***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: OBJECTIVE : In epidemiological studies , weight loss is usually associated with increased mortality rate . Contrarily , among obese people , weight loss reduces other risk factors for disease and death . We hypothesised that this paradox could exist because weight is used as an implicit adiposity index . No study has considered the independent effects of weight loss and fat loss on mortality rate . We studied mortality rate as a function of weight loss and fat loss . DESIGN : Analysis of ‘ time to death ’ in two prospect i ve population -based cohort studies , the Tecumseh Community Health Study ( 1890 subjects ; 321 deaths within 16 y of follow-up ) and the Framingham Heart Study ( 2731 subjects ; 507 deaths within 8 y of follow-up ) , in which weight and fat ( via skinfolds ) loss were assessable . RESULTS : In both studies , regardless of the statistical approach , weight loss was associated with an increased , and fat loss with a decreased , mortality rate ( P<0.05 ) . Each st and ard deviation ( s.d . ) of weight loss ( 4.6 kg in Tecumseh , 6.7 kg in Framingham ) was estimated to increase the hazard rate by 29 % ( 95 % confidence interval CI ) , ( 14 % , 47 % , respectively ) and 39 % ( 95 % CI , 25 % , 54 % respectively ) , in the two sample s. Contrarily , each s.d . of fat loss ( 10.0 mm in Tecumseh , 4.8 mm in Framingham ) was estimated to reduce the hazard rate 15 % ( 95 % CI , 4 % , 25 % ) and 17 % ( 95 % CI , 8 % , 25 % ) in Tecumseh and Framingham , respectively . Generalisability of these results to severely ( that is , body mass index BMI ) ≥34 ) obese individuals is unclear . CONCLUSIONS : Among individuals that are not severely obese , weight loss is associated with increased mortality rate and fat loss with decreased mortality rate Binge eating disorder ( BED ) is associated with high levels of obesity and psychological suffering , but little is known about 1 ) the distribution of features of BED in the general population and 2 ) their consequences for weight development and psychological distress in young adulthood . We investigated the prevalence of features of BED and their association with  body mass index ( BMI )  and  psychological distress  among men ( n = 2423 ) and women ( n = 2825 ) from the longitudinal community-based FinnTwin16 cohort ( born 1975 - 1979 ) . Seven eating-related cognitions and behaviors similar to the defining features of BED were extracted from the Eating Disorder Inventory-2 and were assessed at a mean age of 24 .  BMI and psychological distress  , measured with the General Health Question naire , were assessed at ages 24 and 34 . We assessed prevalence of the features and their association with  BMI and psychological distress cross-sectionally and prospect ively . More than half of our participants reported at least one feature of BED ; clustering of several features in one individual was less common , particularly among men . The most frequently reported feature was ' stuffing oneself with food ' , whereas the least common was ' eating or drinking in secrecy ' . All individual features of BED and their clustering particularly were associated with higher BMI and more psychological distress cross-sectionally . Prospect ively , the clustering of features of BED predicted increase in psychological distress but not additional weight gain when baseline BMI was accounted for . In summary , although some features of BED were common , the clustering of several features in one individual was not . The features were cumulatively associated with BMI and psychological distress and predicted further increase in psychological distress over ten years of follow-up Aims : To compare effectiveness of a 1-year weight loss program in moderately and severely obese patients . Methods : The study sample included 311 obese patients participating in a weight loss program  , which comprised a 12-week weight reduction phase ( low-calorie formula diet ) and a 40-week weight maintenance phase . Body weight and glucose and lipid values were determined at the beginning of the program as well as after the weight reduction and the weight maintenance phase . Participants were analyzed according to their BMI class at baseline ( 30 - 34.9 kg/m2 ; 35 - 39.9 kg/m2 ; 40 - 44.9 kg/m2 ; 45 - 49.9 kg/m2 ; ≥50 kg/m2 ) . Furthermore , moderately obese patients ( BMI < 40 kg/m2 ) were compared to severely obese participants ( BMI ≥ 40 kg/m2 ) . Results : Out of 311 participants , 217 individuals completed the program .  