***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 goal of evidence -based medicine is ultimately to improve patient outcomes and quality of care .  Systematic review s of the available published evidence are required to identify interventions that lead to improvements in behavior , health , and well-being . Authoritative literature review s depend on the quality of published research and research reports . The Consoli date d St and ards for Reporting Trials ( CONSORT ) Statement ( www.consort-statement.org ) was developed to improve the design and reporting of interventions involving r and omized clinical trials ( RCTs ) in medical journals . We describe the 22 CONSORT guidelines and explain their application to behavioral medicine research and to evidence -based practice . Additional behavioral medicine-specific guidelines ( e.g. , treatment adherence ) are also presented . Use of these guidelines by clinicians , educators , policymakers , and research ers who design , report , and evaluate or review RCTs will strengthen the research itself and accelerate efforts to apply behavioral medicine research to improve the processes and outcomes of behavioral medicine practice 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 : Maintaining weight loss is a major challenge in obesity treatment . Individuals often indicate that waning motivation prompts cessation of effective weight management behaviors . Therefore , a novel weight loss maintenance program that specifically targets motivational factors was evaluated . Design : Overweight women ( N=338 ; 19 % African American ) with urinary incontinence were r and omized to lifestyle obesity treatment or control and followed for 18 months . All participants in lifestyle ( N=226 ) received the same initial 6-month group behavioral obesity treatment and were then r and omized to ( 1 ) a novel motivation-focused maintenance program ( N=113 ) or ( 2 ) a st and ard skill-based maintenance approach (N=113).Main Outcome Measure : Weight assessed at baseline , 6 and 18 months . Results : Both treatment groups ( motivation-focused and skill-based ) achieved comparable 18-month weight losses ( −5.48 % for motivation-focused vs −5.55 % in skill-based , P=0.98 ) , and both groups lost significantly more than controls ( −1.51 % ; P=0.0012 in motivation-focused and P=0.0021 in skill-based ) . Conclusions : A motivation-focused maintenance program offers an alternative , effective approach to weight maintenance exp and ing available evidence -based interventions beyond traditional skill-based programs . Trial Registration : clinical trials.gov identifier : NCT00091988 BACKGROUND Long-term maintenance of weight loss remains a therapeutic challenge in obesity treatment . OBJECTIVE This multicenter , double-blind , placebo-controlled study was design ed to test the hypothesis that orlistat , a gastrointestinal lipase inhibitor , is significantly more effective than a placebo in preventing weight regain . DESIGN Obese subjects who lost > or = 8 % of their initial body weight during a 6-mo lead-in of a prescribed hypoenergetic diet ( 4180-kJ/d deficit ) with no adjunctive pharmacotherapy  were r and omly assigned to receive placebo , 30 mg orlistat , 60 mg orlistat , or 120 mg orlistat 3 times daily for 1 y in combination with a maintenance diet to help prevent weight regain . Of 1313 recruited subjects [ body mass index ( in kg/m2 ) : 28 - 43 ] , 729 subjects lost > or = 8 % of their initial body weight during the 6-mo weight-loss lead-in period and were enrolled in the double-blind phase . RESULTS After 1 y , subjects treated with 120 mg orlistat 3 times daily regained less weight than did placebo-treated subjects ( 32.8 + /- 4.5 % compared with 58.7 + /- 5.8 % regain of lost weight ; P < 0.001 ) . Moreover , more subjects in the 120-mg orlistat group than in the placebo group regained < or = 25 % of lost weight ( 47.5 % of subjects compared with 29.9 % ) . In addition , orlistat treatment ( 120 mg 3 times daily ) was associated with significantly greater reductions in total and LDL-cholesterol concentrations than was placebo ( P < 0.001 ) . CONCLUSION The use of orlistat during periods of attempted weight maintenance minimizes weight readjustment and facilitates long-term improvement in obesity-related disease risk factors OBJECTIVE : To investigate whether supplementation of carbohydrate , chromium , dietary fibre and caffeine is effective for maintenance of weight-loss in the long-term . DESIGN : A longitudinal , double-blind , r and omly assigned intervention study of 16 months with supplementation of either 50 g of carbohydrates ( CHO ) , 200 µg chromium-picolinate ( Cr-Pic ) , 20 g of soluble fibre plus 100 mg caffeine ( CHO+ ) or 50 g of plain CHO , for 16 months besides a very low energy diet ( VLED ) during the first two months . SUBJECTS : Thirtythree female obese subjects ( age , 34.8±7.0 y ; body weight ( BW ) : 85.5±10.0 kg ; body mass index ( BMI ) 31.2±3.7 kg.m−2 ) participated , 13 subjects were supplemented with CHO+ , 11 subjects were supplemented with CHO  and 9 subjects served as a control group .  