***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 Obesity remains a serious issue in many countries . Web-based programs offer good potential for delivery of weight loss programs . Yet , many Internet-delivered weight loss studies include support from medical or nutritional experts , and relatively little is known about purely web-based weight loss programs . Objective To determine whether supportive features and personalization in a 12-week web-based lifestyle intervention with no in-person professional contact affect retention and weight loss . Methods We assessed the effect of different features of a web-based weight loss intervention using a 12-week repeated- measures r and omized parallel design . We developed 7 sites representing 3 functional groups . A national mass media promotion was used to attract overweight/obese Australian adults ( based on body mass index [ BMI ] calculated from self-reported heights and weights ) . Eligible respondents ( n = 8112 ) were r and omly allocated to one of 3 functional groups : information-based ( n = 183 ) , supportive ( n = 3994 ) , or personalized-supportive ( n = 3935 ) . Both supportive sites included tools , such as a weight tracker , meal planner , and social networking platform . The personalized-supportive site included a meal planner that offered recommendations that were personalized using an algorithm based on a user ’s preferences for certain foods . Dietary and activity information were constant across sites , based on an existing and tested 12-week weight loss program ( the Total Wellbeing Diet ) . Before and /or after the intervention , participants completed demographic ( including self-reported weight ) , behavioral , and evaluation question naires online . Usage of the website and features was objective ly recorded . All screening and data collection procedures were performed online with no face-to-face contact . Results Across all 3 groups , attrition was high at around 40 % in the first week and 20 % of the remaining participants each week . Retention was higher for the supportive sites compared to the information-based site only at week 12 ( P = .01 ) . The average number of days that each site was used varied significantly ( P = .02 ) and was higher for the supportive site at 5.96 ( SD 11.36 ) and personalized-supportive site at 5.50 ( SD 10.35 ) , relative to the information-based site at 3.43 ( SD 4.28 ) . In total , 435 participants provided a valid final weight at the 12-week follow-up . Intention-to-treat analyses ( using multiple imputations ) revealed that there were no statistically significant differences in weight loss between sites ( P = .42 ) . On average , participants lost 2.76 % ( SE 0.32 % ) of their initial body weight , with 23.7 % ( SE 3.7 % ) losing 5 % or more of their initial weight . Within supportive conditions , the level of use of the online weight tracker was predictive of weight loss ( model estimate = 0.34 , P < .001 ) . Age ( model estimate = 0.04 , P < .001 ) and initial BMI ( model estimate = -0.03 , P < .002 ) were associated with frequency of use of the weight tracker . Conclusions Relative to a static control , inclusion of social networking features and personalized meal planning recommendations in a web-based weight loss program did not demonstrate additive effects for user weight loss or retention . These features did , however , increase the average number of days that a user engaged with the system . For users of the supportive websites , greater use of the weight tracker tool was associated with greater weight loss The transition to college has been identified as a critical period for increases in overweight status . Overweight college students are at-risk of becoming obese adults , and , thus prevention efforts targeting college age individuals are key to reducing adult obesity rates . The current study evaluated an Internet intervention with first year college students ( N=170 ) r and omly assigned to one of four treatment conditions : 1 ) no treatment , 2 ) 6-week online intervention 3 ) 6-week weight and caloric feedback only ( via email ) , and 4 ) 6-week combined feedback and online intervention . The combined intervention group had lower BMI s at post-testing than the other three groups . This study demonstrated the effectiveness and feasibility of an online intervention to prevent weight gain among college students Background The work setting provides an opportunity to introduce overweight ( i.e. , Body Mass Index ≥ 25 kg/m2 ) adults to a weight management programme , but new approaches are needed in this setting . The main purpose of this study was to investigate the effectiveness of lifestyle counselling by phone or e-mail on body weight , in an overweight working population . Secondary purpose s were to establish effects on waist circumference and lifestyle behaviours , and to assess which communication method is the most effective . Methods A r and omized controlled trial with three treatments : intervention material s with phone counselling ( phone group ) ; a web-based intervention with e-mail counselling ( internet group ) ; and usual care , i.e. lifestyle brochures ( control group ) . The interventions used lifestyle modification and lasted a maximum of six months . Subjects were 1386 employees , recruited from seven companies ( 67 % male ; mean age 43 ( SD 8.6 ) y ; mean BMI 29.6 ( SD 3.5 ) kg/m2 ) .  