***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: CONTEXT Obesity in the United States has increased dramatically during the past several decades . There is debate about optimum calorie balance for prevention of weight gain , and proponents of some low-carbohydrate diet regimens have suggested that the increasing obesity may be attributed , in part , to low-fat , high-carbohydrate diets . OBJECTIVES To report data on body weight in a long-term , low-fat diet trial for which the primary end points were breast and colorectal cancer and to examine the relationships between weight changes and changes in dietary components . DESIGN , SETTING , AND PARTICIPANTS R and omized intervention trial of 48,835 postmenopausal women in the United States who were of diverse background s and ethnicities and participated in the Women 's Health Initiative Dietary Modification Trial ; 40 % ( 19,541 ) were r and omized to the intervention and 60 % ( 29,294 ) to a control group . Study enrollment was between 1993 and 1998 , and this analysis includes a mean follow-up of 7.5 years ( through August 31 , 2004 ) . INTERVENTIONS The intervention included group and individual sessions to promote a decrease in fat intake and increases in vegetable , fruit , and grain consumption and did not include weight loss or caloric restriction goals . The control group received diet-related education material s. MAIN OUTCOME MEASURE Change in body weight from baseline to follow-up . RESULTS Women in the intervention group lost weight in the first year ( mean of 2.2 kg , P<.001 ) and maintained lower weight than control women during an average 7.5 years of follow-up ( difference , 1.9 kg , P<.001 at 1 year and 0.4 kg , P = .01 at 7.5 years ) . No tendency toward weight gain was observed in intervention group women overall or when stratified by age , ethnicity , or body mass index . Weight loss was greatest among women in either group who decreased their percentage of energy from fat . A similar but lesser trend was observed with increases in vegetable and fruit servings , and a nonsignificant trend toward weight loss occurred with increasing intake of fiber . CONCLUSION A low-fat eating pattern does not result in weight gain  in postmenopausal women . Clinical Trial Registration Clinical Trials.gov , NCT00000611 Diet and exercise studies of premenopausal women have shown reductions in obesity and other cardiovascular disease ( CVD ) risk factors . Forty-one healthy , moderately obese ( 120 - 140 % of ideal body weight , LBW ) , postmenopausal women ( 65.6 + /- 3.3 y ) participating in 24-wk diet or diet + exercise programs  were studied to determine whether similar CVD risk reduction would occur . Daily energy need ( DEN ) was estimated from basal energy expenditure and self-reported activity . The diet + exercise group ( n = 16 ) reduced their daily energy intake ( DEI ) by 2092 kJ from their DEN and expended 837 kJ/d in walking and resistance exercise . The two diet-only groups ( n = 13 and n = 12 ) reduced their DEI by 2092 and 2929 kJ from their DEN , respectively . Body weight , waist-to-hip and subscapula-to-triceps ratios , blood lipids ( total , low-density-lipoprotein , and high-density-lipoprotein cholesterol , and triacylglycerols ) , glucose , and insulin concentrations were measured at baseline and after 12 and 24 wk of diet and diet + exercise . Data were analyzed by using analysis of variance with repeated measures ( P < or = 0.05 ) and Tukey 's post hoc test . Loss of body weight was significant for all groups between baseline and 12 and 24 wk ( baseline : 79.3 + /- 7.6 kg ; 12 wk ; 75.1 + /- 7.7 kg ; 24 wk ; 72.8 + /- 8.0 kg ) but did not differ among groups . No significant time or treatment effects were observed between baseline and 24 wk for changes in mean blood lipid , glucose , and fasting insulin concentrations or measures of body fat distribution . Although 24 wk of diet or diet+exercise significantly reduced body weight in this group , this loss in body weight was not accompanied by a reduction of other commonly accepted CVD risks BACKGROUND The impact of a 6-month lifestyle change intervention on cardiovascular risk factors in obese , sedentary , postmenopausal women was examined . A secondary aim of this investigation was to determine whether the addition of self-control skills training to an empirically supported lifestyle change intervention would result in greater cardiovascular risk reduction . METHODS