***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 
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    Input: BACKGROUND Few weight loss surgery trials have evaluated the changes in health-related quality of life ( HRQOL ) relative to obese individuals not participating in weight loss interventions . In a prospect i ve study at a bariatric surgery practice , we evaluated the 2-year changes in HRQOL in gastric bypass patients compared with 2 severely obese groups who did not undergo surgical weight loss .  METHODS A total of 308 gastric bypass patients were compared with 253 individuals who sought but did not undergo gastric bypass and 272 population -based obese individuals using the weight-related ( Impact of Weight on Quality of Life-Lite ) and general ( Medical Outcomes Study 36-item Short-Form Health Survey ) HRQOL question naires at baseline and 2 years of follow-up . RESULTS The percentage of weight loss was 34.2 % for the gastric bypass and 1.4 % for the no gastric bypass groups , with a .5 % gain for population -based obese group . Both measures of HRQOL showed greater improvements for the gastric bypass group , even after controlling for baseline differences . Effect sizes for changes in physical and weight-related HRQOL were very large for gastric bypass , but small to medium for the 2 comparison groups . Effect sizes for changes in the psychosocial aspects of HRQOL were moderate to very large for gastric bypass , but small for the 2 comparison groups . Of the gastric bypass patients , 97 % had meaningful improvements in the Impact of Weight on Quality of Life-Lite total score compared with 43 % of the no gastric bypass group and 30 % of the population -based obese group . CONCLUSION Dramatic improvements had occurred in weight-related and physical HRQOL for gastric bypass patients at 2 years after surgery compared with 2 severely obese groups who had not undergone surgery . These results support the effectiveness of gastric bypass surgery in improving patients ' HRQOL OBJECTIVES To prospect ively examine whether changes in smoking , heavy alcohol consumption , sedentary lifestyle , and obesity are associated with the risk of  erectile dysfunction .  METHODS Data were collected as part of a cohort study of a r and om sample of men 40 to 70 years old , selected from street listings in the Boston Metropolitan Area , Massachusetts .  In-home interviews were completed by 1709 men at baseline in 1987 to 1989 and 1156 men at follow-up in 1995 to 1997 ( average follow-up 8.8 years ) . Analyses included 593 men without erectile dysfunction at baseline , who were free of prostate cancer , and had not been treated for heart disease or diabetes . The incidence of moderate to complete erectile dysfunction was determined by discriminant analysis of responses to a self-administered sexual function question naire . RESULTS Obesity status was associated with erectile dysfunction ( P = 0.006 ) , with baseline obesity predicting a higher risk regardless of follow-up weight loss . Physical activity status was associated with erectile dysfunction ( P = 0.01 ) , with the highest risk among men who remained sedentary and the lowest among those who remained active or initiated physical activity . Changes in smoking and alcohol consumption were not associated with the incidence of erectile dysfunction ( P > 0.3 ) . CONCLUSIONS Midlife changes may be too late to reverse the effects of smoking , obesity , and alcohol consumption on erectile dysfunction . In contrast , physical activity may reduce the risk of erectile dysfunction even if initiated in midlife . Early adoption of healthy lifestyles may be the best approach to reducing the burden of erectile dysfunction on the health and well-being of older men Objective and Participants : The authors examined cognitive and affective dimensions of body image of a r and omized sample of 188 college men on the basis of body mass index ( BMI ) . Methods : They conducted chi-square tests and ANOVAs to determine differences between 4 BMI groups ( underweight , normal weight , overweight , and obese ) on demographics and body image measures . Results : The authors found significant differences in regard to total body image ( p < .001 ) , weight or shape concern ( p < .001 ) , and body dissatisfaction ( p < .001 ) . BMI was significantly correlated with negative body image . Overweight and obese participants reported significantly higher levels of negative body image than did normal- and underweight participants . Overweight participants reported significantly higher weight and shape concerns than did underweight , normal-weight , and obese participants . In regard to body dissatisfaction , underweight , overweight , and obese participants reported significantly higher levels of body dissatisfaction than that reported by normal-weight participants . Conclusions : BMI may be an important factor in identifying potential body image disorders in college-aged men INTRODUCTION Weight loss in sexually active women improves their quality of life . At present , no studies have investigated whether weight loss may affect female sexual function in severe obese women . AIM The aim of this study was to investigate the effects of different programs of weight loss on female sexual dysfunction complaints and on endothelial function in premenopausal obese females . METHODS Forty-four out of overall 80 obese fertile women ( age 18 - 49 years ; mean 36 years ) were enrolled because of sexual complaints at Female Sexual Function Index-6 ( FSFI-6 score ≤19 ) . Patients were then allocated to different treatments of 8 weeks duration each : an intensive residential program with hypocaloric diet plus controlled physical exercise along with lifestyle modifications at a specialized clinic ( Group A , N = 23 ) and a non-intensive outpatient clinic program consisting of hypocaloric diet and physical exercise at home ( Group B , N = 21 ) . Afterward , overall patients were allocated to an extended 8-week follow-up period consisting of outpatient clinic controlled diet plus physical exercise at home . MAIN OUTCOME MEASURES Primary end points were modifications of FSFI-6 scores and endothelial function as measured by reactive hyperemia ( RHI ) with EndoPat-2000 . Secondary end points were modifications in body composition as measured by dual-energy X-ray absorptiometry ( DEXA ) . RESULTS After 16 weeks , FSFI-6 score and the frequency of sexual activity were significantly higher in Group A compared with Group B ( P < 0.01 ) , and significant improvements in arousal , lubrication , and satisfaction sub-domain scores were also found ( P < 0.01 ) . Group A showed improvements in RHI ( P < 0.01 ) and marked improvement in homeostasis model assessment of insulin resistance ( P < 0.001 ) , anthropometric parameters as weight ( P < 0.01 ) , body mass index ( P < 0.01 ) , fat mass ( P < 0.0001 ) , and percentage of fat mass ( P < 0.005 ) compared with Group B. A relationship between peak insulin ( P < 0.0001 ) and RHI ( P < 0.001 ) vs. FSFI-6 scores was found , respectively . CONCLUSIONS A multidisciplinary approach to female obesity appears to be superior to conventional outpatient clinic to produce weight loss and to improve several aspects of sexual dysfunction  in obese women . Such changes might be related to persistent improvements in endothelial function and in insulin resistance INTRODUCTION AND OBJECTIVES Erectile dysfunction ( ED ) leads to psychological disturbances , especially anxiety and loss of self-esteem . We try to underst and the emotional changes , based on self-esteem and relationships in a group of Spanish men with ED after sildenafil treatment , with the use of the the SEAR question naire ( Self-Esteem And Relationship ) . MATERIAL S AND METHODS The patients recruited in Spain , where selected from an international , multicenter , r and omized , parallel-group , double-blind , placebo-controlled , sildenafil study design ed to assess self-esteem and relationships in men with ED . We compared the changes in the different domains of the SEAR question naire  ( Self-steem , sexual activity , self-confidence and general relationships ) that was administered before and after treatment ; the different domains of the IIEF was evaluated as well . We also calculated the correlation between changes in self-esteem domain of the SEAR question naire . The statistical study was based on an analysis of covariance of change in scores and a correlation analysis . RESULTS The Spanish group of research ers included 119 patients . The erectile function domain score showed significantly greater improvement for the group of sildenafil . The difference in change in total mean score of the SEAR after treatment was 16.9 ( 95 % CI 8.9 , 24.8 ) for sildenafil over placebo ( p=0.0001 ) , with a significantly higher score improvement in all the domains of the SEAR for Sildenafil . There was a significant correlation between the changes in the domain of self-esteem of the SEAR and the IIEF erectile