***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 SenseWear ™ Armb and ( SWA ) ( BodyMedia , Inc. Pittsburgh , PA ) is a physical activity and lifestyle monitor that objective ly and accurately measures free-living energy balance and sleep and includes software for self-monitoring of daily energy expenditure and energy intake . The real-time feedback of the SWA can improve individual self-monitoring and , therefore , enhance weight loss outcomes . Methods We recruited 197 sedentary overweight or obese adults ( age , 46.8 ± 10.8 y ; body mass index ( BMI ) , 33.3 ± 5.2 kg/m2 ; 81 % women , 32 % African-American ) from the greater Columbia , South Carolina area . Participants were r and omized into 1 of 4 groups , a self-directed weight loss program via an evidence -based weight loss manual ( St and ard Care , n = 50 ) , a group-based behavioral weight loss program ( GWL , n = 49 ) , the armb and alone ( SWA-alone , n = 49 ) , or the GWL plus the armb and ( GWL+SWA , n = 49 ) , during the 9-month intervention . The primary outcome was change in body weight and waist circumference . A mixed-model repeated- measures analysis compared change in the intervention groups to the st and ard care group on weight and waist circumference status after adjusting for age , sex , race , education , energy expenditure , and recruitment wave . Results Body weight was available for 62 % of participants at 9 months ( 52 % st and ard care , 70 % intervention ) . There was significant weight loss in all 3 intervention groups ( GWL , 1.86 kg , P = 0.05 ; SWA-alone , 3.55 kg , P = 0.0002 ; GWL+SWA , 6.59 kg , P < 0.0001 ) but not in the St and ard Care group ( 0.89 kg , P = 0.39 ) at month 9 . Only the GWL+SWA group achieved significant weight loss at month 9 compared to the St and ard Care group ( P = 0.04 ) . Significant waist circumference reductions were achieved in all 4 groups at month 9 ( St and ard Care , 3.49 cm , P = 0.0004 ; GWL , 2.42 cm , P = 0.008 ; SWA-alone , 3.59 cm , P < 0.0001 ; GWL+SWA , 6.77 cm , P < 0.0001 ) , but no intervention group had significantly reduced waist circumference compared to the St and ard Care group . Conclusions Continuous self-monitoring from wearable technology with real-time feedback may be particularly useful to enhance lifestyle changes that promote weight loss in sedentary overweight or obese adults . This strategy , combined with a group-based behavioral intervention , may yield optimal weight loss . Trial Registration Clinical Trials.gov : Background : Greater than 65 percent of the United States ( US ) population is overweight , with 32 percent obese . It is a problem in both developed and developing nations . While guidelines exist , counseling by physicians about obesity and weight loss is inconsistent , and physician approaches to obesity management have limited success . This study attempted to increase involvement in translating proven research into practice to improve physician awareness and improve outcomes of overweight/obesity . Twenty-one physicians in a suburban , middle class population in the Midwestern United States participated . Methods : Physician obesity awareness , weight , height , BMI , blood pressure , lipids , and glycohemoglobin were measured from 641 patients at baseline and were compared to 631 at 12-month follow-up . All 21 physicians received academic detailing and were presented with their clinical outcomes . Ten physicians received an Enhanced Intervention . They were additionally asked to place a sticker in the chart of their overweight or obese patients . Results : Fifty-three percent of physicians were not comfortable discussing obesity with their patients at baseline , decreasing to 0 % at followup ( p=0.041 ) . Reference to obesity management by Intervention physicians increased from 2.4 % to 9.2 % ( p=0.001 ) while for Enhanced Intervention physicians documentation increased from 3.9 % to 15.6 % ( p=0.002 ) . Those patients in the Enhanced Intervention group lost an average of 6.19 lbs ( 3.3 % ) ( p=0.083 ) during the one year period versus 4.6 lbs ( 2.5 % ) ( p=0.20 ) in the Intervention group . The BMI dropped 1.2 in the Intervention group and 0.72 in the Enhanced Intervention group . The data from both groups was pooled at both baseline and follow-up . The average weight of patients decreased from 185.7 lbs to 180.3 lbs ( excluding outliers weighing > 311 lbs ) . This 5.4 pound loss was significant ( p=0.027 ) . The BMI decreased from 30.1 to 29.1 ( p=0.095 ) . Cardiovascular co-morbidities improved . Conclusion : Obesity and overweight have a very high prevalence in a primary care community based setting s. Clinicians are not comfortable diagnosing and managing obese and overweight patients . A combination of academic detailing and presentation of outcomes to physicians will improve their awareness and result in improved clinical outcomes including weight loss BACKGROUND Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits . METHODS We conducted a r and omized controlled trial of a 12-month intervention at 2 large community health centers , enrolling 310 patients with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 25 or greater . In the intervention group , self-management goals for nutrition and physical activity were set using a tailored computer program . Goals were then review ed at each clinic visit by physicians . The control group received only printed health education material s. The main outcome measures included change in physical activity and body weight . RESULTS In the intervention group , recommended levels of physical activity increased from 26 % at baseline to 53 % at 12 months ( P < .001 ) compared with controls ( 30 % to 37 % ; P= .27 ) , and 32 % of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9 % of controls ( odds ratio , 2.2 ; P= .006 ) . CONCLUSION A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss IMPORTANCE Few weight loss treatments produce clinical ly meaningful weight loss outcomes among black women , particularly in the primary care setting . New weight management strategies are necessary for this population . Weight gain prevention might be an effective treatment option , with particular benefits for overweight and class 1 obese black women . OBJECTIVE To compare changes in weight and cardiometabolic risk during a 12-month period among