***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed . METHODS We r and omly assigned 132 severely obese subjects ( including 77 blacks and 23 women ) with a mean body-mass index of 43 and a high prevalence of diabetes ( 39 percent ) or the metabolic syndrome ( 43 percent ) to a carbohydrate-restricted ( low-carbohydrate ) diet or  a calorie- and fat-restricted ( low-fat ) diet . RESULTS Seventy-nine subjects completed the six-month study . An analysis including all subjects , with the last observation carried forward for those who dropped out , showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet ( mean [ + /-SD ] , -5.8+/-8.6 kg vs. -1.9+/-4.2 kg ; P=0.002 ) and had greater decreases in triglyceride levels ( mean , -20+/-43 percent vs. -4+/-31 percent ; P=0.001 ) , irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications . Insulin sensitivity , measured only in subjects without diabetes , also improved more among subjects on the low-carbohydrate diet ( 6+/-9 percent vs. -3+/-8 percent , P=0.01 ) . The amount of weight lost ( P<0.001 ) and assignment to the low-carbohydrate diet ( P=0.01 ) were independent predictors of improvement in triglyceride levels and insulin sensitivity . CONCLUSIONS Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet , with a relative improvement in insulin sensitivity and triglyceride levels , even after adjustment for the amount of weight lost . This finding should be interpreted with caution , given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study . Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed BACKGROUND Effective clinical weight management  approaches are needed to reach African-Americans . METHODS African-Americans recruited through outpatient practice s for a culturally-adapted Healthy Eating and Lifestyle Program were offered 10 weekly weight loss classes ( Phase 1 ) with the option of continuing for another 8 - 18 months ( Phase 2 ) in a r and omized comparison of further group counseling or staff-facilitated self-help vs. follow-up clinic visits only . RESULTS Of 237 enrollees ( 91 % women ; mean age 43.5 years ; mean body mass index 38.0 kg/m(2 ) ) , 70 [ corrected ] attended no classes or only the first Phase 1 class , 134 provided Phase 1 follow-up data , 128 were r and omized in Phase 2 , and 87 provided final follow-up data ( " completers " ) . Mean weight changes for completers were : -1.5 ( P < 0.001 ) , + 0.3 ( P = 0.47 ) , and -1.2 ( P = 0.04 ) kg , respectively , for Phase 1 , Phase 2 , and overall ( baseline to final visit ; average 18 months total duration ) , with no Phase 2 treatment effect ( P = 0.55 ) . Final study weight was > or = 5 % below baseline for 25 % of completers and was strongly predicted by Phase 1 weight loss . CONCLUSIONS Weight loss achieved in Phase 1 was maintained even with relatively minimal follow-up contact . Increasing the percent who achieve clinical ly significant weight loss initially would improve long-term results OBJECTIVE This study tested the efficacy of an 8-week culturally targeted nutrition and physical activity intervention on body composition . METHODS A r and omized , attention-controlled , two-group trial was conducted in a blackowned commercial gym with a sample of 366 predominantly healthy , obese African American women . A free 1-year membership to the study site gym was provided to participants in both groups . Data were collected at baseline , 2 , 6 , and 12 months . RESULTS Sample retention at 1 year was 71 % . Between-group longitudinal analysis including only participants with complete data revealed a trend toward weight stability in the intervention group at 2 months compared with controls ( + 0.05 kg/m(2 ) , p = 0.75 ; + 0.32 kg/m(2 ) , p = 0.08 , respectively ) , disappearing at 12 months ( + 1.37 kg/m(2 ) , p = 0.0001 ; + 1.02 kg/m(2 ) , p = 0.001 , respectively ) . Within-group analysis demonstrated that intervention and control participants ' fitness ( 1-mile run-walk ) improved by 1.9 minutes ( p = 0.0001 ) and 2.3 minutes ( p = 0.0001 ) , respectively , at 12 months . Mixed model regression analyses demonstrated a significant main effect of the intervention on fitness ( p = 0.0185 ) and a marginally significant effect on body mass index ( BMI ) ( p = 0.057 ) , at 2 months , disappearing by 6 months . By 12 months , however , the controls exhibited a significant advantage in waist circumference stability compared with intervention participants ( + 1.1 cm , p = 0.2763 ; + 2.1 