Five-year medical and pharmacy costs after a medically supervised intensive treatment program for obesity.

PURPOSE: The financial impact of intensive medical interventions for weight loss has not been fully studied. DESIGN: A randomized pragmatic clinical trial. SETTING: Seven primary care clinics and one research center in Louisiana. SUBJECTS: Severely obese individuals (body mass index 40-60 kg/m(2)) randomized to usual care (n = 190) or intensive medical management (n = 200). Forty-seven percent of participants completed year 2 follow-up and were included in the analyses. INTERVENTION: Physician-monitored intervention with recommendations for 12 weeks of liquid diet followed by 4 months of group behavioral therapy, structured diet, and option of pharmacotherapy, and an additional 16 months of maintenance strategies. MEASURES: Two-year preintervention and 5-year postintervention measures were computed from claims data and included (1) medical costs excluding pharmacy, (2) pharmacy costs only, (3) total medical and pharmacy costs, and (4) medical and pharmacy subcategory costs. ANALYSIS: Differential categories for preintervention and postintervention were created using total sample 75th percentiles. Chi-square tests were employed to compare the intervention groups both preintervention and postintervention with respect to the proportion of subjects above the 75th percentile for each of the cost categories. RESULTS: Medical costs excluding pharmacy did not differ between groups. The intensive medical intervention group had a significantly smaller percentage of subjects above the 75th percentile for pharmacy costs only (p = .0125), and for antidiabetic agents (p = .0464), antihypertensives (p = .0075), and dyslipidemic subcategories (p = .0197). CONCLUSION: An intensive medical intervention may reduce pharmaceutical expenditures in severely obese individuals. These results must be viewed with caution given the high attrition of study participants.

Mindfulness Ameliorates the Relationship between Weight Concerns and Smoking Behavior in Female Smokers: A Cross-Sectional Investigation.

Weight concerns are common among female smokers and may interfere with smoking cessation. It is imperative to identify protective factors to lessen the likelihood that smoking-related weight concerns prompt smoking and hinder cessation efforts. Mindfulness is one potential protective factor that might prevent weight concerns from triggering smoking. In the current study, relationships among facets of trait mindfulness, smoking-related weight concerns, and smoking behavior were examined among 112 young adult female smokers (70.5% daily smokers; 83% Caucasian; mean age 20 [SD = 1.69]). After controlling for demographic variables, the Describing facet of trait mindfulness predicted lower smoking-related weight concerns. The mindfulness characteristics of Acting with Awareness, Nonreactivity, and Describing moderated the relationship between smoking-related weight concerns and smoking frequency, such that smoking-related weight concerns predicted greater smoking frequency in female smokers with low and medium levels of these mindfulness characteristics but did not in those with higher levels of mindfulness. These results suggest that mindfulness-based interventions may be effective for weight-concerned smokers.

A randomized clinical trial comparing the efficacy of two active conditions of a brief intervention for heavy college drinkers.

Brief interventions for college heavy drinkers have shown promise in reducing drinking and alcohol-related negative consequences. However, intervention duration, content, method of delivery, and follow-up length vary across studies. It therefore remains unclear whether intervention length significantly influences the interventions' efficacy. The present study is a randomized clinical trial systematically evaluating the efficacy of two brief interventions aimed at reducing alcohol use and alcohol-related negative consequences among college student drinkers. Treatment mediators were also evaluated. Participants (N=278) were, on average, 20.1 years old (SD=2.4), mostly Caucasian (87%) and female (71%). They were randomly assigned to a 10-minute brief intervention, a 50-minute brief intervention, or an attention-control group. Both active interventions were provided by clinical graduate students trained in Brief Alcohol Screening and Intervention for College Students (BASICS). As hypothesized, participants in both active conditions significantly reduced their alcohol consumption, as compared to the control group participants F(2,264)=9.84, p=.00, η(2)=.07. There were no significant differences in alcohol-related negative consequences F(2,264)=3.08, p=.06, η(2)=.02. The hypothesized mediators, alcohol drinking norms and coping behavioral strategies, explained significant variance in intervention efficacy, but neither self-efficacy nor alcohol expectancies were significant mediators. Given the preliminary nature of our investigation, more research is warranted to determine parameters of the critical mechanisms of change within brief alcohol interventions with college student drinkers.

Food cravings and food cue responding across the menstrual cycle in a non-eating disordered sample.

The study aim was to examine changes in food cue-elicited cravings and the macronutrient content of craved foods across menstrual cycle phases in a non-eating disordered sample. Thirty-five college females attended laboratory sessions in the late follicular and late luteal phases. In each session they completed a measure of state food craving before and after exposure to preferred, high fat/high sugar chocolate candy. Candy consumption following cue exposure was measured during an ad libitum "taste test." Additionally, participants rated their desire to eat foods differing systematically and significantly in macronutrient content. Ovulation was confirmed with luteinizing hormone detection kits. Results show that whereas the food cue increased cravings, this effect did not differ between cycle phases examined. The macronutrient content of foods desired also did not differ significantly between cycle phases, however, a non-significant trend suggested that high fat/high complex carbohydrate and low fat/high protein foods were more strongly desired in the late luteal phase. Amount of chocolate candy eaten did not differ between cycle phases. These results suggest that cravings for high fat/high sugar foods do not differ between menstrual cycle phases examined, whereas cravings for other foods may fluctuate across cycle phases in non-eating disordered women.