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Background: Primary care providers (PCPs) are expected to provide weight management counseling despite having low confidence in their ability to be effective. This analysis examined change in weight status between children who received usual care from their PCP and those who received one of two structured weight management programs in a randomized control trial. Methods: Data from parent-child dyads who were referred to the Guided Self-Help Obesity Treatment in the Doctor's Office study, but did not participate, were examined to determine change in weight status compared with those who participated in the trial. Families were divided into four groups: Group 1, structured treatment with high attendance; Group 2, structured treatment with low attendance; Group 3, PCP/usual care with some weight management counseling; and Group 4, PCP/usual care with no counseling. Anthropometric data and PCP delivery of weight management counseling were abstracted from the electronic health record. Main outcomes were changes in child BMI z-scores, BMI as a percentage relative to the 95th percentile, and BMI as a difference relative to the 95th percentile at the end of treatment and 6-month follow-up for each group. Results: Groups 1 and 2 showed significant decreases in weight status over time, with Group 1 showing the greatest decrease. Groups 3 and 4 remained relatively stable. Changes in weight status in Groups 2, 3, and 4 were significantly different from Group 1 at post-treatment. Conclusions: While structured weight management programs have a significant impact on weight status, those who received some counseling by their PCP did not show significant increases in weight status and were relatively weight stable. Efforts should be broadened to support PCPs as they provide weight management counseling in the office.

Adolescence is a period of development particularly vulnerable to the effects of alcohol use, with recent studies underscoring alcohol's effects on adolescent brain development. Despite the alarming rates and consequences of adolescent alcohol use, gifted adolescents are often overlooked as being at risk for early alcohol use. Although gifted adolescents may possess protective factors that likely inhibit the use of alcohol, some gifted youth may be vulnerable to initiating alcohol use during adolescence as experimenting with alcohol may be one way gifted youth choose to compensate for the social price (whether real or perceived) of their academic talents. To address the dearth of research on alcohol use among gifted adolescents the current study (a) examined the extent to which gifted adolescents use alcohol relative to their nongifted peers and (b) examined the adjustment profile of gifted adolescents who had tried alcohol relative to nongifted adolescents who tried alcohol as well as gifted and nongifted abstainers. More than 300 students in seventh grade (42.5% gifted) participated in the present study. Results indicated gifted students have, in fact, tried alcohol at rates that do not differ from nongifted students. Although trying alcohol was generally associated with negative adjustment, giftedness served as a moderating factor such that gifted students who had tried alcohol were less at risk than their nongifted peers. However, evidence also suggests that gifted adolescents who tried alcohol may be a part of a peer context that promotes substance use, which may place these youth at risk for adjustment difficulties in the future.