***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 Despite a growing literature on the efficacy of behavioral weight loss interventions , we still know relatively little about the long terms effects they have on HRQL . Therefore , we conducted a study to investigate the immediate post-intervention ( 6 months ) and long-term ( 12 and 24 months ) effects of clinical ly based weight management programs on HRQL . Methods We conducted a r and omized clinical trial in which all participants completed a 6 month clinical weight loss program  and were r and omized into two 6-month extended care groups . Participants then returned at 12 and 24 months for follow-up assessment s. A total of 144 individuals ( 78 % women , M age = 50.2 ( 9.2 ) yrs , M BMI = 32.5 ( 3.8 ) kg/m2 ) completed the 6 month intervention and 104 returned at 24 months . Primary outcomes of weight and HRQL using the SF-36 were analyzed using multivariate repeated measures analyses . Results There was complete data on 91 participants through the 24 months of the study . At baseline the participants scored lower than U.S. age-specific population norms for bodily pain , vitality , and mental health . At the completion of the 6 month clinical intervention there were increases in the physical and mental composite measures as well as physical functioning , general health , vitality , and mental health subscales of the SF-36 . Despite some weight regain , the improvements in the mental composite scale as well as the physical functioning , vitality , and mental health subscales were maintained at 24 months . There were no significant main effects or interactions by extended care treatment group or weight loss group ( whether or not they maintained 5 % loss at 24 months ) . Conclusion A clinical weight management program focused on behavior change was successful in improving several factors of HRQL at the completion of the program and many of those improvements were maintained at 24 months . Maintaining a significant weight loss ( > 5 % ) was not necessary to have and maintain improvements in HRQL RATIONALE Obesity is the most important risk factor for obstructive sleep apnea ( OSA ) . However , although included in clinical guidelines , no r and omized controlled studies have been performed on the effects of weight reduction on mild OSA . OBJECTIVES The aim of this prospect i ve , r and omized controlled parallel-group 1-year follow-up study was to determine whether a very low calorie diet ( VLCD ) with supervised lifestyle counseling could be an effective treatment for adults with mild OSA . METHODS Seventy-two consecutive overweight patients ( body mass index , 28 - 40 ) with mild OSA were recruited . The intervention group ( n = 35 ) completed the VLCD program with supervised lifestyle modification , and the control group ( n = 37 ) received routine lifestyle counseling . The apnea-hypopnea index ( AHI ) was the main objective ly measured outcome variable . Change in symptoms and the 15D- Quality of Life tool were used as subjective measurements . MEASUREMENTS AND MAIN RESULTS The lifestyle intervention was found to effectively reduce body weight ( -10.7 + /- 6.5 kg ; body mass index , -3.5 + /- 2.1 [ mean + /- SD ] ) . There was a statistically significant difference in the mean change in AHI between the study groups ( P = 0.017 ) . The adjusted odds ratio for having mild OSA was markedly lowered ( odds ratio , 0.24 [ 95 % confidence interval , 0.08 - 0.72 ] ; P = 0.011 ) in the intervention group . All common symptoms related to OSA , and some features of 15D- Quality of Life improved after the lifestyle intervention . Changes in AHI were strongly associated with changes in weight and waist circumference . CONCLUSIONS VLCD combined with active lifestyle counseling result ing in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA , and the achieved beneficial outcomes are maintained at 1-year follow-up BACKGROUND Effective clinical weight management  approaches are needed to reach African-Americans . METHODS African-Americans recruited through outpatient practice s for a culturally-adapted Healthy Eating and Lifestyle Program were offered 10 weekly weight loss classes ( Phase 1 ) with the option of continuing for another 8 - 18 months ( Phase 2 ) in a r and omized comparison of further group counseling or staff-facilitated self-help vs. follow-up clinic visits only . RESULTS Of 237 enrollees ( 91 % women ; mean age 43.5 years ; mean body mass index 38.0 kg/m(2 ) ) , 70 [ corrected ] attended no classes or only the first Phase 1 class , 134 provided Phase 1 follow-up data , 128 were r and omized in Phase 2 , and 87 provided final follow-up data ( " completers " ) . Mean weight changes for completers were : -1.5 ( P < 0.001 ) , + 0.3 ( P = 0.47 ) , and -1.2 ( P = 0.04 ) kg , respectively , for Phase 1 , Phase 2 , and overall ( baseline to final visit ; average 18 months total duration ) , with no Phase 2 treatment effect ( P = 0.55 ) . Final study weight was > or = 5 % below baseline for 25 % of completers and was strongly predicted by Phase 1 weight loss . CONCLUSIONS Weight loss achieved in Phase 1 was maintained even with relatively minimal follow-up contact . Increasing the percent who achieve clinical ly significant weight loss initially would improve long-term results BACKGROUND Recommending increased physical activity facilitates long-term weight loss , but the optimal level of physical activity to recommend is unknown . OBJECTIVE The objective of the study was to evaluate the efficacy for long-term weight loss of recommendations for much higher physical activity than those normally used in behavioral treatments . DESIGN Overweight men and women ( n = 202 ) were r and omly assigned to either a st and ard behavior therapy ( SBT ) for obesity , incorporating an energy expenditure ( EE ) goal of 1000 kcal/wk , or to a high physical activity ( HPA ) treatment , in which the goal was an EE of 2500 kcal/wk . To help HPA treatment group participants achieve this high exercise goal , their treatment included encouragement to recruit 1 - 3 exercise partners into the study , personal counseling from an exercise coach , and small monetary incentives . RESULTS The HPA treatment group reported achieving higher mean ( + /- SD ) physical activity levels than did the SBT group at 6 mo ( EE of 2399 + /- 1571 kcal/wk compared with 1837 + /- 1431 kcal/wk ) , 12 mo ( EE of 2249 + /- 1751 kcal/wk compared with 1565 + /- 1309 kcal/wk ) , and 18 mo ( EE of 2317 + /- 1854 kcal/wk compared with 1629 + /- 1483 kcal/wk ) ( all P < 0.01 ) . Mean ( + /- SEM ) cumulative weight losses at 6 , 12 , and 18 mo in the HPA treatment group were 9.0 + /- 7.1 , 8.5 + /- 7.9 , and 6.7 + /- 8.1 kg , respectively . In the SBT group , the corresponding weight losses were 8.1 + /- 7.4 , 6.1 + /- 8.8 , and 4.1 + /- 7.3 kg , respectively . Between-group differences in weight loss were significant at 12 and 18 mo . CONCLUSION These results suggest that recommendations of higher levels of physical activity ( EE of 2500 kcal/wk ) promote long-term weight loss better than do conventional recommendations BACKGROUND Pregnancy and the postpartum period have been suggested as important contributors to overweight and obesity among women . This paper presents the design , rationale , and baseline participant characteristics of a r and omized controlled intervention trial to enhance weight loss in postpartum women who entered pregnancy overweight or obese . METHODS Active Mothers Postpartum ( AMP ) is based on the rationale that the birth of a child can be a teachable moment . AMP 's primary objectives are to promote and sustain a reduction in body mass index ( BMI ) up to 2 years postpartum via changes in diet and exercise behavior , with a secondary aim to assess racial differences in these outcomes . Women in the intervention arm participate in ten physical activity group sessions , eight healthy eating classes , and six telephone counseling sessions over a 9-month period . They also receive motivational tools , including a workbook with recipes and exercises , a pedometer , and a sport stroller . RESULTS Four hundred fifty women aged > or = 18 ( mean 30.9 ) , with a BMI > or = 25 kg/m(2 ) ( mean 33.0 ) at baseline ( 6 weeks postpartum ) were enrolled ; 45 % of the final sample are black and 53 % are white . Baseline characteristics by study arm and by race are presented . CONCLUSIONS Our intervention is design ed to be disseminated broadly to benefit the public health . Behavior change interventions based on principles of social cognitive theory , stage of readiness , and other models that coincide with a teachable moment , such as the birth of a child , could be important motivators for postpartum weight loss CONTEXT Rapid increases in access to the Internet have made it a viable mode for public health