Forty-four women were r and omly assigned to receive either a lifestyle change or a lifestyle change with self-control skills intervention . Pretreatment and posttreatment weight loss , body composition , physical activity , cardiorespiratory fitness , diet , blood pressure ( BP ) , blood lipids , and psychosocial functioning were assessed . Also , at 1-year posttreatment , weight loss , body composition , self-reported physical activity , and psychosocial functioning were assessed . RESULTS The women significantly increased their physical activity ( + 39.6 % ) and cardiorespiratory fitness ( + 13.5 % ) and reduced their body weight ( -6.5 % ) , fat mass ( -7.4 % ) , body fat ( -2.4 % ) , BP ( SBP -6.2 % , DBP -9.2 % ) , total cholesterol ( -7.4 % ) , triglycerides ( -16.5 % ) , and low-density lipoprotein ( LDL ) cholesterol ( 9.1 % ) and improved their diet ( p < 0.05 ) . At the 1-year follow-up , women had regained approximately 63 % of their posttreatment weight loss ( p < 0.05 ) , but had maintained their previous increases in physical activity . Additionally , there were no significant changes in fat free mass , body fat , anxiety , or depression between the end of treatment and 1-year posttreatment . The addition of self-control skills training did not significantly improve cardiovascular risk reduction . CONCLUSIONS Lifestyle change interventions may be an effective means for reducing cardiovascular risk in obese , sedentary , postmenopausal women . However , greater attention should be devoted to the maintenance of these positive lifestyle changes The aim of this study was to study the influence of hormone replacement therapy ( HRT ) on weight changes , body composition , and bone mass in early postmenopausal women in a partly r and omized comprehensive cohort study design . A total of 2016 women ages 45 - 58 years from 3 months to 2 years past last menstrual bleeding were included . One thous and were r and omly assigned to HRT or no HRT in an open trial , whereas the others were allocated according to their preferences . All were followed for 5 years for body weight , bone mass , and body composition measurements . Body weight increased less over the 5 years in women r and omized to HRT ( 1.94 + /- 4.86 kg ) than in women r and omized to no HRT ( 2.57 + /- 4.63 , p = 0.046 ) . A similar pattern was seen in the group receiving HRT or not by their own choice . The smaller weight gain in women on HRT was almost entirely caused by a lesser gain in fat . The main determinant of the weight gain was a decline in physical fitness . Women opting for HRT had a significantly lower body weight at inclusion than the other participants , but the results in the self-selected part of the study followed the pattern found in the r and omized part . The change in fat mass was the strongest predictor of bone changes in untreated women , whereas the change in lean body mass was the strongest predictor when HRT was given . Body weight increases after the menopause . The gain in weight is related to a decrease in working capacity . HRT is associated with a smaller increase in fat mass after menopause . Fat gain protects against bone loss in untreated women but not in HRT-treated women . The data suggest that women 's attitudes to HRT are more positive if they have low body weight , but there is no evidence that the conclusions in this study are skewed by selection bias Objective : To evaluate the effect of moderate-intensity exercise on the occurrence and severity of  menopause symptoms . Design : A yearlong , r and omized , clinical trial , conducted in Seattle , WA , with 173 overweight , postmenopausal women not taking hormone therapy in the previous 6 months . The intervention was a moderate-intensity exercise intervention ( n = 87 ) versus stretching control group ( n = 86 ) . Using logistic regression , odds ratios comparing exercise with controls were calculated at 3 , 6 , 9 , and 12 months for menopause symptoms and their severity . Results : There was a significant increase in hot flash severity and decreased risk of memory problems in exercisers versus controls over 12 months , although the numbers affected were small . No other significant changes in symptoms were observed . Conclusions : Exercise does not seem to decrease the risk of having menopause symptoms in overweight , postmenopausal women not taking hormone therapy and may increase the severity of some symptoms in a small number of women