cm , p = 0.0002 , respectively ) . CONCLUSIONS The intervention produced modest short-term improvements in body composition , but the economic incentive of a free 1-year gym membership provided to all participants was a more potent intervention than the education and social support intervention tested . However , longer-term fitness enhancement remains elusive and dem and s research and policy attention . These findings have policy implication s in that employer-/insurer-subsidized gym memberships may require interventions targeting other levels of change ( e.g. , physical or social/environmental ) to foster sustainable fitness improvements A continuing challenge in weight loss treatment is attaining maintenance of weight loss . The goal of this study was to develop a counseling method that would assist African American breast cancer survivors with weight loss maintenance . In this pilot study , 31 obese breast cancer survivors were recruited .  Individualized , dietitian-led counseling by telephone and free Weight Watchers coupons were provided to all participants for 18 months . At the 6-month time point , women were r and omized to receive spirituality counseling or not in addition to the st and ard program . The spirituality counseling was delivered via telephone using an 8-step framework . Subjects were asked to utilize  daily meditation or prayer , daily readings  , and the recording of thoughts in a journal . Mean weight loss from baseline to 6 months was a modest 2.0 % of baseline weight . From 6 to 18 months , there was no further weight change in the spirituality arm and a gain of 0.7 % in the dietitian-only arm . Despite little effect on weight loss , it did appear that spirituality counseling positively affected spiritual well-being ( FACIT-Sp ) scores and dietary quality . The spirituality counseling framework therefore may be further refined and useful for other health promotion studies with African American population BACKGROUND Few studies have examined the weight-control practice s that promote weight loss and weight-loss maintenance in the same sample . PURPOSE To examine whether the weight control practice s associated with weight loss differ from those associated with weight-loss maintenance . METHODS Cross-sectional survey of a r and om sample of 1165 U.S. adults . The adjusted associations of the use of 36 weight-control practice s in the past week with success in weight loss ( ≥10 % lost in the past year ) and success in weight-loss maintenance ( ≥10 % lost and maintained for ≥1 year ) were examined . RESULTS Of the 36 practice s , only 8 ( 22 % ) were associated with both weight loss and weight-loss maintenance . Overall , there was poor agreement ( kappa=0.22 ) between the practice s associated with weight loss and /or weight-loss maintenance . For example , those who reported more often following a consistent exercise routine or eating plenty of low-fat sources of protein were 1.97 ( 95 % CI=1.33 , 2.94 ) and 1.76 ( 95 % CI=1.25 , 2.50 ) times more likely , respectively , to report weight-loss maintenance but not weight loss . Alternatively , those who reported more often doing different kinds of exercises or planning meals ahead of time were 2.56 ( 95 % CI=1.44 , 4.55 ) and 1.68 ( 95 % CI=1.03 , 2.74 ) times more likely , respectively , to report weight loss but not weight-loss maintenance . CONCLUSIONS Successful weight loss and weight-loss maintenance may require two different sets of practice s. Design ing interventions with this premise may inform the design of more effective weight-loss maintenance interventions OBJECTIVE The current study examined ethnic differences in patterns of weight loss and regain in response to an initial behavioral weight loss intervention followed by an extended-care maintenance program . METHODS We analyzed data from 224 women ( African American n = 43 , Caucasian n = 181 ) from rural communities who participated in an initial 6-month lifestyle intervention for obesity and were then r and omized to a face-to-face , telephone , or educational/control extended-care condition .  