***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: This study examined the effects of calorie alternation and exercise on weight loss .  Moderately obese women ( 130 - 160 % of ideal body weight ) were r and omly assigned to an alternating- or constant-calorie diet with or without aerobic exercise . Both diets provided an average of 1200 kcal/d over a 12-wk period ; daily intake of subjects in the alternating-diet condition varied in a prescribed pattern from 600 to 1800 kcal/d . Exercising subjects walked 5 d/wk . All subjects participated in an intensive outpatient behavior-modification program . At the end of the study , exercised subjects had greater reductions in body weight and body fat percentage than did nonexercised subjects . The type of caloric restriction did not affect weight or fat loss . Changes in resting metabolic rate did not differ among groups . Alternating calories was neither beneficial nor detrimental as a weight-loss strategy whereas exercise was clearly beneficial in weight-loss therapy Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To compare two different very low calorie diet (VLCD)-based weight maintenance strategies . DESIGN AND SETTING A r and omized 2-year clinical trial performed at the Department of Body Composition and Metabolism , Sahlgrenska University Hospital , Sweden . SUBJECTS A total of 334 patients , body mass index ( BMI ) > 30 kg m-2 , aged 18 - 60 years . INTERVENTIONS All the patients started with 16 VLCD weeks . Subjects in the intermittent group were then scheduled to use VLCD for 2 weeks every third month , whilst patients in the on-dem and group were instructed to use VLCD whenever their body weight passed an individualized cut-off level . Irrespective of the treatment group , all the subjects were recommended a hypocaloric diet during VLCD-free periods . MAIN OUTCOME MEASURES Changes in body weight , body composition , anthropometric variables and cardiovascular risk factors . RESULTS Completers in both groups maintained highly significant weight losses after 2 years : 7.0 + /- 11.0 kg ( 6.2 + /- 9.5 % ) in the intermittent group and 9.1 + /- 9.7 kg ( 7.7 + /- 8.1 % ) in the on-dem and group ( P < 0.001 , ns between groups ) . Male completers in the on-dem and group lost significantly more weight than men in the intermittent group , 14.5 + /- 11.0 kg vs. 4.0 + /- 10.5 kg , respectively ( P < 0.01 ) . Most cardiovascular risk factors improved during the first year , whilst anthropometric measures , insulin , HDL- and LDL-cholesterol were also significantly improved after 2 years of treatment . CONCLUSION Clinical ly significant weight reductions were achieved after 2 years of VLCD-based treatment . The structure of VLCD treatment during the maintenance phase did not affect weight loss in the total study population , whilst male subjects might benefit from the VLCD on-dem and strategy AIMS Weight loss improves glycaemic control in type 2 diabetes mellitus ( T2DM ) . However , as achieving and maintaining weight loss is difficult , alternative strategies are needed . Our primary aim was to investigate the effects of intermittent energy restriction ( IER ) compared to continuous energy restriction ( CER ) on glycated haemoglobin A1c ( HbA1c ) . Secondary aims were to assess effects on weight loss , body composition , medication changes and subjective measures of appetite . Using a 2-day IER method , we expected equal improvements to HbA1c and weight in both groups . METHOD Sixty-three overweight or obese participants ( BMI 35.2±5kg/m2 ) with T2DM ( HbA1c 7.4±1.3 % ) ( 57mmol/mol ) were r and omised to a 2-day severe energy restriction ( 1670 - 2500kJ/day ) with 5days of habitual eating , compared to a moderate CER diet ( 5000 - 6500kJ/day ) for 12weeks . RESULTS At 12weeks HbA1c ( -0.7±0.9 % P<0.001 ) and percent body weight reduction ( -5.9±4 % P<0.001 ) was similar in both groups with no group by time interaction . Similar reductions were also seen for medication dosages , all measures of body composition and subjective reports of appetite . CONCLUSIONS In this pilot trial , 2days of IER compared with CER result ed in similar improvements in glycaemic control and weight reduction offering a suitable alternative treatment strategy PURPOSE To evaluate a year-long behavioral weight control program , used with and without an intermittent very-low-calorie diet ( VLCD ) in the treatment of type II diabetes mellitus . PATIENTS AND METHODS Subjects ( n = 93 ) were r and omly assigned to 50-week treatment programs that used either a balanced low-calorie diet ( LCD ) of 1,000 to 1,000 kilocalories ( kcal ) per day throughout or included 2 12-week periods of a VLCD of 400 to 500 kcal per day alternating with the balanced LCD .  