function domain for both treatment groups . CONCLUSIONS Emotional improvement was confirmed in patients treated with sildenafil based on improved self-esteem , self-confidence and relationships . Changes in the IIEF erectile function domain correlate with the SEAR self-esteem domain Background : It is well known that selective serotonin reuptake inhibitors ( SSRIs ) can cause sexual dysfunction , so it is possible that sibutramine , a serotonin and norepinephrine reuptake inhibitor , could induce sexual dysfunction . Design and subjects : The effect of sibutramine on sexual function was evaluated in 46 overweight and obese ( body mass index ( BMI ) ⩾23 kg/m2 ) but otherwise healthy married women ( 28–44 years ) . Participants were r and omly assigned at baseline to either the sibutramine or control group . The Female Sexual Function Index ( FSFI ) question naire was used to assess sexual function at baseline and after treatment with behavioral therapy plus sibutramine 10 mg once daily or behavioral therapy alone ( control ) for 8 weeks . Results : Mean weight loss from baseline to week 8 was −6.03 % in sibutramine group and −0.38 % in the control group . There was significant improvement of FSFI total score , arousal domain score and lubrication domain score in the sibutramine group ( P<0.05 ) , and significant differences in arousal , orgasm , satisfaction domain score and total score ( P<0.05 ) in favor of sibutramine . Decreases in body weight and BMI were correlated with the improvement of arousal ( r=−0.44 and r=−0.48 , respectively ) and orgasm ( r=−0.45 and r=−0.46 , respectively ) domains . Conclusion : Treatment with sibutramine plus behavioral therapy did not induce sexual dysfunction and sibutramine-induced weight reduction appeared to have a positive impact on sexual function in this small group of overweight and moderately obese women . The degree of improvement in sexual function was correlated with the degree of weight reduction CONTEXT Healthy lifestyle factors are associated with maintenance of  erectile function in men . OBJECTIVE To determine the effect of weight loss and increased physical activity on erectile and endothelial functions in obese men . DESIGN , SETTING , AND PATIENTS R and omized , single-blind trial of 110 obese men ( body mass index > or = 30 ) aged 35 to 55 years , without diabetes , hypertension , or hyperlipidemia , who had erectile dysfunction that was determined by having a score of 21 or less on the International Index of Erectile Function ( IIEF ) . The study was conducted from October 2000 to October 2003 at a university hospital in Italy . INTERVENTIONS The 55 men r and omly assigned to the intervention group received detailed advice about how to achieve a loss of 10 % or more in their total body weight by reducing caloric intake and increasing their level of physical activity .  Men in the control group ( n = 55 ) were given general information about healthy food choices and exercise . MAIN OUTCOMES MEASURES Erectile function score , levels of cholesterol and triglycerides , circulating levels of interleukin 6 , interleukin 8 , and C-reactive protein , and endothelial function as assessed by vascular responses to l-arginine . RESULTS After 2 years , body mass index decreased more in the intervention group ( from a mean [ SD ] of 36.9 [ 2.5 ] to 31.2 [ 2.1 ] ) than in the control group ( from 36.4 [ 2.3 ] to 35.7 [ 2.5 ] ) ( P<.001 ) , as did serum concentrations of interleukin 6 ( P = .03 ) , and C-reactive protein ( P = .02 ) . The mean ( SD ) level of physical activity increased more in the intervention group ( from 48 [ 10 ] to 195 [ 36 ] min/wk ; P<.001 ) than in the control group ( from 51 [ 9 ] to 84 [ 28 ] min/wk ; P<.001 ) . The mean ( SD ) IIEF score improved in the intervention group ( from 13.9 [ 4.0 ] to 17 [ 5 ] ; P<.001 ) , but remained stable in the control group ( from 13.5 [ 4.0 ] to 13.6 [ 4.1 ] ; P = .89 ) . Seventeen men in the intervention group and 3 in the control group ( P = .001 ) reported an IIEF score of 22 or higher . In multivariate analyses , changes in body mass index ( P = .02 ) ,  physical activity ( P = .02 ) , and C-reactive protein ( P = .03 ) were independently associated with changes in IIEF score . CONCLUSION Lifestyle changes are associated with improvement in sexual function in 
    Output:
    
Research demonstrates an association between obesity , mental health , and sexual functioning , but has failed to identify casual pathways between these conditions .