Body weight was measured by research personnel and by question naire . Secondary outcomes fat , fruit and vegetable intake , physical activity and waist circumference were assessed by question naire . Measurements were done at baseline and after six months . Missing body weight was multiply imputed . Results Body weight reduced 1.5 kg ( 95 % CI -2.2;-0.8 , p < 0.001 ) in the phone group and 0.6 kg ( 95 % CI -1.3 ; -0.01 , p = 0.045 ) in the internet group , compared with controls . In completers analyses , weight and waist circumference in the phone group were reduced with 1.6 kg ( 95 % CI -2.2;-1.0 , p < 0.001 ) and 1.9 cm ( 95 % CI -2.7;-1.0 , p < 0.001 ) respectively , fat intake decreased with 1 fatpoint ( 1 to 4 grams)/day ( 95 % CI -1.7;-0.2 , p = 0.01 ) and physical activity increased with 866 METminutes/week ( 95 % CI 203;1530 , p = 0.01 ) , compared with controls . The internet intervention result ed in a weight loss of 1.1 kg ( 95 % CI -1.7;-0.5 , p < 0.001 ) and a reduction in waist circumference of 1.2 cm ( 95 % CI -2.1;-0.4 , p = 0.01 ) , in comparison with usual care . The phone group appeared to have more and larger changes than the internet group , but comparisons revealed no significant differences . Conclusion Lifestyle counselling by phone and e-mail is effective for weight management  in overweight employees and shows potential for use in the work setting .Trial registration ISCRTN04265725 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 Web-based interventions for weight control could promote more-widespread dissemination of weight-loss opportunities ; however , they remain limited in effectiveness . Incorporating weight-control practice s used by individuals with long-term weight-loss success ( " positive deviants " ) may improve the efficacy of web-based weight control interventions . PURPOSE To evaluate the efficacy of AchieveTogether , a web-based weight-loss intervention for adults based on user-generated weight-loss strategies from successful weight losers . DESIGN In 2009 - 2010 , participants were r and omized to either a 12-week  web-based intervention , AchieveTogether , or a wait-list control condition . SETTING / PARTICIPANTS 100 overweight or obese adults participated in the study . INTERVENTION AchieveTogether was design ed to help individuals implement weight control practice s used by others who successfully lost and maintained weight . MAIN OUTCOME MEASURES The primary outcome was change in weight . Secondary outcomes included blood pressure , daily caloric intake , quality of life , and use of weight control practice s. ANCOVA , with adjustment for baseline values on outcome measures , was used to assess differences between groups in primary and secondary outcomes . Statistical analyses were conducted in 2010 - 2011 . RESULTS Most participants were women ( 69.7 % ) and white ( 90.8 % ) , with a mean age of 50.3 years and baseline BMI of 33.2 ; 88 % completed post-program assessment s.  Mean weight loss among intervention participants was -1.4 kg ( 95 % CI= -2.2 , -0.5 ) , compared with a mean weight gain of 0.6 kg ( 95 % CI= -0.3 , 1.4 ) in control participants ( p<0.01 ) . CONCLUSIONS User-generated weight-loss practice s from " positive deviants " could promote weight control in web-based interventions ; however , further research is needed to improve program efficacy . TRIAL REGISTRATION This study is registered at Clinical Trials.govNCT00709501 Background Rising levels of obesity coupled with the limited success of currently available weight control methods highlight the need for investigation of novel approaches to obesity treatment . This study aims to determine the effectiveness and cost-effectiveness of an Internet-based re source for obesity management . Methods A r and omised controlled trial conducted in a community setting , where obese volunteers ( n = 221 ) were r and omly assigned to  Internet group ( n = 111 ) or usual care group ( n = 110 ) . Objective measures of weight and height were obtained . Question naires were used to collect dietary , lifestyle , physical activity and quality of life data . Data were collected at baseline , six months and 12 months . Results Data were collected on 54 ( 49 % ) participants in the Internet group and 77 ( 70 % ) participants in the usual care group at 12 months . Based on analysis conducted on all available data , the Internet group lost 1.3 kg , compared with 1.9 kg weight loss in the usual care group at 12 months , a non-significant difference ( difference = 0.6 kg ; 95 % CI : -1.4 to 2.5 , p = 0.56 ) . No significant differences in change in secondary outcome measures between the two groups at six or 12 months were revealed . Total costs per person per year were higher in the Internet group than the usual care group ( £ 992.40 compared to £ 276.12 ) , primarily due to the fixed costs associated with setting up the website , and QALYs were similar ( 0.78 and 0.77 ) for both groups . Conclusion This trial failed to show any additional benefit of this website in terms of weight loss or secondary outcome measures compared with usual care . High attrition and low compliance limits the results of this research . The results suggest that the Internet-based weight control re source was not a 
    Output:
    
Findings suggest that the use of technology-assisted behavioral interventions , particularly those that incorporate text messaging or e-mail , may be effective for producing weight loss among overweight and obese adults .