Weight , glycemic control , blood pressure , and lipids were assessed at baseline , at the end of the year-long treatment , and at 2-year follow-up . RESULTS Subjects in the VLCD program lost significantly more weight than did LCD subjects at the end of the 50-week program ( 14.2 kg versus 10.5 kg ; P = 0.057 ) and remained off diabetes medication longer ( P < 0.05 ) . These benefits of the VLCD were due primarily to the first 12 weeks of the diet ; the second diet maintained , but did not increase , these effects . Subjects in both groups experienced marked improvements in glycemic control and cardiovascular risk factors over the year-long program , but attendance declined in the latter weeks of treatment and weight was regained . There was also marked recidivism in both groups in the year following treatment . CONCLUSIONS The intermittent VLCD improved weight loss and glycemic control , but these effects were quite modest and do not appear to justify the clinical use of an intermittent VLCD . Moreover , lengthening treatment to a full year did not prevent relapse . Thus , further research is needed to develop a successful approach to long-term weight control OBJECTIVE : To investigate the effectiveness of intensive innovative methods for implementing dietary prescriptions on weight management and glycaemic control in overweight men with Type II diabetes . DESIGN : A r and omised clinical trial with a 12-week intervention period — three isocaloric dietary intervention groups ( intermittent energy restriction , pre-portioned meals and self-selected meals ) each with weekly dietitian contact — and a follow-up visit after 18 months . SUBJECTS : A total of 51 men with Type II diabetes ( mean age 54 y , mean body mass index ( BMI ) 31.7 kg/m2 ) .  MEASUREMENTS : Weight , body composition , waist circumference , glycaemic control ( HbA1c ) and blood lipids . RESULTS : For all subjects , intensive diet therapy over the 12-week intervention period result ed in a mean reduction in energy intake of 2360±2780 kJ/day ( 564±665 kcal/day ) and significant reductions in weight ( 6.4±4.6 kg ) , waist circumference ( 8.1±4.6 cm ) , percent body fat ( 1.9±1.5 % ) , HbA1c ( 1.0±1.4 % ) and triglyceride levels ( 0.3±0.6 mmol/l ) compared to baseline levels . Intervention group did not affect clinical outcomes , with the exception of percent body fat . A total of 27 ( 52.9 % ) subjects attended the 18-month follow-up visit . At this visit , none of the improvements in clinical parameters was maintained , with all parameters returning to preintervention levels . CONCLUSIONS : A dietary prescription of 6000–7000 kJ/day ( 1400–1700 kcal/day ) was effective in achieving a 6 % weight loss and improving glycaemic control . The method of implementation made no difference to the outcomes between groups at 12 weeks or 18 months . Thus , we propose that it was the intensive weekly contact with a health professional in combination with moderate energy restriction that facilitated the successful short-term results seen OBJECTIVE Research on long-term maintenance of weight loss is hampered by the fact that relapse typically does not occur until after 6 months . We sought to determine whether relapses could be induced earlier by intentionally interrupting the momentum of weight loss during a treatment program and thus provide a model for weight maintenance research . RESEARCH METHODS AND PROCEDURES Subjects ( N = 142 ) were recruited at two centers and r and omly assigned to a control group , a long break group ( LB ) , or a short break group ( SB ) . The control group received a st and ard behavioral weight loss program with 14 weekly sessions ; the LB and SB groups received the same . However , the LB group took a 6-week break after lesson 7 , and the SB group took