) emphasize eating behavior as the primary cause for weight gain; (d) view pregnancy, motherhood, and caregiving as major precursors to weight gain; (e) view health as the most important reason to lose weight; (f) have mixed experiences and expectations for social support for weight loss; and (g) prefer treatments that incorporate long-term lifestyle modification rather than fad diets or medication.

Research Methods and Procedures:A randomized, controlled trial was conducted between 1999 and 2003 with 144 overweight or obese women (predominantly African-American) enrolled at two primary care clinics. Four physicians at each clinic were randomly assigned to provide either tailored weight management interventions or standard care. The tailored condition consisted of six monthly outpatient visits lasting ϳ15 minutes each, which included personalized materials and messages. The main outcome was body weight change. Results: The intervention group lost more weight than the standard care group (p ϭ 0.03). The tailored group lost a mean (standard deviation) of 2.0 (3.2) kg by Month 6. The standard care group gained 0.2 (2.9) kg. More participants in the tailored group lost weight (79% vs. 47%; p ϭ 0.04). Discussion: Obese, low-income, African-American women provided with 90 minutes of physician-delivered, tailored weight management instruction over 6 months achieved greater weight loss than those receiving standard medical care. The primary care physician can be effective in delivering weight loss interventions, and the primary care clinic may be a useful setting to implement weight management interventions.

Improving the recognition and treatment of obesity in primary care settings is a critical initiative. Rural populations suffer disproportionately with obesity, and better methods of delivering obesity care are needed for this population. Further research is needed to establish the effectiveness of a CCM approach for obesity care.