***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: Abstract Compared to other racial/ethnic groups , African American ( AA ) women are more likely to be obese but less likely to participate in weight loss interventions or to successfully lose weight . Sustained motivation for weight loss may be especially difficult for AA women due to socioeconomic and cultural factors . The purpose of this study was to examine whether the addition of motivational interviewing ( MI ) to a culturally-targeted behavioral weight loss program for AA women improved adherence to the program , diet and physical activity behaviors , and weight loss outcomes .  Forty-four obese ( mean BMI = 39.4 , SD = 7.1 ) AA women were r and omized to receive a 16-week behavioral weight loss program plus four MI sessions , or the same behavioral weight loss program plus four health education ( HE ; attention control ) sessions . Results showed that participants in both MI and HE conditions lost a significant amount of weight , reduced their energy intake and percent calories from fat , and increased their fruit and vegetable consumption ( ps < .05 ) . However , adherence to the behavioral weight loss program and changes in diet , physical activity , and weight did not differ across MI and HE conditions . Future research is warranted to determine the sub population s with which MI is most effective OBJECTIVE : To compare two group treatment programmes for obese out patients . Both programmes included behaviour modification , nutrition counselling , very-low-calorie diet ( VLCD ) and a continuous measuring of metabolic and anthropometrical status , but they differed regarding the treatment intensiveness . The main aim was to study whether intensive treatment gives a larger weight reduction compared with less intensive treatment and what level of input from health care personnel is needed to reach adequate treatment results . DESIGN : A 2-y r and omised clinical trial . SUBJECTS : A total of 43 obese subjects aged 24–60 y , BMI 35 kg/m2 (29–48).INTERVENTION : Two programmes were used . Both were based on group therapy and were supervised by a dietitian and a psychologist . Group 1 received a continuous intensive treatment with planned group meetings every fortnight during the first year and six group meetings the second year . Group 2 had planned group meetings every third month  . Anthropometrical and metabolic data were measured every third month in both groups . The VLCD periods were the same . RESULTS : There was no evidence that a more intensive treatment promotes a larger weight reduction . Weight reduction after 1 y : group 1 , −7.6 ( ±0.97 ) kg , BMI −2.6 ( ±0.3 ) kg/m2 ; group 2 , −6.4 ( ±1.16 ) kg , BMI −2.2 ( ±0.4 ) kg/m2 . Weight reduction after 2 y : group 1 , −6.8 ( ±1.4 ) kg , BMI −2.4 ( ±0.3 ) kg/m2 ; group 2 , −8.6 ( ±1.6 ) kg , BMI −3.0 ( ±0.3 ) kg/m2 . The dropout rate was 26 % . CONCLUSION : There were no significant differences in weight reduction , compliance or dropout rate between the groups and there was no evidence that a more intensive treatment promotes a larger weight reduction . This observation is of value when setting up treatment programmes . To measure the metabolic and anthropometrical status during the treatment and to give continuous feedback to the subjects seem to be important factors for compliance . Both treatment programmes gave highly significant weight reductions in the range of 5–10 % , which has been referred to as a realistic goal for the treatment of obese patients Background Drop-out is a major problem in weight loss studies . Although previous attrition research has examined some predictors of drop-out , theoretically grounded research on psychological predictors of drop-out from weight interventions has been lacking . Purpose To examine psychological predictors of drop-out from a weight reduction study in diabetes type 2 patients . Method A clinical trial was conducted with 101 overweight/obese ( body mass index > 27 ) diabetes type 2 patients . Patients were r and omly assigned to a self-regulation intervention , an active control group , and a passive control group .  Psychological , somatic , socio-demographic , and lifestyle variables were examined as predictors of drop-out from baseline to 6 months follow-up . Results Multiple logistic regression analysis indicated that low autonomous regulation or low ‘ goal ownership ’ was the best predictor of drop-out . Conclusion It is suggested that the assessment of ‘ goal ownership ’ prior to a weight reduction intervention could identify patients who are sufficiently motivated to participate . Patients who score low on ‘ goal ownership ’ may be offered pretreatment interventions to increase their motivation 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 ] . OBJECTIVE The aim of this r and omized pilot study was to examine whether the addition of motivational interviewing strategies to a behavioral obesity intervention enhances adherence and glucose control in older obese women with NIDDM . RESEARCH DESIGN AND METHODS Twenty-two older obese women ( 41 % black ) with NIDDM were r and omly assigned to 1 ) a st and ard 16-week group behavioral weight-control program that provided instruction in diet , exercise , and behavioral modification or 2 ) the same group behavioral program with three individualized motivational interviewing sessions added . RESULTS The motivational group attended significantly more group meetings ( 13.3 vs. 8.9 ) , completed significantly more food diaries ( 15.2 vs. 10.1 ) , and recorded blood glucose significantly more often ( 46.0 vs. 32.2 days ) than the st and ard group . Further , participants in the motivational group had significantly better glucose control post-treatment ( 9.8 vs. 10.8 % ) . Although both groups demonstrated significant weight loss , no differences were apparent between groups . CONCLUSIONS These results suggest that augmenting a st and ard behavioral treatment program for obese women