***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: The behavioral processes of weight reduction are poorly understood , and responses to treatments based primarily on caloric restriction have been unfavorable . A theory-based path derived from proposed relations of physical activity , changes in psychological factors , and weight loss was separately tested with women with Class I and Class II obesity ( body mass index [ BMI ] from 30 to 39.9 kg/m2 ; n = 116 ) , and Class III ( BMI ≥ 40.0 kg/m2 ; n = 57 ) obesity . Participation in a cognitive-behavioral exercise support treatment along with nutrition education was significantly associated with changes in measures of self-efficacy , body satisfaction , and mood . Changes did not significantly differ by BMI group . Multiple regression analyses indicated that changes in the psychological factors explained 14 % ( Class I/II obesity group ) and 22 % ( Class III obesity group ) of the variance in exercise session attendance , and attendance was strongly related to weight loss . Implication s for weight loss theory and treatment are discussed Background Despite a growing literature on the efficacy of behavioral weight loss interventions , we still know relatively little about the long terms effects they have on HRQL . Therefore , we conducted a study to investigate the immediate post-intervention ( 6 months ) and long-term ( 12 and 24 months ) effects of clinical ly based weight management programs on HRQL . Methods We conducted a r and omized clinical trial in which all participants completed a 6 month clinical weight loss program  and were r and omized into two 6-month extended care groups . Participants then returned at 12 and 24 months for follow-up assessment s. A total of 144 individuals ( 78 % women , M age = 50.2 ( 9.2 ) yrs , M BMI = 32.5 ( 3.8 ) kg/m2 ) completed the 6 month intervention and 104 returned at 24 months . Primary outcomes of weight and HRQL using the SF-36 were analyzed using multivariate repeated measures analyses . Results There was complete data on 91 participants through the 24 months of the study . At baseline the participants scored lower than U.S. age-specific population norms for bodily pain , vitality , and mental health . At the completion of the 6 month clinical intervention there were increases in the physical and mental composite measures as well as physical functioning , general health , vitality , and mental health subscales of the SF-36 . Despite some weight regain , the improvements in the mental composite scale as well as the physical functioning , vitality , and mental health subscales were maintained at 24 months . There were no significant main effects or interactions by extended care treatment group or weight loss group ( whether or not they maintained 5 % loss at 24 months ) . Conclusion A clinical weight management program focused on behavior change was successful in improving several factors of HRQL at the completion of the program and many of those improvements were maintained at 24 months . Maintaining a significant weight loss ( > 5 % ) was not necessary to have and maintain improvements in HRQL Background Although lifestyle interventions targeting multiple lifestyle behaviors are more effective in preventing unhealthy weight gain and chronic diseases than intervening on a single behavior , few studies have compared individual and combined effects of diet and /or exercise interventions on health-related quality of life ( HRQOL ) . In addition , the mechanisms of how these lifestyle interventions affect HRQOL are unknown . The primary aim of this study was to examine the individual and combined effects of dietary weight loss and /or exercise interventions on HRQOL and psychosocial factors ( depression , anxiety , stress , social support ) . The secondary aim was to investigate predictors of changes in HRQOL . Methods This study was a r and omized controlled trial . Overweight/obese postmenopausal women were r and omly assigned to 12 months of dietary weight loss ( n = 118 ) , moderate-to-vigorous aerobic exercise ( 225 minutes/week , n = 117 ) , combined diet and exercise ( n = 117 ) , or control ( n = 87 ) . Demographic , health and anthropometric information , aerobic fitness , HRQOL ( SF-36 ) , stress ( Perceived Stress Scale ) , depression [ Brief Symptom Inventory (BSI)-18 ] , anxiety ( BSI-18 ) and social support ( Medical Outcome Study Social Support Survey ) were assessed at baseline and 12 months . The 12-month changes in HRQOL and psychosocial factors were compared using analysis of covariance , adjusting for baseline scores . Multiple regression was used to assess predictors of changes in HRQOL . Results Twelve-month changes in HRQOL and psychosocial factors differed by intervention group . The combined diet + exercise group improved 