***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 General health promoting campaigns are often not targeted at the people who need them the most . Web- and app-based tools are a new way to reach , motivate , and help people with poor health status . Objective The aim of our study was to test a Web- and mobile app-based tool ( “ SoSu-life ” ) on employees in the social welfare and health care sector in Denmark . Methods A r and omized controlled trial was carried out as a workplace intervention . The tool was design ed to help users make healthy lifestyle changes such as losing weight , exercise more , and quit smoking . A team competition between the participating workplaces took place during the first 16 weeks of the intervention . Twenty nursing homes for elderly people in 6 municipalities in Denmark participated in the study . The employees at the nursing homes were r and omized either 1:1 or 2:1 on a municipality level to use the SoSu-life tool or to serve as a control group with no intervention . All participants underwent baseline measurements including body weight , waist circumference , body fat percentage , blood pressure , and blood cholesterol level and they filled in a question naire covering various aspects of health . The participants were measured again after 16 and 38 weeks . Results A total of 566 ( SoSu-life : n=355 , control : n=211 ) participants were included in the study . At 16 weeks there were 369 participants still in the study ( SoSu-life : n=227 , control : n=142 ) and 269 participants completed the 38 week intervention ( SoSu-life : n=152 , control : n=117 ) . At 38 weeks , the SoSu-life group had a larger decrease in body weight ( −1.01 kg , P=.03 ) , body fat percentage ( −0.8 % , P=.03 ) , and waist circumference ( −1.8 cm , P=.007 ) compared with the control group . Conclusions The SoSu-life Web- and app-based tool had a modest yet beneficial effect on body weight and body fat percentage in the health care sector staff . Trial Registration Clinical trials.gov NCT02438059 ; http:// clinical trials.gov/ct2/show/NCT02438059 ( Archived by WebCite at http://www.webcitation.org/6i6y4p2AS OBJECTIVE The Diabetes Prevention Program demonstrated the ability to delay or prevent type 2 diabetes in participants with impaired glucose tolerance ( IGT ) . Participants with IGT are at high risk for cardiovascular disease ( CVD ) , with a marked increase in the number and severity of CVD risk factors . We prospect ively assessed the impact of our interventions on hypertension , dyslipidemia , and CVD events . RESEARCH DESIGN AND METHODS The study group consisted of 3,234 individuals with IGT r and omly assigned to receive intensive lifestyle intervention , metformin , or placebo . Annual assessment of blood pressure , lipids , electrocardiogram , and CVD events was undertaken . RESULTS Hypertension was present in 30 % of participants at study entry and then increased in the placebo and metformin groups , although it significantly decreased with intensive lifestyle intervention . Triglyceride levels fell in all treatment groups , but fell significantly more with intensive lifestyle intervention . Total cholesterol and LDL cholesterol levels were similar among treatment groups . Intensive lifestyle intervention significantly increased the HDL cholesterol level and reduced the cumulative incidence of the proatherogenic LDL phenotype B. At 3 years of follow-up , the use for pharmacologic therapy to achieve established goals in the intensive lifestyle group was 27 - 28 % less for hypertension and 25 % less for hyperlipidemia compared with placebo and metformin groups . Over an average of 3 years , 89 CVD events from 64 participants were positively adjudicated study wide , with no differences among treatment groups . CONCLUSIONS Lifestyle intervention improves CVD risk factor status compared with placebo and metformin therapy . Although no differences in CVD events were noted after 3 years , achieved risk factor modifications suggest that longer intervention may reduce CVD event rates BACKGROUND The prevalence of male obesity is increasing but few men take part in weight loss programmes . We assessed the effect of a weight loss and healthy living programme on weight loss in football ( soccer ) fans . METHODS We did a two-group , pragmatic , r and omised controlled trial of 747 male football fans aged 35 - 65 years with a body-mass index ( BMI ) of 28 kg/m(2 ) or higher from 13 Scottish professional football clubs . Participants were r and omly assigned with SAS ( version 9·2 , block size 2 - 9 ) in a 1:1 