intervention . No controlled studies have evaluated this re source for weight loss . OBJECTIVE To determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site . DESIGN R and omized , controlled trial conducted from April to December 1999 . SETTING AND PARTICIPANTS Ninety-one healthy , overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m(2 ) . Analyses were performed for the 65 who had complete follow-up data . INTERVENTIONS Participants were r and omly assigned to a 6-month weight loss program of either Internet education ( education ; n = 32 with complete data ) or Internet behavior therapy ( behavior therapy ; n = 33 with complete data ) . All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss re sources . Participants in the behavior therapy group received additional behavioral procedures , including a sequence of 24 weekly behavioral lessons via e-mail , weekly online su bmi ssion of self-monitoring diaries with individualized therapist feedback via e-mail , and an online bulletin board . MAIN OUTCOME MEASURES Body weight and waist circumference , measured at 0 , 3 , and 6 months , compared the 2 intervention groups . RESULTS Repeated- measures analyses showed that the behavior therapy group lost more weight than the education group ( P = .005 ) . The behavior therapy group lost a mean ( SD ) of 4.0 ( 2.8 ) kg by 3 months and 4.1 ( 4.5 ) kg by 6 months . Weight loss in the education group was 1.7 ( 2.7 ) kg at 3 months and 1.6 ( 3.3 ) kg by 6 months . More participants in the behavior therapy than education group achieved the 5 % weight loss goal ( 45 % vs 22 % ; P = .05 ) by 6 months . Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months ( P = .001 ) and 6 months ( P = .005 ) . CONCLUSIONS Participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites . Thus , the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs Background The prevalence of overweight is increasing and its consequences will cause a major public health burden in the near future . Cost-effective interventions for weight control among the general population are therefore needed . The ALIFE@Work study is investigating a novel lifestyle intervention , aim ed at the working population , with individual counselling through either phone or e-mail . This article describes the design of the study and the participant flow up to and including r and omisation . Methods / Design ALIFE@Work is a controlled trial , with r and omisation to three arms : a control group , a phone based intervention group and an internet based intervention group . The intervention takes six months and is based on a cognitive behavioural approach , addressing physical activity and diet . It consists of 10 lessons with feedback from a personal counsellor , either by phone or e-mail , between each lesson . Lessons contain educational content combined with behaviour change strategies . Assignments in each lesson teach the participant to apply these strategies to every day life . The study population consists of employees from seven Dutch companies . The most important inclusion criteria are having a body mass index ( BMI ) ≥ 25 kg/m2 and being an employed adult . Primary outcomes of the study are body weight and BMI , diet and physical activity . Other outcomes are : perceived health ; empowerment ; stage of change and self-efficacy concerning weight control , physical activity and eating habits ; work performance/productivity ; waist circumference , sum of skin folds , blood pressure , total blood cholesterol level and aerobic fitness . A cost-utility- and a cost-effectiveness analysis will be performed as well . Physiological outcomes are measured at baseline and after six and 24 months . Other outcomes are measured by question naire at baseline and after six , 12 , 18 and 24 months . Statistical analyses for short term ( six month ) results are performed with multiple linear regression . Analyses for long term ( two year ) results are performed with multiple longitudinal regression . Anal 
    Output:
    
In general , weight loss appeared to be greater in the intervention groups than in the comparator groups .
In these studies there were no statistically significant differences in weight loss between interventions .
Long-term multicomponent weight management interventions were generally shown to promote weight loss in overweight or obese adults .
Weight changes were small however and weight regain was common .