4 aspects of HRQOL ( physical functioning , role-physical , vitality , and mental health ) , and stress ( p ≤ 0.01 vs. controls ) . The diet group increased vitality score ( p < 0.01 vs. control ) , while HRQOL did not change differently in the exercise group compared with controls . However , regardless of intervention group , weight loss predicted increased physical functioning , role-physical , vitality , and mental health , while increased aerobic fitness predicted improved physical functioning . Positive changes in depression , stress , and social support were independently associated with increased HRQOL , after adjusting for changes in weight and aerobic fitness . Conclusions A combined diet and exercise intervention has positive effects on HRQOL and psychological health , which may be greater than that from exercise or diet alone . Improvements in weight , aerobic fitness and psychosocial factors may mediate intervention effects on HRQOL.Trial Registration Clinical Trials , Clinical Trials.gov register , To examine the effect of treatment-induced weight loss on Health-Related Quality of Life ( HRQL )  , 38 mildly-to-moderately overweight persons recruited to participate in a study to examine the efficacy of a lifestyle modification treatment program  completed a sociodemographic question naire , the Beck Depression Inventory ( BDI ) , the Medical Outcomes Study Short-Form Health Survey ( SF-36 , as an assessment of HRQL ) , and underwent a series of clinical evaluations prior to treatment . After baseline evaluations , participants were r and omly assigned to either a program of lifestyle physical activity or a program of traditional aerobic activity . Participants again completed the SF-36 and BDI after the 13-week treatment program had ended . Weight loss averaged 8.6 ± 2.8 kg over the 13-week study . We found that weight loss was associated with significantly higher scores ( enhanced HRQL ) , relative to baseline , on the physical functioning , role-physical , general health , vitality and mental health domains of the SF-36 . The largest improvements were with respect to the vitality , general health perception and role-physical domains . There were no significant differences between the lifestyle and aerobic activity groups on any of the study measures . These data indicate that , at least in the short-term , weight loss appears to profoundly enhance HRQL Abstract The aim of this study was to examine the effects of the addition of a resistance training programme to a caloric restriction weight loss intervention on psychosocial profile . The study sample consisted of 137 overweight and obese post-menopausal women . Participants were r and omized to a caloric restriction group and caloric restriction + resistance training group .  Psychosocial , anthropometric , and metabolic variables were measured before and after the 6-month weight loss intervention . Both groups presented similar weight loss and there were no significant differences between the caloric restriction group and caloric restriction + resistance training group for changes in psychosocial profile . Thereafter , all participants were classified into quintiles based on the amount of weight loss . In all quintiles , women markedly improved body esteem and self-esteem , and decreased hunger and perceived risk for diabetes mellitus ( P < 0.05 ) . However , significant increases in dietary restraint were observed in quintiles 2–5 ( ≥2.4 % body weight loss ) , decreases in disinhibition in quintiles 3–5 ( ≥4.9 % ) , increases in self-efficacy in quintiles 3–5 ( ≥4.9 % ) , and increases in health perceptions in quintile 5 ( ≥11.1 % ) . The results of this study do not support the hypothesis that the addition of a resistance training programme to a caloric restriction weight loss intervention has additional benefits on psychosocial profile . Overall , the significant improvements in the psychosocial profile observed were mostly accounted for by the degree of weight loss Weight loss improves health-related quality of life ( HRQoL ) . However , regain after loss is common ; little is known about the impact of weight regain on HRQoL in postmenopausal women . Woman on the Move through Activity and Nutrition ( WOMAN ) is a r and omized lifestyle intervention trial of diet , physical activity , and weight loss  in 508 postmenopausal women aged 52 - 62 years . This analysis focused on the women who lost > or = 5 lb during the initial phase of the study , baseline to 6 months ( n = 248 ) . This cohort was divided into three groups based on subsequent weight change between 6 and 18 months : weight loss ( WL ; > or = 5 lb loss ) , weight stable ( WS ; < + /-5 lb change ) , and weight regain ( WR ; > or = 5 lb gain ) . HRQoL was measured at baseline , 6 , and 18 months using the Short