a 2-week break after lessons 3 , 6 , and 9 . Participants were instructed to stop all weight loss efforts during breaks . RESULTS Participants seemed to take breaks as prescribed , with interruptions in self-monitoring , dietary adherence , and self-weighing ( but not in exercise ) . However , participants quickly resumed these behaviors after the break . Breaks produced a slowing of weight loss or slight regain , but weight losses during the breaks were not significantly different from the control group . Importantly , overall weight losses ( 0 to 5 months or 0 to 11 months ) did not differ between conditions . DISCUSSION This study was not successful in developing a method to experimentally produce weight loss relapses . However , the finding that prescribed breaks do not have adverse effects may have clinical application Effective strategies are needed to help individuals  lose weight and maintain weight loss . The primary aim of this study was to investigate the effect of intermittent energy restriction ( IER ) compared to continuous energy restriction ( CER )  on weight loss after 8 weeks and weight loss maintenance after 12 months . Secondary aims were to determine changes in waist and hip measurements and diet quality . In a r and omized parallel study , overweight and obese ( body mass index [ BMI ] ≥ 27 kg m−2 ) women were stratified by age and BMI before r and omization . Participants undertook an 8‐week intensive period with weight , waist and hip circumference measured every 2 weeks , followed by 44 weeks of independent dieting . A food frequency question naire was completed at baseline and 12 months , from which diet quality was determined . Weight loss was not significantly different between the two groups at 8 weeks ( −3.2 ± 2.1 kg CER , n = 20 , −2.0 ± 1.9 kg IER , n = 25 ; P = 0.06 ) or at 12 months ( −4.2 ± 5.6 kg CER , n = 17 −2.1 ± 3.8 kg IER , n = 19 ; P = 0.19 ) . Weight loss between 8 and 52 weeks was –0.7 ± 49 kg CER vs. −1 ± 1.1 kg IER ; P = 0.6 . Waist and hip circumference decreased significantly with time ( P < 0.01 ) , with no difference between groups . There was an increase in the Healthy Eating Index at 12 months in the CER compared with the IER group ( CER 8.4 ± 9.1 vs. IER −0.3 ± 8.4 , P = 0.006 ) . This study indicates that intermittent dieting was as effective as continuous dieting over 8 weeks and for weight loss maintenance at 12 months . This may be useful for individuals who find CER too difficult to maintain Changes in weight , thyroid hormones and mood were examined in 15 obese ( 113 kg ) women over an 18-week period . After 4 weeks of a 1200 kcal/day diet , patients were r and omly assigned to one of two dietary conditions : very low calorie diet ( VLCD ) ( n = 8) or balanced deficit diet ( BDD ) ( n = 7 ) . VLCD patients consumed 400 kcal/day for 8 weeks and then gradually returned to a 1200 kcal/day diet . BDD patients consumed 1200 kcal/day for the entire 18 weeks . Differences in weight losses between the conditions were statistically significant only during the consumption of the VLCD . Serum T3 decreased by as much as 66 percent in VLCD patients during consumption of the 400 kcal/day diet , whereas rT3 increased by as much as 27 percent . T3 increased when patients were realimented with a 1000 kcal/day balanced diet but remained a significant 22 percent below baseline at the end of the study . BDD patients also showed marked reductions in T3 , as great as 40 percent , so that the differences between the two conditions were not statistically significant . Multiple regression analyses , collapsing across conditions ( n = 15 ) , indicated that weight loss at week 12 and baseline T3 accounted for 63 percent of the variance in the change in T3 at week 12 . Patients in both conditions showed improvements 
    Output:
    
Conclusions This systematic review in obese and overweight individuals showed that regular intermittent dieting  decreased lean mass compared to continuous dieting .
There were no differences in effects for either intermittent vs continuous interventions across all other outcomes .
In contrast to previous systematic review s , this study suggested that lean mass is better preserved in continuous dieting compared to regular intermittent dieting