***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: Weight losses and psychological well-being were examined at 30 months in 69 men and 61 women initially treated with behavior therapy as a function of ( a ) initial weight loss and ( b ) weight-loss goals .  Initial weight losses were positively , not negatively , related to weight loss at 30 months . Weight loss goals did not predict short-term or long-term weight loss . People who reached weight goals had better long-term weight losses than those who did not , but this finding was largely due to differences in initial weight loss . Psychological well-being at 30 months was not related to initial weight losses or goals . Although correlational rather than experimental , these results do not support the hypothesis that obese patients should be encouraged to set lower weight-loss goals BACKGROUND Weight loss medications are recommended as an adjunct to diet and exercise modification but seem to be prescribed as a monotherapy by many physicians . This practice is likely to be associated with suboptimal weight loss . METHODS This 1-year , r and omized trial compared the effects of sibutramine hydrochloride used alone ( ie , the drug-alone group ) to sibutramine plus group lifestyle modification , prescribed with either a 5021- to 6276-kJ/d diet ( 1200 - 1500-kcal/d diet ) ( ie , the drug-plus-lifestyle group ) or , for the first 4 months , a 4184-kJ/d diet ( 1000-kcal/d diet ( ie , drug-plus-lifestyle with a portion-controlled diet [ the combined treatment ] group ) . Participants were 53 women with a mean ( + /-SD ) age of 47.2 + /- 9.8 years and weight of 101.3 + /- 9.7 kg . At baseline , they reported the number of pounds they expected to lose at the end of treatment . RESULTS At month 12 , patients treated with the drug alone lost ( mean + /- SD ) 4.1 % + /- 6.3 % of their initial body weight compared with significantly ( P<.05 ) larger losses in the drug-plus-lifestyle group of 10.8 % + /- 10.3 % and the combined treatment group of 16.5 % + /- 8.0 % . Women in the 2 lifestyle groups achieved a significantly ( P<.05 ) greater percentage of their expected weight loss than those in the drug-alone group and were significantly more satisfied with the medication and with changes in weight , health , appearance , and self-esteem ( P<.05 for all ) . Significant reductions were observed at 12 months in triglyceride and low-density lipoprotein cholesterol levels but systolic and diastolic blood pressure both increased significantly ( P<.05 for all ) . CONCLUSION The addition of group lifestyle modification to the pharmacologic management of obesity significantly improved weight loss and patients ' satisfaction with treatment outcome OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE : To investigate , among women with obesity who have lost weight , the psychological factors associated with successfully maintaining the new lower weight , as opposed to weight regain . DESIGN : Qualitative research methods ( in-depth individual interviews and group interviews ) were used to assess the characteristics of successful weight maintainers , as compared with weight regainers and healthy-weight women . SUBJECTS : In all , 76 females were recruited from the community , comprising 28 formerly obese women who had lost weight and maintained their new lower weight for at least 1 y ; 28 obese women who had lost weight but regained the weight that they had lost ; and 20 women with a stable weight in the healthy range . RESULTS : Certain psychological factors were identified which characterised the regainers but not the maintainers . These factors were : failure to achieve weight goals and dissatisfaction with the weight achieved ; the tendency to evaluate self-worth in terms of weight and shape ; a lack of vigilance with regard to weight control ; a dichotomous ( black- and -white ) thinking style ; and the tendency to use eating to regulate mood . CONCLUSION : The results suggest that psychological factors may provide some explanation as to why many people with obesity  regain weight following successful weight loss . The factors identified in this study need to be examined further using prospect i ve design Participants in weight loss programs typically set unrealistically high weight loss goals that some believe are detrimental to success . This study examined outcomes associated with goal and ideal body mass index ( BMI ) .  Participants ( N=1801 ) were enrolled in a weight loss trial comprised of low-intensity mail or telephone interventions vs usual care .  Goal and ideal weight losses were assessed by asking participants how many pounds they expect to lose in the program ( goal ) and how much they would like to weigh ( ideal ) . Goal and ideal weight losses were unrealistically high ( men : −16 and −19 % , women : −21 and −27 % ) . For women , less realistic goals were associated with greater weight loss at 24 months . Goals were not associated with participation or weight loss for men . Results are more supportive of the idea that higher goals motivate women to lose weight than of the hypothesis that high goals undermine effort OBJECTIVE To examine cross-sectional correlates of current , goal , and dream weight and their prospect i ve associations with weight loss in treatment . RESEARCH METHODS AND PROCEDURES Goal and dream weights , demographic characteristics , and psychosocial factors were assessed by