MEASUREMENTS : BW , body composition , energy intake and blood parameters were measured before the VLED ( 0 ) , after the VLED at 2 months ( 2 ) , and at 4 , 10 and 16 months . RESULTS : The amount and course of relapse of BW was equal for the supplemented and control groups . The average regain at 16 months ( the weight gained as a percentage of the total weight loss during the VLED ) was 66.1±81.2 % , and was not different between the groups . No differences in body composition were found between the groups at 16 months . The CHO supplements result ed in significantly elevated energy percentage ( En % ) intake of CHO daily , in both supplemented groups , although this did not result in less regain . Pearson correlation analysis for all subjects revealed that the more fat consumed , the more regain was found at 16 months ( r= 0.41 , P<0.05 ) . A high CHO consumption was correlated with less regain ( r=−0.40 , P=0.05 ) . Furthermore , chromium intake did not result in significant changes in blood parameters and body composition . CONCLUSION : Although additional supplementation of CHO , chromium , dietary fibre and caffeine intake did not affect BW , the En % CHO daily was increased significantly . Our results indicate that a high En % intake of CHO and a low En % intake of fat daily is beneficial for prevention of weight regain 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 OBJECTIVES To compare two different very low calorie diet (VLCD)-based weight maintenance strategies . DESIGN AND SETTING A r and omized 2-year clinical trial performed at the Department of Body Composition and Metabolism , Sahlgrenska University Hospital , Sweden . SUBJECTS A total of 334 patients , body mass index ( BMI ) > 30 kg m-2 , aged 18 - 60 years . INTERVENTIONS All the patients started with 16 VLCD weeks . Subjects in the intermittent group were then scheduled to use VLCD for 2 weeks every third month , whilst patients in the on-dem and group were instructed to use VLCD whenever their body weight passed an individualized cut-off level . Irrespective of the treatment group , all the subjects were recommended a hypocaloric diet during VLCD-free periods . MAIN OUTCOME MEASURES Changes in body weight , body composition , anthropometric variables and cardiovascular risk factors . RESULTS Completers in both groups maintained highly significant weight losses after 2 years : 7.0 + /- 11.0 kg ( 6.2 + /- 9.5 % ) in the intermittent group and 9.1 + /- 9.7 kg ( 7.7 + /- 8.1 % ) in the on-dem and group ( P < 0.001 , ns between groups ) . Male completers in the on-dem and group lost significantly more weight than men in the intermittent group , 14.5 + /- 11.0 kg vs. 4.0 + /- 10.5 kg , respectively ( P < 0.01 ) . Most cardiovascular risk factors improved during the first year , whilst anthropometric measures , insulin , HDL- and LDL-cholesterol were also significantly improved after 2 years of treatment . CONCLUSION Clinical ly significant weight reductions were achieved after 2 years of VLCD-based treatment . The structure of VLCD treatment during the maintenance phase did not affect weight loss in the total study population , whilst male subjects might benefit from the VLCD on-dem and strategy 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 % ) BACKGROUND Failure to maintain weight losses in lifestyle change programs continues to be a major problem and warrants investigation of innovative approaches to weight control . OBJECTIVE The goal of this study was to compare two novel group interventions , both aim ed at improving weight loss maintenance , with a control group . METHODS AND PROCEDURES A total of 103 women lost weight on a meal replacement-supplemented diet  and were then r and omized to one of three conditions for the 14-week maintenance phase : cognitive-behavioral treatment ( CBT ) ; CBT with an enhanced food monitoring accuracy ( EFMA ) program ; or these two interventions plus a reduced energy density eating ( REDE ) program . Assessment s were conducted periodically through an 18-month postintervention . Outcome measures included weight and self-reported dietary intake . Data were analyzed using completers only as well as baseline-carried-forward imputation . RESULTS Participants lost an average of 7.6 + /- 2.6 kg during the weight loss phase and 1.8 + /- 2.3 kg during the maintenance phase . Results do not suggest that the EFMA intervention was successful in improving food monitoring accuracy . The REDE group decreased the energy density ( ED ) of their diets more so than the other two groups . However , neither the REDE nor the EFMA condition showed any advantage in weight loss maintenance 
    Output:
    
All orlistat studies reported higher frequencies of adverse gastrointestinal events in the experimental compared with placebo control groups .
Behavioural interventions that deal with both diet and physical activity show small but significant benefits on weight loss maintenance