***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 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 This article reports the results of two studies evaluating strategies to improve maintenance of weight loss . Study 1 evaluated the effect of frequent contact with patients through phone calls design ed to promote adherence to self-monitoring ; Study 2 evaluated a crisis intervention model , where subjects could obtain food boxes during high-risk periods to simplify dietary adherence . All subjects had originally participated in an initial six-month behavioral weight control program conducted at the University of Minnesota or at the University of Pittsburgh and had lost > 4.0 kg . Subjects from the University of Minnesota ( N=53 ) were r and omly assigned to either a year-long maintenance program involving weekly phone calls from a staff member or to a no-contact control ( Study 1 ) . Weekly phone calls , which inquired about self-monitoring and current weight , were completed with high frequency ( 76 % completion rate ) ; call completion and self-reported adherence to daily monitoring were negatively associated with weight regain ( r=−0.52 to −0.59 , p<.01 ) . However , weight regain did not differ significantly in the Phone Maintenance versus Control Condition ( + 3.9 kg versus + 5.6 kg , p=.28 ) . Study 2 , conducted at the University of Pittsburgh , involved 47 subjects who were r and omly assigned to a Control or Optional Food Provision Condition . Both groups attended monthly maintenance meetings ; the Food Provision Group had the option of purchasing boxes of food containing five breakfasts and five dinners . Twelve of the 26 subjects in the Food Provision Group purchased these food boxes for at least one month of maintenance . However , weight regain in those people who purchased the box , or in the Food Provision Condition as a whole , did not differ from the Control Condition ( + 4.2 kg for intervention versus + 4.3 kg for control ) . Further research is needed to develop more effective 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 BACKGROUND Since many successful dieters regain the weight they lose , programs that teach maintenance skills are needed . We developed a maintenance program based on self-regulation theory and tested the efficacy of delivering the program face to face or over the Internet . METHODS We r and omly assigned 314 participants who had lost a mean of 19.3 kg of body weight in the previous 2 years to one of three groups : a control group , which received quarterly newsletters ( 105 participants ) , a group that received face-to-face intervention ( 105 ) , and a group that received Internet-based intervention ( 104 ) . The content of the programs in the two intervention groups was the same , emphasizing daily self-weighing and self-regulation , as was the frequency of contact with the groups . The primary outcome was weight gain over a period of 18 months . RESULTS The mean ( + /-SD ) weight gain was 2.5+/-6.7 kg in the face-to-face group , 4.7+/-8.6 kg in the Internet group , and 4.9+/-6.5 kg in the control group , with a significant difference between the face-to-face group and the control group ( 2.4 kg ; 95 % confidence interval [ CI ] , 0.002 to 10.8 ; P=0.05 ) . The proportion of participants who regained 2.3 kg or more over the 18-month period was significantly higher in the control group ( 72.4 % ) than in the face-to-face group ( 45.7 % ; absolute difference , 27 % ; 95 % CI , 14 to 39 ; P<0.001 ) or the Internet group ( 54.8 % ; absolute difference , 18 % ; 95 % CI , 5 to 30 ; P=0.008 ) . Daily self-weighing increased in both intervention groups and was associated with a decreased risk of regaining 2.3 kg or more ( P<0.001 ) . CONCLUSIONS As compared with receiving quarterly newsletters , a self-regulation program based on daily weighing improved maintenance of weight loss , particularly when delivered face to face . ( Clinical Trials.gov number , NCT00067145 [ Clinical Trials.gov ] . The present study compared the relative effectiveness of a therapist-supported maintenance condition with a minimal contact maintenance condition in preventing relapse following an obesity treatment program . Thirty-two subjects who completed an initial 12-week cognitive/behavioral plus aerobic exercise treatment program  were matched on absolute weight loss and r and omly assigned to one of two maintenance conditions . Subjects were assessed at pretreatment , posttreatment , and 3 , 6 , and 12 months following posttreatment using measures of weight , blood pressure , and depression . Three- and six-month follow-up results indicated that subjects who participated in the therapist-supported maintenance group continued to lose weight and /or maintained therapy-induced weight loss to a greater degree than control subjects . At the 12-month follow-up assessment therapist-supported subjects maintained therapy-induced weight loss better than the control subjects . These