ratio , stratified by club , to a weight loss programme delivered by community coaching staff in 12 sessions held every week . The intervention group started a weight loss programme within 3 weeks , and the comparison group were put on a 12 month waiting list . All participants received a weight management booklet . Primary outcome was mean difference in weight loss between groups at 12 months , expressed as absolute weight and a percentage of their baseline weight . Primary outcome assessment was masked . Analyses were based on intention to treat . The trial is registered with Current Controlled Trials , number IS RCT N32677491 . FINDINGS 374 men were allocated to the intervention group and 374 to the comparison group . 333 ( 89 % ) of the intervention group and 355 ( 95 % ) of the comparison group completed 12 month assessment s. At 12 months the mean difference in weight loss between groups , adjusted for baseline weight and club , was 4·94 kg ( 95 % CI 3·95 - 5·94 ) and percentage weight loss , similarly adjusted , was 4·36 % ( 3·64 - 5·08 ) , both in favour of the intervention ( p<0·0001 ) . Eight serious adverse events were reported , five in the intervention group ( lost consciousness due to drugs for pre-existing angina , gallbladder removal , hospital admission with suspected heart attack , ruptured gut , and ruptured Achilles tendon ) and three in the comparison group ( transient ischaemic attack , and two deaths ) . Of these , two adverse events were reported as related to participation in the programme ( gallbladder removal and ruptured Achilles tendon ) . INTERPRETATION The FFIT programme can help a large proportion of men to lose a clinical ly important amount of weight ; it offers one effective strategy to challenge male obesity . FUNDING Scottish Government and The UK Football Pools funded delivery of the programme through a grant to the Scottish Premier League Trust . The National Institute for Health Research Public Health Research Programme funded the assessment ( 09/3010/06 ) To investigate the impact which commitment has on the achievement of behavioral-change goals in a weight control program , a behavioral contracting process was used . One- hundred six adult volunteers were r and omly identified as treatment or control group members and co- participated in a four-week , eight-hour , behavioral self-management weight control program . As part of homework assignments , all participants were provided with three take-home contracts which were to be returned either signed by the participant only ( control group with baseline commit ment ) or by the participant and at least one friend , relative , or peer(treatment group with enhanced commitment ) . Analyses of comparable treatment and control group members shows the treatment group holding significantly stronger behavioral intentions 10 to 15 weeks after the program ended and losing weight at a significantly faster rate . Implication s for program plan ning , implementation , and evaluation are discussed This study assessed the efficacy of a comprehensive behavioral health program design ed to promote self-initiated change in overweight healthy middle-aged adults ( M=49 years ) . Three treatment groupss ( total n=25 ) differing in type of social support provided ( i.e. ,  group plus professional versus group plus peer versus group only )  received 13 treatment sessions and 6 maintenance sessions scheduled over a full year . A self-directed change intervention taught several cognitive-behavioral techniques as they applied to exercise adherence , weight reduction/maintenance , and stress management . Combined treatment groups ( n=25 ) improved significantly more than an assessment only control group ( n=9 ) in weight , percentage body fat , cardiovascular fitness , exercise adherence , health-risk appraisal , chronic tension ( MBHI , scale A ) , and systolic and diastolic blood pressure at both post-treatment and 6-month follow-up assessment s. Self-motivation , group treatment attendance , and health-risk appraisal significantly related ( r's=.30–.56 ) to several posttreatment and follow-up measures of behavioral health change . No significant differences were found among the three treatment groups on any of the outcome measures Background : Dietary adherence has been implicated as an important factor in the success of dieting strategies ; however , studies assessing and investigating its association with weight loss success are scarce . Objective : We aim ed to document the level of dietary adherence using measured diet data and to examine its association