RESULTS African American participants  lost less weight during the initial phase of treatment than Caucasian participants ( mean + /- SE = -6.8 + /-.80 vs -10.7 + /- .38 kg , respectively , P = .003 ) . Investigating weight change during month 6 to month 18 , we found a significant interaction between ethnicity and the provision of an extended-care program . Caucasian participants r and omized to either of two extended-care programs regained less weight than those assigned to the control condition ( 1.2 + /- .58 and 4.2 + /- .79 kg , respectively , P=.003 ) , but the provision of extended care did not influence weight regain among African American participants ( 1.9 + /- 1.12 and 1.34 + /- 2.04 kg , respectively , P = .815 ) . CONCLUSION Collectively , these findings suggest that although African American participants lost less weight during the initial phase of treatment , they exhibited better long-term weight-loss maintenance than Caucasian participants . Further , while the provision of extended care successfully enhanced weight maintenance among Caucasian participants , African American participants maintained their initial weight losses regardless of extended care The Hypertension Prevention Trial ( HPT ) was a r and omized , controlled , multicenter ( four clinics , four re source centers ) trial design ed to test the feasibility of achieving and sustaining dietary changes in the intake of calories , sodium , and potassium and to assess the effect of those changes on blood pressure in a normotensive population . The trial involved 841 men and women ( plus a test cohort of 78 ) who , at the first baseline ( BL ) examination , were in the age range of 25 - 49 years and had diastolic blood pressure ( DBP ) greater than or equal to 76 but less than 100 mm Hg ( average of two readings ) , and at the examination prior to r and omization ( BL 2 ) had DBP greater than or equal to 78 but less than 90 mm Hg ( also averaged ) . Participants were r and omly assigned to a control treatment group ( no dietary counseling ) or to one of four dietary treatment groups involving counseling design ed to reduce calorie intake , reduce sodium intake , reduce sodium and calorie intake , and reduce sodium and increase potassium intake . Dietary counseling was provided primarily in group setting s and was aim ed at changing participants ' shopping , cooking , and eating habits related to a design ated treatment assignment . The effect of dietary counseling was measured through changes in urinary excretion of sodium and potassium , changes in body weight , and changes in reported food intake based on 24-hour food records . Blood pressure changes during the 3-year course of followup were based on measurements taken at 6-month intervals from enrollment using a r and om-zero sphygmomanometer . This chapter provides a general description of the design and methods of the HPT and the underlying rationale for decisions affecting the design Objective : Maintaining weight loss is a major challenge in obesity treatment . Individuals often indicate that waning motivation prompts cessation of effective weight management behaviors . Therefore , a novel weight loss maintenance program that specifically targets motivational factors was evaluated . Design : Overweight women ( N=338 ; 19 % African American ) with urinary incontinence were r and omized to lifestyle obesity treatment or control and followed for 18 months . All participants in lifestyle ( N=226 ) received the same initial 6-month group behavioral obesity treatment and were then r and omized to ( 1 ) a novel motivation-focused maintenance program ( N=113 ) or ( 2 ) a st and ard skill-based maintenance approach (N=113).Main Outcome Measure : Weight assessed at baseline , 6 and 18 months . Results : Both treatment groups ( motivation-focused and skill-based ) achieved comparable 18-month weight losses ( −5.48 % for motivation-focused vs −5.55 % in skill-based , P=0.98 ) , and both groups lost significantly more than controls ( −1.51 % ; 
    Output:
    
The majority of studies failed to describe the specific strategies used in the delivery of the maintenance intervention , adherence to those strategies , and did not incorporate a maintenance phase process evaluation making it difficult to identify intervention characteristics associated with better weight loss maintenance .
However , the inclusion of cultural adaptations , particularly in studies with a mixed ethnicity/race sample , result ed in less % weight regain for African American women .
Studies with a formal maintenance intervention and weight management as the primary intervention focus reported more positive weight maintenance outcomes for African American women .
Nonetheless , our results present both the difficulty in weight loss and maintenance experienced by African American women in behavioral lifestyle interventions