findings suggest that maintenance programs which provide continued contact emphasizing relapse prevention training may be an important adjunct in the maintenance of therapy-induced weight loss OBJECTIVE —The effectiveness of intentional weight loss in reducing cardiovascular disease ( CVD ) events in type 2 diabetes is unknown . This report describes 1-year changes in CVD risk factors in a trial design ed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events . RESEARCH DESIGN AND METHODS —This study consisted of a multicentered , r and omized , controlled trial of 5,145 individuals with type 2 diabetes , aged 45–74 years , with BMI > 25 kg/m2 ( > 27 kg/m2 if taking insulin ) . An intensive lifestyle intervention ( ILI ) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education ( DSE ) condition . RESULTS — Participants assigned to ILI lost an average 8.6 % of their initial weight vs. 0.7 % in DSE group ( P < 0.001 ) . Mean fitness increased in ILI by 20.9 vs. 5.8 % in DSE ( P < 0.001 ) . A greater proportion of ILI participants had reductions in diabetes , hypertension , and lipid-lowering medicines . Mean A1C dropped from 7.3 to 6.6 % in ILI ( P < 0.001 ) vs. from 7.3 to 7.2 % in DSE . Systolic and diastolic pressure , triglycerides , HDL cholesterol , and urine albumin-to-creatinine ratio improved significantly more in ILI than DSE participants ( all P < 0.01 ) . CONCLUSIONS —At 1 year , ILI result ed in clinical ly significant weight loss in people with type 2 diabetes . This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE . Continued intervention and follow-up will determine whether these changes are maintained and will reduce CVD risk This study compared 2 extended therapy programs for weight management with st and ard behavioral treatment ( BT ) without additional therapy contacts . Participants were 80 obese women who completed 20 weekly group sessions of BT and achieved a mean initial weight loss of 8.74 kg . Participants were r and omly assigned to a no-further-contact condition ( BT only ) or to one of two extended interventions consisting of relapse prevention training ( RPT ) or problem-solving therapy ( PST ) . No significant overall weight-change differences were observed between RPT and BT or between RPT and PST . However , participants who completed the PST intervention had significantly greater long-term weight reductions than BT participants , and a significantly larger percentage of PST participants achieved clinical ly significant losses of 10 % or more in body weight than did BT participants ( 35 % vs. 6 % ) OBJECTIVE This study assessed whether a 5 % to 10 % reduction in initial weight would be associated with as favorable long-term ( i.e. , 100 weeks ) changes in lipids and lipoproteins , as have been observed on a short-term basis ( i.e. , 8 weeks ) . RESEARCH METHODS AND PROCEDURES This was a prospect i ve evaluation of 25 obese women , each of whom had lost > or = 5 % of initial weight during 48 weeks of treatment and had maintained a weight loss of this magnitude at 1-year follow-up ( week 100 ) .  Lipids and lipoproteins  were obtained at baseline and at weeks 8 , 24 , 48 , and 100 . All participants had a baseline total cholesterol > or = 5.17 mmol/L ( 200 mg/dL ) . RESULTS At the end of the first 8 weeks , weight fell an average of 11.7+/-2.8 % , total cholesterol 20.6+/-7.5 % , low-density-lipoprotein ( LDL ) cholesterol 23.0+/-18.1 % , and triglycerides 26.0+/-20.1 % . At week 48 , weight had fallen to 20.1+/-7.0 % below baseline , but total cholesterol and LDL cholesterol were reduced only 11.5+/-10.4 % and 12.0+/-14.0 % below baseline , respectively . These latter reductions were significantly ( p<0.05 ) smaller than those observed at week 8 , despite the larger weight loss at week 48 . High-density-lipoprotein cholesterol declined significantly ( p<0.05 ) during the first 8 weeks , but returned to baseline values by week 24 . Patients gained 7.4+/-7.4 kg from weeks 48 to 100 , during which time total and LDL cholesterol ( but not triglycerides ) rose significantly ( p<0.05 ) . Patients who , at week 100 , maintained losses > 10 % of initial weight had significantly greater reductions in total and LDL cholesterol values than did patients who maintained losses of only 5 % to 10 % of initial weight . DISCUSSION Results of this study underscore the importance of assessing long-term changes in weight-related health complications when patients have lost weight but are no longer dieting ( and exercising ) as aggressively as they did during the initial months of treatment OBJECTIVE To investigate the efficacy of an Internet weight maintenance program . RESEARCH METHODS AND PROCEDURES Two hundred fifty-five healthy overweight and obese adults ( mean + /- SD BMI , 31.8 + /- 4.1 kg/m(2 ) ) men ( 18 % ; mean + /- SD age , 4 
    Output:
    
These findings suggest that extended care is a viable and efficacious solution to addressing long-term maintenance of lost weight .