Their mean baseline BMI was 41.8 ± 0.5 kg/m2 . Average weight loss was 17.9 ± 0.6 % , result ing in a BMI of 34.3 ± 0.4 kg/m2 after 1 year ( p < 0.001 ) . Overall weight loss was not significantly different in moderately and severely obese participants . Yet , severely obese participants achieved greater weight loss during the weight maintenance phase than moderately obese participants ( -3.1 ± 0.7 % vs. -1.2 ± 0.6 % ; p = 0.04 ) . Improvements in lipid profiles and glucose metabolism were found throughout all BMI classes . Conclusion : 1-year weight loss intervention improves body weight as well as lipid and glucose metabolism not only in moderately , but also in severely obese individuals Background Behavioral lifestyle interventions during pregnancy can prevent excessive gestational weight gain ( GWG ) in women with normal weight ; however , effective interventions to reduce GWG in ethnically diverse women with obesity are lacking . Objective A r and omized controlled trial was conducted to test whether a behavioral lifestyle intervention with partial meal replacement reduces GWG rate in Hispanic and non-Hispanic women with overweight or obesity relative to enhanced usual care . Design Participants ( n = 257 ) were recruited in San Luis Obispo , California , and Providence , Rhode Isl and , between November 2012 and May 2016 . Participants were pregnant ( mean ± SD : 13.6 ± 1.8 wk of gestation ) with overweight or obesity and had a mean age of 30.3 y ; 41.6 % of participants were Hispanic . Women were r and omly assigned within site and by ethnicity to enhanced usual care ( n = 128 ) or to a behavioral lifestyle intervention with partial meal replacement ( n = 129 ) . The primary outcome was GWG per week of observation . Secondary outcomes were proportions exceeding Institute of Medicine ( IOM ) guidelines for total GWG , changes in weight-control behaviors and cardiovascular disease risk factors , and incidence of pregnancy complications . Study retention was 99.6 % ( 256 of 257 ) . Results The intervention compared with usual care result ed in less mean ± SD weekly GWG ( 0.33 ± 0.25 compared with 0.39 ± 0.23 kg/wk ; P = 0.02 ) and total GWG ( 9.4 ± 6.9 compared with 11.2 ± 7.0 kg ; P = 0.03 ) and reduced the proportion of women who exceeded IOM guidelines for total GWG ( 41.1 % compared with 53.9 % ; P = 0.03 ) . No significant group × time × demographic subgroup ( ethnicity , BMI , age , parity , and income ) interactions were observed . Among intervention participants , greater meal replacement intake was related to reduced GWG rate ( β = -0.07 ; 95 % CI:-0.12 , -0.03 ; P = 0.002 ) . The intervention compared with usual care increased weight-control strategies ( P < 0.0001 ) and cognitive restraint ( P < 0.0001 ) and reduced triglycerides ( P = 0.03 ) . Conclusion Prenatal behavioral intervention with partial meal replacement significantly reduced GWG in Hispanic and non-Hispanic women with overweight or obesity . This trial was registered at www . clinical trials.gov as NCT01545934 Background We evaluated the effectiveness of a sequential diet regimen termed the obese preoperative diet ( OPOD ) in morbidly obese patients with and without type 2 diabetes mellitus ( T2DM ) scheduled for laparoscopic bariatric surgery . Methods Fifty patients ( body mass index 53.5 ± 8.4 kg/m2 ) scheduled for bariatric surgery , including 14 with T2DM , were prospect ively enrolled and followed the OPOD regimen : a very low-calorie ketogenic diet for 10 days , followed by a very low-calorie diet for 10 days , and then a low-calorie diet for 10 days . Patients were evaluated at baseline ( T0 ) and after 10 days ( T1 ) , 20 days ( T2 ) , and 30 days ( T3 ) . Results Body weight , body mass index , waist circumference , and neck circumference were significantly lower at T1 , T2 , and T3 than at T0 in the 48 patients who completed the OPOD . Two patients discontinued the OPOD after 4–7 days . In patients with T2DM , fasting plasma glucose levels decreased significantly , enabling reduction of diabetic medications . Plasma and urine ketone levels increased at T1 but were all < 1 mmol/L , and hunger decreased during the diet period . Conclusions OPOD , including 10 days of a VLCKD , was safe and effective in morbidly obese patients , and it seems to be promising in morbidly obese patients with and without T2DM scheduled for laparoscopic bariatric surgery Objective Attrition rates of up to 77 % have been reported in conservative weight-reduction programs for the treatment of obesity . In view of the cost of such programs to the health system , there is a need to identify the variables that predict premature discontinuation of treatment . Previous studies have focused mainly on somatic and sociodemographic parameters . The prospect i ve influence of psychological factors has not been systematic ally investigated to date . Methods A total of 164 patients ( 138 of whom were women ) with a mean age of 45 years and a mean body mass index of 39.57 participated in a 1-year outpatient weight-reduction program at the Charité – Universitätsmedizin Berlin University Hospital . The program included movement therapy , dietary advice , psychoeducational and behavioral interventions , relaxation procedures , and consultations with a specialist in internal medicine and a psychologist . Patients also underwent regular laboratory and psychological testing . The results were evaluated using a t-test , χ2-test , and logistic regression analysis . Results Seventy-one of the 164 patients ( 61 women , mean age = 43 years , mean body mass index = 39.53 ) withdrew before the end of the program ( attrition rate = 43.3 % ) . While there were no differences between the somatic and metabolic characteristics of those who withdrew and those who remained , the sociodemographic and psychological factors had some relevance . In particular , “ expectation of self-efficacy ” ( Fragebogen zu Selbstwirksamkeit , Optimismus und Pessimismus [ SWOP ] ) , “ not working , ” “ tiredness ” ( Berliner Stimmungsfragebogen [ BSF ] ) , “ pessimism ” ( SWOP ) and “ positive reframing ” ( Brief-COPE ) were found to play a role in whether participants subsequently dropped out of the treatment . “ Support coping ” ( Brief-COPE ) and “ older age ” prior to the start of treatment were identified as variables that promoted treatment adherence . Conclusion The results are discussed in light of previous findings and with regard to whether the modules of the weight-reduction program should be adapted Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies OBJECTIVE To estimate the effect of intentional weight loss on mortality in overweight individuals with diabetes . RESEARCH DESIGN AND METHODS We performed a prospect i ve analysis with a 12-year mortality follow-up ( 1959 - 1972 ) of 4,970 overweight individuals with diabetes , 40 - 64 years of age , who were enrolled in the American Cancer Society 's Cancer Prevention Study I.  Rate ratios ( RRs ) were calculated , comparing overall death rates , and death from cardiovascular disease ( CVD ) or diabetes in individuals with and without reported intentional weight loss . RESULTS Intentional weight loss was reported by 34 % of the cohort . After adjustment for initial BMI , sociodemographic factors , health status , and physical activity , intentional weight loss was associated with a 25 % reduction in total mortality ( RR = 0.75 ; 95 % CI 0.67 - 0.84 ) , and a 28 % reduction in CVD and diabetes mortality ( RR = 0.72 ; 0.63 - 0.82 ) . Intentional weight loss  of 20 - 29 lb was associated with the largest 
    Output:
    
While the included publications had a moderate risk of bias score , which may inflate reported weight loss outcomes , the published data to date suggest that severely energy-restricted diets , delivered via diets of varying composition , effectively produce clinical ly relevant weight loss ( ≥10 % of initial body weight ) when used for 6 weeks or more in people with class III obesity