self-report question naire  in 302 adult women enrolled in a weight loss trial . Height and weight were assessed at baseline , after 8 weeks of active treatment , and at 6- and 18-month follow-up . Regression techniques examined associations among baseline , goal , and dream weights , psychosocial factors , and treatment outcomes . RESULTS On average , goal and dream weight losses were unrealistically high ( -24 % and -30 % , respectively ) . High goals were associated with greater expected effort and greater expected reward but were not associated with psychological distress . Goal and dream weight losses were only weakly associated with behavioral or weight outcomes . An association between higher dream weight losses and greater weight loss at 18 months was the only outcome result to reach statistical significance . DISCUSSION Results suggest that lack of realism in weight loss goals is not important enough to justify counseling people to accept lower weight loss goals when trying to lose weight Participants in weight-loss programs expect unreasonably large weight losses and believe that such reductions will produce dramatic improvements in their lives . The failure to achieve such benefits may contribute to poor maintenance of lost weight . This r and omized pilot study investigated a new cognitive-behavioral intervention design ed to modify unrealistic expectations regarding weight loss and its likely impact on appearance , attractiveness , and self-esteem .  Twenty-eight overweight and obese young women who completed 10 sessions of st and ard behavioral weight-loss treatment  were r and omly assigned to 10 additional sessions of either st and ard behavioral ( SB ) treatment or a reformulated cognitive-behavioral ( RCB ) treatment . At posttreatment , the RCB intervention produced more realistic weight-loss expectations , decreased participants ' motivation to lose weight as a means of improving self-confidence , and increased their overall self-esteem , compared with the SB condition ( all p's<.05 ) . The mean posttreatment weight changes achieved in the SB ( -6.2+/-4.5 kg ) and RCB ( -5.5+/-3.6 kg ) conditions were equivalent , as were the amounts of weight regained during a 6-month follow-up ( SB=2.3+/-2.7 kg ; RCB=1.5+/-1.7 kg ) . Collectively , these findings indicate that the RCB intervention was effective in changing unrealistic weight-loss expectations , but it did not produce significantly better maintenance of lost weight than did the SB intervention This study investigated whether informing obese individuals that they would lose only modest amounts of weight would lead them to adopt more realistic weight loss expectations . At a screening interview , 53 obese women reported that they expected to lose the equivalent of 28 % of their initial weight during 1 year of treatment with the medication sibutramine .  Prior to beginning treatment , participants were informed , both verbally and in writing , that they could expect to lose 5 % to 15 % of initial weight , the loss typically induced by current behavioral and pharmacologic approaches . This information , however , had little impact on their weight loss expectations when assessed on subsequent occasions . Results are discussed in terms of the origins , clinical significance , and potential malleability of obese individuals ' weight loss expectations OBJECTIVE To investigate the influence of weight loss expectations ( expected 1-year BMI loss , dream and maximum acceptable BMI ) on attrition in obese patients seeking treatment . RESEARCH METHODS AND PROCEDURES Obese subjects ( 1,785 ; 1,393 women ; median age , 46 years ; median BMI , 36.7 kg/m(2 ) ) seeking treatment in 23 medical Italian centers were evaluated . Baseline  diet  and  weight history , weight loss expectations , and primary motivation for seeking treatment ( health or improving appearance ) were systematic ally recorded . Psychiatric distress , binge eating , and body image dissatisfaction were tested at baseline by self-administered question naires ( Symptom Check List-90 , Binge Eating Scale , and Body Uneasiness Test ) .  Attrition and BMI change at 12 months were prospect ively recorded . RESULTS At 12 months , 923 of 1,785 patients ( 51.7 % ) had discontinued treatment . Compared with continuers , drop-outs had a significantly lower age , a lower age at first dieting , lower dream BMI , a higher expected 1-year BMI loss , and a higher weight phobia . At logistic regression analysis , the strongest predictors of attrition at 12 months were lower age and higher expected 1-year BMI loss . The risk of drop-out increased systematic ally for unit increase in expected BMI loss at 12 months ( hazard ratio , 1.12 ; 95 % confidence interval , 1.04 to 1.20 ; p = 0.0018 ) . The risk was particularly elevated in the first 6 months . DISCUSSION Baseline weight loss expectations are independent cognitive predictors of attrition in obese patients entering a weight-losing program ; the higher the expectations , the higher attrition at 12 months . Unrealistic weight goals should be tackled at the very beginning of treatment 
    Output:
    
RESULTS Findings were largely unclear .
The relationship between expectations and weight loss appears to change with time , whilst the findings from studies looking at weight regain suggest that there is no association .
The relationship between expectations with attendance/attrition is also unclear .