Postmenopausal women are believed to have a higher risk of coronary artery disease than premenopausal women . In this study , we prospect ively determined changes in coronary risk factors that were attributable to natural menopause in 541 healthy , initially premenopausal women 42 to 50 years of age . After approximately 2 1/2 years , 69 women had spontaneously stopped menstruating for at least 12 months , and 32 women had stopped natural menstruation and received hormone-replacement therapy for a period of at least 12 months . An equal number of age-matched premenopausal women in the study group served as controls . In women who had a natural menopause and did not receive hormone-replacement therapy , serum levels of high-density lipoprotein ( HDL ) cholesterol declined as compared with those of premenopausal controls ( -0.09 vs. 0.00 mmol per liter ; P = 0.01 ) , and levels of low-density lipoprotein ( LDL ) cholesterol increased ( + 0.31 vs. + 0.14 mmol per liter ; P = 0.04 ) . In menopausal women who received hormone-replacement therapy , HDL and LDL cholesterol levels did not change , but the levels of triglycerides ( + 0.42 vs. -0.04 mmol per liter ; P less than 0.001 ) , apolipoprotein A-I ( + 0.18 vs. + 0.03 g per liter ; P less than 0.01 ) , and apolipoprotein A-II ( + 0.05 vs. -0.03 g per liter ; P less than 0.05 ) increased as compared with premenopausal controls . Natural menopause did not affect blood pressure , plasma glucose or insulin levels , body weight , the total number of kilojoules consumed in the diet , or the total number of kilojoules expended in physical activity . These results suggest that a natural menopause has an unfavorable effect on lipid metabolism , which may contribute to an increase in the risk of coronary disease .  Hormone-replacement therapy may prevent some of these changes OBJECTIVE To investigate whether fat distribution or sex hormone status in overweight postmenopausal women do influence the response to treatment of overweight . DESIGN Longitudinal , clinical intervention study of a 4.2 MJ diet daily with or without exercise . SUBJECTS 98 healthy , overweight , postmenopausal women ( age : 49 - 58 y , BMI : 25 - 42 kg/m2 ) . MEASUREMENTS Various fatness and fat distribution parameters ( by dual-energy x-ray absorptiometry and anthropometry ) , sex hormone-binding globulin ( SHBG ) , sex hormones , and the resting energy expenditure ( REE ) at baseline and after 3 months . RESULTS Reductions in weight and fat were independent of the initial fat distribution and the REE , but were significantly associated with high initial SHBG levels . Furthermore , loss of fat was significantly and independently associated with increases in SHBG and reductions in central fat distribution . CONCLUSION Postmenopausal women with an and roid and gynoid fat distribution respond with similar weight loss to treatment of overweight . Furthermore , a more healthy , less and roid , fat distribution and sex hormone status may be achieved with increasing weight loss OBJECTIVE The Women 's Health Trial : Feasibility Study in Minority Population s ( WHT : FSMP ) documented that a low-fat diet was associated with a reduced fat intake in older women of diverse ethnic background s. The purpose of the current study was to examine the effect of the low-fat diet on anthropometric and biochemical variables . DESIGN R and omized clinical trial in 2,208 postmenopausal women , 50 to 79 years of age . RESULTS The decrease in fat intake correlated directly with a decrease in body weight ( r=.22 , P<.001 ) . After 6 months , the intervention group had an average weight loss of 1.8 kg . Body mass index decreased 0.7 kg/m2 . Waist circumference decreased 1.8 cm . All of these changes were statistically significant , compared to changes in the control group ( P<.01 ) . Changes in systolic ( -3.1 mm Hg ) and diastolic ( -1.1 mm Hg ) blood pressures ( BP ) occurred in the intervention group . 
    Output:
    
All active-treatment arms demonstrated significant improvements in weight and body composition from baseline .
Significant effects between treatment groups were shown only in intervention versus control studies .
Significant weight loss was not accompanied by beneficial changes in cardiovascular risk factors in the majority of studies .
Lifestyle interventions do produce weight loss in overweight postmenopausal women and have the potential to improve disease outcomes associated with overweight