Our study has several limitations. First, it is limited by our inability to achieve our predetermined power. Recruitment for this study was terminated secondary to the time restrictions involved with completing a resident research project. Second, we cannot exclude a potential Hawthorne effect. Participants selected for a study in which they are counseled on weight gain, nutrition, and exercise are more likely to pay specific attention to these factors in their life and modify behaviors accordingly. This could be viewed as a positive effect that universal counseling would bring out in all of our patients. A third limitation is the potential for the healthy volunteer bias. People who are healthier in general tend to volunteer for research studies. Finally, we were unable to control strictly the content of the counseling that actually took place at each clinic visit.