***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 In addition to an increased risk for chronic illnesses , obese individuals suffer from social stigmatization and discrimination , and severely obese people may experience greater risk of impaired psychosocial and physical functioning . Lower health-related quality of life ( HRQOL ) has been reported among obese persons seeking intensive treatment for their disease . To aid in the treatment of obesity , meal replacements have been recommended as an effective therapeutic strategy for weight loss , particularly when consumed in the beginning of an intervention . Hence , the objective of this study was to assess the impact of two 12-month weight reduction interventions ( one arm including a meal replacement ) on changes in HRQOL  among obese females . Methods This controlled trial compared two versions of a st and ardized 12-month weight reduction intervention : the weight-reduction lifestyle program without a meal replacement ( LS ) versus the same lifestyle program with the addition of a soy-based meal replacement product ( LSMR ) . 380 women ( LS : n = 190 , LSMR : n = 190 ) were matched by age , gender , and weight ( 51.4 ± 7.0 yrs . , 35.5 ± 3.03 kg/m2 ) . This sample of women all completed the 12-month lifestyle intervention that was part of a larger study . The lifestyle intervention included instruction on exercise/sport , psychology , nutrition , and medicine in 18 theoretical and 40 practical units . Led by a sport physiologist , participants engaged in group-based exercise sessions once or twice a week . To evaluate HRQOL , all participants completed the SF-36 question naire pre- and post-intervention . Anthropometric , clinical , physical performance ( ergometric stress tests ) , and self-reported leisure time physical activity ( hours/day ) data were collected . Results The LSMR sample showed lower baseline HRQOL scores compared to the LS sample in six of eight HRQOL dimensions , most significant in vitality and health perception ( p < 0.01 ) . After the intervention , body weight was reduced in both lifestyle intervention groups ( LS : -6.6±6.6 vs. LSMR -7.6±7.9 kg ) , however , weight loss and HRQOL improvements were more pronounced in the LSMR sample ( LSMR : seven of eight , LS : four of eight dimensions ) . Conclusions Our results show that HRQOL may improve among middle-aged obese females during a st and ardized lifestyle weight reduction program and may be enhanced by consuming a soy-based meal replacement product . Trial registration Clinical Trials.gov Background Although lifestyle interventions targeting multiple lifestyle behaviors are more effective in preventing unhealthy weight gain and chronic diseases than intervening on a single behavior , few studies have compared individual and combined effects of diet and /or exercise interventions on health-related quality of life ( HRQOL ) . In addition , the mechanisms of how these lifestyle interventions affect HRQOL are unknown . The primary aim of this study was to examine the individual and combined effects of dietary weight loss and /or exercise interventions on HRQOL and psychosocial factors ( depression , anxiety , stress , social support ) . The secondary aim was to investigate predictors of changes in HRQOL . Methods This study was a r and omized controlled trial . Overweight/obese postmenopausal women were r and omly assigned to 12 months of dietary weight loss ( n = 118 ) , moderate-to-vigorous aerobic exercise ( 225 minutes/week , n = 117 ) , combined diet and exercise ( n = 117 ) , or control ( n = 87 ) . Demographic , health and anthropometric information , aerobic fitness , HRQOL ( SF-36 ) , stress ( Perceived Stress Scale ) , depression [ Brief Symptom Inventory (BSI)-18 ] , anxiety ( BSI-18 ) and social support ( Medical Outcome Study Social Support Survey ) were assessed at baseline and 12 months . The 12-month changes in HRQOL and psychosocial factors were compared using analysis of covariance , adjusting for baseline scores . Multiple regression was used to assess predictors of changes in HRQOL . Results Twelve-month changes in HRQOL and psychosocial factors differed by intervention group . The combined diet + exercise group improved 4 aspects of HRQOL ( physical functioning , role-physical , vitality , and mental health ) , and stress ( p ≤ 0.01 vs. controls ) . The diet group increased vitality score ( p < 0.01 vs. control ) , while HRQOL did not change differently in the exercise group compared with controls . However , regardless of intervention group , weight loss predicted increased physical functioning , role-physical , vitality , and mental health , while increased aerobic fitness predicted improved physical functioning . Positive changes in depression , stress , and social support were independently associated with increased HRQOL , after adjusting for changes in weight and aerobic fitness . Conclusions A combined diet and exercise intervention has positive effects on HRQOL and psychological health , which may be greater than that from exercise or diet alone . Improvements in weight , aerobic fitness and psychosocial factors may mediate intervention effects on HRQOL.Trial Registration Clinical Trials , Clinical Trials.gov register , Abstract The aim of this study was to examine the effects of the addition of a resistance training programme to a caloric restriction weight loss intervention on psychosocial profile . The study sample consisted of 137 overweight and obese post-menopausal women . Participants were r and omized to a caloric restriction group and caloric restriction + resistance training group .  Psychosocial , anthropometric , and metabolic variables were measured before and after the 6-month weight loss intervention . Both groups presented similar weight loss and there were no significant differences between the caloric restriction group and caloric restriction + resistance training group for changes in psychosocial profile . Thereafter , all participants were classified into quintiles based on the amount of weight loss . In all quintiles , women markedly improved body esteem and self-esteem , and decreased hunger and perceived risk for diabetes mellitus ( P < 0.05 ) . However , significant increases in dietary restraint were observed in quintiles 2–5 ( ≥2.4 % body weight loss ) , decreases in disinhibition in quintiles 3–5 ( ≥4.9 % ) , increases in self-efficacy in quintiles 3–5 ( ≥4.9 % ) , and increases in health perceptions in quintile 5 ( ≥11.1 % ) . The results of this study do not support the hypothesis that the addition of a resistance training programme to a caloric restriction weight loss intervention has additional benefits on psychosocial profile . Overall , the significant improvements in the psychosocial profile observed were mostly accounted for by the degree of weight loss Aims /hypothesisA positive impact of exercise intervention programmes on quality of life ( QoL ) may be important for long-term patient compliance to exercise recommendations . We have previously shown that QoL improves significantly with supervised exercise , whereas it worsens with counselling alone , in patients with type 2 diabetes from the Italian Diabetes and Exercise Study ( IDES ) . Here , we report data on the relationship between changes in QoL and volume of physical activity/exercise in these individuals . Methods This multicentre parallel r and omised controlled , open-label , trial enrolled sedentary patients with type 2 diabetes ( n = 606 of 691 eligible ) in 22 outpatient diabetes clinics . Patients were r and omised by centre , age and diabetes treatment using a permuted-block design to twice-a-week supervised aerobic and resistance training plus exercise counselling ( exercise group ) versus counselling alone ( control group ) for 12 months . Health-related QoL was assessed by the 36-Item Short Form ( SF-36 ) Health Survey . Results In the exercise group ( n = 268 of 303 r and omised ) , there was a trend for increasing QoL with increasing exercise volume , with significant improvement of the physical component summary ( PCS ) measure only above 17.5 metabolic equivalents h−1 week−1 and a clear volume-relationship for the mental component summary ( MCS ) measure . A relationship with volume of physical activity also was observed in the control group ( n = 260 of 303 r and omised ) , despite overall deterioration of all scores . Independent correlates of improvements in both PCS and MCS were exercise volume , study arm and , inversely , baseline score . Conclusions /interpretationThis large trial shows a relationship between changes in physical and mental health-related QoL measures and volume of physical activity/exercise , with supervised exercise training also providing volume-independent benefits .Trial registration : IS RCT N-04252749 Funding : The study was funded by Lifescan SrL , Novo Nordisk Ltd , Bristol Myers Squibb Italy , Technogym SpA and Cosmed Context Observational studies have shown sustained weight loss after surgery for extreme obesity . No r and omized trial of contemporary surgical methods has been performed . Contribution The authors r and omly assigned 80 mildly to moderately obese ( body mass index , 30 to 35 kg/m2 ) adults to laparoscopic placement of an adjustable gastric b and or to an intensive nonsurgical weight loss program . After 2 years , the surgical group had lost 21.6 % of initial weight , and the nonsurgical group had lost 5.5 % of initial weight . Four patients required laparoscopic revision