with NIDDM with a motivational interviewing component may significantly enhance adherence to program recommendations and glycemic control . Preliminary data warrant further investigation with larger sample s and a longer follow-up BACKGROUND The purpose of this study was to test the ability of the Transtheoretical Model ( TTM ) to predict exercise stage transition of individuals in a large , untreated- population -based , r and om sample of Canadian adults ( 18 - 65 years of age ) over two consecutive time periods . METHODS Assessment s of TTM 's  stage of exercise behavior change , self-efficacy , pros , cons , experiential processes , and behavioral processes were made at baseline ( time 1 ) , 6 months ( time 2 ) , and 1 year ( time 3 ) . Six hundred eighty-three men and women , identified through r and om-digit telephone dialing , completed all measures across the three time points . Within each time period ( time 1 - 2 ; time 2 - 3 ) participants were categorized as having regressed ( moved back at least on stage ) , remained ( no stage change ) , or progressed ( moved forward at least one stage ) . Baseline TTM constructs were analyzed for their ability to predict change transition across the two time periods . RESULTS Of 40 possible predictions ( 20 for each time period ) 18 ( 45 % ) were supported . CONCLUSIONS Overall , the findings demonstrate partial support for the internal validation of TTM in the exercise domain . Implication s of the findings are discussed and future directions for research ers , practitioners , and program planners are provided 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 In this r and omized controlled study , a st and ardized motivation intervention was compared with a relaxation intervention with regard to its effectiveness in decreasing dropout rates and increasing physical activity in a sample of obese patients . METHOD Thirty-eight obese participants were r and omly assigned to a one-session motivation or relaxation intervention . Thereafter , both groups participated in an 8-week aerobic program .  Adherence , physical activity , motivational stage of change , and body mass index ( BMI ) were assessed during intervention and at 3- and 6-month follow-ups . RESULTS During the aerobic program , the motivation group showed significantly fewer dropouts but comparable adherence if only completers were considered . Moreover , their weekly minutes of physical activity increased over time before leveling off , whereas steady decreases were observed in the relaxation group . For motivational stage of change and BMI , no significant group differences were observed . DISCUSSION The importance and efficacy of motivational interventions in enhancing the high dropout rates in obesity treatment is underlined Participants were 65 obese men and women who were r and omly assigned to either weight control or weight control plus cognitive behavioral body image therapy . Both conditions showed clinical ly significant improvements in body image at posttreatment and 1-year follow-up . Adding body image therapy to weight control did not result in greater psychological improvements and did not result in better maintenance of body image change when participants regained weight after treatment . Weight loss and maintenance were equivalent between groups . Adding body image therapy did not improve or detract from weight loss . Although body image therapy has been shown to be effective in obese persons , it appears that a well-rounded cognitive-behavioral weight control program is effective as well BACKGROUND Physical activity is a predictor of maintained weight loss ; however , causal mechanisms are unclear . Behavioral theories suggest that associated psychologic changes may indirectly affect weight loss . OBJECTIVE We sought to test the association of a behaviorally based exercise support protocol ( The Coach Approach [ CA ] ) , with and without a group-based nutrition education program ( Cultivating Health ) , with adherence to exercise and changes in physiologic and psychologic factors , and to assess theory-based paths to weight and body-fat changes . SETTING The study took place in YMCA wellness centers . STUDY SUBJECTS Study participation was open to formerly sedentary obese women . DESIGN Study participants were r and omly assigned to the CA Only ( CA ; n = 81 ) , The CA Plus Cultivating Health ( CA/CH ; n = 128 ) , or the control ( n = 64 ) group . We contrasted dropout and attendance rates and changes in self-efficacy ( SE ) , physical self-concept ( PSC ) , total mood disturbance ( TMD ) , body areas satisfaction ( BAS ) , and select physiologic factors during a six-month period . We also analyzed proposed paths to weight loss . RESULTS The CA and CA/CH groups had significantly lower exercise dropout rates ( χ(2 ) = 44.67 , p < 0.001 ) and higher attendance rates ( F = 10.02 ; p < 0.001 ) than the control group did . Improvements in body fat , body mass index ( BMI ) , and waist circumference were significant for only the CA and CA/CH groups . Significant improvements in TMD , PSC , and BAS scores were found for all groups , with effect sizes greater in the groups incorporating the CA protocol . Within the five paths assessed , entry of changes in TMD and BAS scores into multiple-regression equations , along with SE and PSC scores , increased the explained variance in exercise session attendance from 5 % ( p = 0.01 ) to 16 % ( 
    Output:
    
The aim of this systematic review and meta- analysis is to determine if behavioural treatment strategies ( e.g. goal setting , motivational interviewing , relapse prevention , cognitive restructuring etc . )
This meta- analysis of r and omized controlled trials provides evidence that behavioural treatment strategies  improve adherence to lifestyle intervention programmes  in adults with obesity .
If adherence were improved , treatment effectiveness , health outcomes and the ultimate burden of chronic disease could also be improved