Form-36 . Of the 248 women studied , 51 ( 21 % ) continued to lose weight after initial weight loss , while 127 ( 51 % ) maintained a stable weight , and 70 ( 28 % ) regained weight . Between baseline and 6 months , women in WR group had decreased mental health and social-functioning scores , while the WL and WS groups improved in these subscales . Between baseline and 18 months , energy improved most significantly in those with continued weight loss ( P = 0.0003 ) . Weight loss was correlated with a small to moderate improvement in perceived general health and energy , which was reversed by weight gain . Further study is needed to investigate the impact of a decline in mental health and social functioning on future weight regain Objectives To provide information on the frequency and reasons for outcome reporting bias in clinical trials . Design Trial protocol s were compared with subsequent publication(s ) to identify any discrepancies in the outcomes reported , and telephone interviews were conducted with the respective trialists to investigate more extensively the reporting of the research and the issue of unreported outcomes . Participants Chief investigators , or lead or co authors of trials , were identified from two sources : trials published since 2002 covered in Cochrane systematic review s where at least one trial analysed was suspected of being at risk of outcome reporting bias ( issue 4 , 2006 ; issue 1 , 2007 , and issue 2 , 2007 of the Cochrane library ) ; and a r and om sample of trial reports indexed on PubMed between August 2007 and July 2008 . Setting Australia , Canada , Germany , the Netherl and s , New Zeal and , the United Kingdom , and the United States . Main outcome measures Frequency of incomplete outcome reporting — signified by outcomes that were specified in a trial ’s protocol but not fully reported in subsequent publications— and trialists ’ reasons for incomplete reporting of outcomes . Results 268 trials were identified for inclusion ( 183 from the cohort of Cochrane systematic review s and 85 from PubMed ) . Initially , 161 respective investigators responded to our requests for interview , 130 ( 81 % ) of whom agreed to be interviewed . However , failure to achieve subsequent contact , obtain a copy of the study protocol , or both meant that final interviews were conducted with 59 ( 37 % ) of the 161 trialists . Sixteen trial investigators failed to report analysed outcomes at the time of the primary publication , 17 trialists collected outcome data that were subsequently not analysed , and five trialists did not measure a prespecified outcome over the course of the trial . In almost all trials in which prespecified outcomes had been analysed but not reported ( 15/16 , 94 % ) , this under-reporting result ed in bias . In nearly a quarter of trials in which prespecified outcomes had been measured but not analysed ( 4/17 , 24 % ) , the “ direction ” of the main findings influenced the investigators ’ decision not to analyse the remaining data collected . In 14 ( 67 % ) of the 21 r and omly selected PubMed trials , there was at least one unreported efficacy or harm outcome . More than a quarter ( 6/21 , 29 % ) of these trials were found to have displayed outcome reporting bias . Conclusion The prevalence of incomplete outcome reporting is high . Trialists seemed generally unaware of the implication s for the evidence base of not reporting all outcomes and protocol changes . A general lack of consensus regarding the choice of outcomes in particular clinical setting s was evident and affects trial design , conduct , analysis , and reporting Long-term behavioral self-regulation is the hallmark of successful weight control . We tested mediators of weight loss and weight loss maintenance in middle-aged women who participated in a r and omized controlled 12-month weight management intervention . Overweight and obese women ( N = 225 , BMI = 31.3 + /- 4.1 kg/m(2 ) ) were r and omly assigned to a control or a 1-year group intervention design ed to promote autonomous self-regulation of body weight . Key exercise , eating behavior , and body image variables were assessed before and after the program , and tested as mediators of weight loss ( 12 months , 86 % retention ) and weight loss maintenance ( 24 months , 81 % retention ) . Multiple mediation was employed and an intention-to-treat analysis conducted . Treatment effects were observed for all putative mediators ( Effect size : 0.32 - 0.79 , P < 0.01 vs. controls ) . Weight change was -7.3 + /- 5.9 % ( 12-month ) and -5.5 + /- 5 
    Output:
    
The results demonstrated consistent improvements in psychological outcomes concurrent with and sometimes without weight loss .
Improvements in body image and HRQoL ( especially vitality ) were closely related to changes in weight .