black women r and omized to a primary care-based behavioral weight gain prevention intervention , relative to usual care . DESIGN , SETTING , AND PARTICIPANTS Two-arm r and omized clinical trial ( the Shape Program ) . We recruited patients from a 6-site community health center system . We r and omized 194 overweight and class 1 obese ( body mass index [ calculated as weight in kilograms divided by height in meters squared ] , 25 - 34.9 ) premenopausal black women aged 25 to 44 years . Enrollment began on December 7 , 2009 ; 12- and 18-month assessment s were completed in February and October 2 , 2012 . INTERVENTIONS The medium-intensity intervention included tailored behavior change goals , weekly self-monitoring via interactive voice response , monthly counseling calls , tailored skills training material s , and a gym membership . MAIN OUTCOMES AND MEASURES Twelve-month change in weight and body mass index and maintenance of change at 18 months . RESULTS Participants had a mean age of 35.4 years , a mean weight of 81.1 kg , and a mean body mass index of 30.2 at baseline . Most were socioeconomically disadvantaged ( 79.7 % with educational level less than a college degree ; 74.3 % reporting annual income < $ 30,000 ) . The 12-month weight change was larger among intervention participants ( mean [ SD ] , -1.0 [ 0.5 ] kg ) , relative to usual care ( 0.5 [ 0.5 ] kg ; mean difference , -1.4 kg [ 95 % CI , -2.8 to -0.1 kg ] ; P = .04 ) . At month 12 , 62 % of intervention participants were at or below their baseline weights compared with 45 % of usual-care participants ( P = .03 ) . By 18 months , intervention participants maintained significantly larger changes in weight ( mean difference , -1.7 kg ; 95 % CI , -3.3 to -0.2 kg ) . CONCLUSIONS AND RELEVANCE A medium-intensity primary care-based behavioral intervention demonstrated efficacy for weight gain prevention among socioeconomically disadvantaged black women . A " maintain , do n't gain " approach might be a useful alternative treatment for reducing obesity-associated disease risk among some premenopausal black women . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00938535 Summary Background The increasing prevalence of overweight and obesity needs effective approaches for weight loss in primary care and community setting s. We compared weight loss with st and ard treatment in primary care with that achieved after referral by the primary care team to a commercial provider in the community . Methods In this parallel group , non-blinded , r and omised controlled trial , 772 overweight and obese adults were recruited by primary care practice s in Australia , Germany , and the UK . Participants were r and omly assigned with a computer-generated simple r and omisation sequence to receive either 12 months of st and ard care as defined by national treatment guidelines , or 12 months of free membership to a commercial programme ( Weight Watchers ) , and followed up for 12 months . The primary outcome was weight change over 12 months . Analysis was by intention to treat ( last observation carried forward [ LOCF ] and baseline observation carried forward [ BOCF ] ) and in the population who completed the 12-month assessment . This trial is registered , number IS RCT N85485463 . Findings 377 participants were assigned to the commercial programme  , of whom 230 ( 61 % ) completed the 12-month assessment ; and 395 were assigned to st and ard care , of whom 214 ( 54 % ) completed the 12-month assessment . In all analyses , participants in the commercial programme group lost twice as much weight as did those in the st and ard care group . Mean weight change at 12 months was −5·06 kg ( SE 0·31 ) for those in the commercial programme versus −2·25 kg ( 0·21 ) for those receiving st and ard care ( adjusted difference −2·77 kg , 95 % CI −3·50 to −2·03 ) with LOCF ; −4·06 kg ( 0·31 ) versus −1·77 kg ( 0·19 ; adjusted difference −2·29 kg , −2·99 to −1·58 ) with BOCF ; and −6·65 kg ( 0·43 ) versus −3·26 kg ( 0·33 ; adjusted difference −3·16 kg , −4·23 to −2·11 ) for those who completed the 12-month assessment . Participants reported no adverse events related to trial participation . Interpretation Referral by a primary health-care professional to a commercial weight loss programme that provides regular weighing , advice about diet and physical activity , motivation , and group support can offer a clinical ly useful early intervention for weight management in overweight and obese people that can be delivered at large scale . Funding Weight Watchers International , through a grant to the UK Medical Research Council Background Obesity and hypertension and their associated health complications disproportionately affect communities of color and people of lower socioeconomic status . Recruitment and retention of these population s in research trials , and retention in weight loss trials has been an ongoing challenge . Methods Be Fit , Be Well was a pragmatic r and omized weight loss and hypertension management trial of patients attending one of three community health centers in Boston , Massachusetts . Participants were asked to complete follow-up assessment s every 6-months for two years . We describe challenges encountered and strategies implemented to recruit and retain trial participants over the 24-month intervention . We also identify baseline participant characteristics associated with retention status . Retention strategies included financial incentives , contact between assessment visits , building relationships with health center primary care providers ( PCPs ) and staff , and putting participant convenience first . Results Active refusal rates were low with 130 of 2,631 patients refusing participation ( 4.9 % ) . Of 474 eligible persons completing telephone screening , 365 ( 77.0 % ) completed their baseline visit and were r and omized into the study . The study population was predominantly non-Hispanic Black ( 71.2 % ) , female ( 68.5 % ) and reported annual household income of less than $ 35,000 ( 70.1 % ) . Recruitment strategies included use of passive approval of potential participants by PCPs , use of part-time staff , and outsourcing calls to a call center . A total of 314 ( 86.0 % ) 
    Output:
    
Overall , the evidence suggests that obesity treatment delivered in primary care has limited effectiveness .