of the gastric b and . Caution s The study was not design ed to detect uncommon adverse events . Implication s Laparoscopic gastric b and ing is effective treatment for mild to moderate obesity . The Editors The development of a safe and effective treatment for obesity is a leading challenge in health care today . Obesity is an increasing health problem across the world with a prevalence of more than 20 % among the adult population in Western countries and more than 30 % in the United States ( 1 , 2 ) . The increasing prevalence is associated with a parallel increase of several obesity-related diseases , in particular , the diseases of the metabolic syndrome ( 3 , 4 ) , which include type 2 diabetes , hypertension , and dyslipidemia , and are linked to nonalcoholic steatohepatitis , obstructive sleep apnea , and the polycystic ovary syndrome . For obese individuals , the options are limited . Behavioral therapies of reduced energy intake , improved eating practice s , and increased exercise and activity , supplemented by pharmacotherapy , generally achieve only modest and often transient effects ( 5 , 6 ) . Observational studies have shown that bariatric surgical therapies involving gastric restriction by various forms of stapling with or without diversion of the gut to generate malabsorption of food are effective in achieving major weight loss and clinical ly significant improvements in health and quality of life ( 7 - 11 ) . Strong direct evidence from r and omized , controlled trials of the relative benefits of nonsurgical and surgical therapies is lacking . We are aware of only a single study , performed in the 1980s , in which 60 morbidly obese patients were r and omly assigned , without informed consent , to diet plus an early form of gastric stapling or to diet alone ( 12 ) . The maximum weight losses did not differ between the groups . However , the weight regain was greater in the diet-only group . The advent of the laparoscopic adjustable gastric b and has provided a new bariatric surgical option , which has proved to be safe , minimally invasive in its application , gentle in its use through its adjustability and easy reversibility , and similarly effective to the other bariatric procedures ( 10 , 13 , 14 ) . Figure 1 shows the LAP-B AND System ( INAMED Health , Santa Barbara , California ) and demonstrates the key feature of adjustability of the area within the b and through which it induces satiety ( 15 ) . Patients require no more than an overnight hospital stay , and the procedure has been shown to be markedly safer than gastric bypass surgery ( 13 ) . Figure 1 . The laparoscopic adjustable gastric b and ( LAP-B AND System , INAMED Health , Santa Barbara , California ) with no added fluid ( top ) and with 2 mL of fluid added ( bottom ) . We hypothesized that surgical therapy would induce more weight loss , health benefit , and improvement in quality of life than nonsurgical therapy and have conducted a r and omized , controlled trial comparing the effectiveness of current nonsurgical therapy with laparoscopic adjustable gastric b and ing in a group of mildly to moderately obese adults ( body mass index , 30 kg/m2 to 35 kg/m2 ) . We did not study patients with a body mass index greater than 35 kg/m2 because current observational data suggest that outcomes after nonsurgical treatment were unlikely to be equal to those after surgical care for these patients . The principal outcome measures were weight change , health , quality of life , and complications of therapy . Methods Patient Recruitment We recruited patients for the study through a newspaper advertisement . All patient assessment s and outpatient treatments were conducted at a community clinic dedicated to obesity management or in the clinics of a university department of surgery . Surgical procedures were conducted at a private community hospital experienced in the care of bariatric surgical patients . Patients in both groups did not pay any medical costs generated by the study . The human ethics committees of The Alfred Hospital and The Avenue Hospital approved the study in accordance with the guidelines of the National Health and Medical Research Council ( www.nhmrc.gov.au/publications/synopses/e35syn.htm ) and with the Helsinki Declaration of 1975 , as revised in 2000 ( www.wma.net/e/ethicsunit/pdf/draft_historical_contemporary_perspectives.pdf ) . Inclusion Criteria We considered patients to be eligible if they were between 20 and 50 years of age ; had a 
    Output:
    
Conclusions A definitive conclusion regarding the capacity of exercise to facilitate greater improvement in HRQOL than diet alone , or , to formulate an exercise prescription for obese adults to address HRQOL is not feasible based on the existing evidence .