with weight loss success . Design : Secondary analysis was performed using data from 181 free-living overweight/obese women ( mean±s.d . age=43±5 years , body mass index=31±4 kg m−2 ) participating in a 1-year r and omized clinical trial ( the A TO Z study ) comparing popular weight loss diets  ( Atkins , Zone and Ornish ) . Participants ' dietary adherence was assessed as the difference between their respective assigned diet 's recommended macronutrient goals and their self-reported intake . Association between dietary adherence and 12-month weight change was computed using Spearman 's correlations . Differences in baseline characteristics and macronutrient intake between the most and least adherent tertiles for diet groups were compared using t-tests . Results : Within each diet group , adherence score was significantly correlated with 12-month weight change ( Atkins , rs=0.42 , P=0.0003 ; Zone , rs=0.34 , P=0.009 and Ornish , rs=0.38 , P=0.004 ) . Twelve-month weight change in the most vs least adherent tertiles , respectively , was −8.3±5.6 vs −1.9±5.8 kg , P=0.0006 ( Atkins ) ; −3.7±6.3 vs −0.4±6.8 kg , P=0.12 ( Zone ) and −6.5±6.8 vs −1.7±7.9 kg , P=0.06 ( Ornish ) . Conclusions : Regardless of assigned diet groups , 12-month weight change was greater in the most adherent compared to the least adherent tertiles . These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss Two types of goal - setting ( daily vs weekly ) and two levels of spouse involvement ( couples vs individual treatment ) were evaluated in a 19-week behavioral weight-control program .  Forty-seven married Ss with spouses willing to participate were r and omly assigned to one of four treatments : Couples/Weekly Goals , Couples/Daily Goals , Individual/Weekly Goals , Individual/Daily Goals . At posttreatment , Ss had lost an average of 171b and reduced their percent over ideal weight from 49 to 36 % . Losses were maintained at the 6-month clinic follow-up . Weight losses for the two goal - setting conditions and the two spouse treatments did not differ . Improvements were observed in resting pulse , blood pressure and step-test time , and these were maintained at the 6-month follow-up . Adherence to caloric self-monitoring , self-reported exercise adherence and marital satisfaction were significantly correlated with weight loss . Decreases in depression and improvements in body-image satisfaction were also observed . Mail and telephone follow-up at 12 and 30 months posttreatment indicated satisfactory maintenance for the majority of Ss . Factors associated with maintenance and relapse during long-term follow up are discussed Abstract The present study was conducted to determine if husb and attendance at treatment sessions and participation in behavioral contracting would produce greater weight losses than two other levels of spouse involvement . The three treatment groups investigated did not significantly differ at post-treatment but by 1-yr follow-up female S s who attended  treatment sessions alone and contracted with the counselor ( HA )  lost significantly more weight than women who attended sessions with their husb and s and also contracted with the counselor ( HNC ) . The S s who attended sessions with their husb and s and contracted with them ( HC ) did not significantly differ from S s in the other two conditions . The total amount lost by S s in the HA , HNC and HC conditions by 1-yr follow-up was 16.4 , 4.4 and 15.5 lb , respectively . The study was also conducted to collect preliminary data about procedures S s used during long-term follow-up to ascertain if weight losses during follow-up could be attributed to the behavioral weight-loss techniques learned during the treatment program . At all follow-up periods , many S s reported using behavioral weight-loss techniques but 4 of the 36 S s ( 11.1 % ) at 1-yr follow-up , 15 of the 23 ( 65.2 % ) and 24 of the 25 ( 96.0 % ) who responded , respectively , at 3- and 4-yr follow-up had used other weight-loss programs or methods . A possible confound for follow-up data was identified and suggestions for future research were presented OBJECTIVES We assessed the effectiveness of an intervention targeting home food and activity environments to reduce energy intake and increase physical activity among overweight and obese patients from 3 community health centers in rural Georgia . METHODS We conducted a r and omized controlled trial ( n = 349 ) from 2011 to 2 
    Output:
    
Commitment devices appeared most successful when made publicly , and targeting diet rather than physical activity .