***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 
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    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 This study examined the effects of dietary weight loss and exercise on the health-related quality of life ( HRQL ) of overweight and obese , older adults with knee osteoarthritis . A total of 316 older men and women with documented evidence of knee osteoarthritis were r and omly assigned to 1 of 4 18-month interventions : dietary weight loss , exercise , dietary weight loss and exercise , or healthy lifestyle control . Measures included the SF-36 Health Survey and satisfaction with body function and appearance . Results revealed that the combined diet and exercise intervention had the most consistent , positive effect on HRQL compared with the control group ; however , findings were restricted to measures of physical health or psychological outcomes that are related to the physical self BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older adults ; however , the appropriate treatment for obese older adults is controversial . METHODS In this 1-year , r and omized , controlled trial , we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese . Participants were r and omly assigned to a control group , a weight-management ( diet ) group , an exercise group , or a weight-management-plus-exercise ( diet-exercise ) group . The primary outcome was the change in score on the modified Physical Performance Test . Secondary outcomes included other measures of frailty , body composition , bone mineral density , specific physical functions , and quality of life . RESULTS A total of 93 participants ( 87 % ) completed the study . In the intention-to-treat analysis , the score on the Physical Performance Test , in which higher scores indicate better physical status , increased more in the diet-exercise group than in the diet group or the exercise group ( increases from baseline of 21 % vs. 12 % and 15 % , respectively ) ; the scores in all three of those groups increased more than the scores in the control group ( in which the score increased by 1 % ) ( P<0.001 for the between-group differences ) . Moreover , the peak oxygen consumption improved more in the diet-exercise group than in the diet group or the exercise group ( increases of 17 % vs. 10 % and 8 % , respectively ; P<0.001 ) ; the score on the Functional Status Question naire , in which higher scores indicate better physical function , increased more in the diet-exercise group than in the diet group ( increase of 10 % vs. 4 % , P<0.001 ) . Body weight decreased by 10 % in the diet group and by 9 % in the diet-exercise group , but did not decrease in the exercise group or the control group ( P<0.001 ) . Lean body mass and bone mineral density at the hip decreased less in the diet-exercise group than in the diet group ( reductions of 3 % and 1 % , respectively , in the diet-exercise group vs. reductions of 5 % and 3 % , respectively , in the diet group ; P<0.05 for both comparisons ) . Strength , balance , and gait improved consistently in the diet-exercise group ( P<0.05 for all comparisons ) . Adverse events included a small number of exercise-associated musculoskeletal injuries . CONCLUSIONS These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone . ( Funded by the National Institutes of Health ; Clinical Trials.gov number , NCT00146107 . ) Background To examine the effects of a 6 month lifestyle intervention on quality of life , depression , self-efficacy and eating behavior changes in overweight and obese endometrial cancer survivors . Methods Early stage endometrial cancer survivors were r and omized to intervention ( n = 23 ) or usual care ( n = 22 ) groups . Chi-square , Student 's t-test and repeated measures analysis of variance were used in intent-to-treat analyses . Outcomes were also examined according to weight loss . Results Morbidly obese patients had significantly lower self-efficacy , specifically when feeling physical discomfort . There was a significant improvement for self-efficacy related to social pressure ( p = .03 ) and restraint ( p = .02 ) in the LI group . There was a significant difference for emotional well-being quality of life ( p = .02 ) , self-efficacy related to negative emotions ( p < .01 ) , food availability ( p = .03 ) , and physical discomfort ( p = .01 ) in women who lost weight as compared to women who gained weight . Improvement in restraint was also reported in women who lost weight ( p < .01 ) . Conclusion This pilot lifestyle intervention had no effect on quality of life or depression but did improve self-efficacy and some eating behaviors . Trial Registration http://www . 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 , To examine the effect of treatment-induced weight loss on Health-Related Quality of Life ( HRQL )  , 38 mildly-to-moderately overweight persons recruited to participate in a study to examine the efficacy of a lifestyle modification treatment program  completed a sociodemographic question naire , the Beck Depression Inventory ( BDI ) , the Medical Outcomes Study Short-Form Health Survey ( SF-36 , as an assessment of HRQL ) , and underwent a series of clinical evaluations prior to treatment . After baseline evaluations , participants were r and omly assigned to either a program of lifestyle physical activity or a program of traditional aerobic activity . Participants again completed the SF-36 and BDI after the 13-week treatment program had ended . Weight loss averaged 8.6 ± 2.8 kg over the 13-week study . We found that weight loss was associated with significantly higher scores ( enhanced HRQL ) , relative to baseline , on the physical functioning , role-physical , general health , vitality and mental health domains of the SF-36 . The largest improvements were with respect to the vitality , general health perception and role-physical domains . There were no significant differences between the lifestyle and aerobic activity groups on any of the study measures . These data indicate that , at least in the short-term , weight loss appears to profoundly enhance HRQL Purpose The purpose of the study was to examine the impact of a 12-month weight loss intervention with either a low-carbohydrate or a low-fat diet on quality of life ( QOL ) among obese patients with type 2 diabetes . Methods Participants were enrolled in a r and omized trial comparing a low-carbohydrate to a low-fat diet in type 2 diabetes . QOL was assessed with the Diabetes-39 question naire , which measures QOL within 5 distinct scales : anxiety and worry , diabetes control , energy and mobility , social burden , and sexual functioning . Repeated measures ANOVA compared change in QOL scales at baseline and 6 and 12 months . Results Forty-six participants completed all measures . Following 12 months , there was a significant reduction in the scores related to sexual function and energy and mobility , suggesting improvement in QOL related to these domains . These changes were not significantly different between dietary arms . Changes in weight , A1C , and dietary composition were not significantly correlated with changes in QOL . Conclusions Participants with diabetes have various options for weight loss . Dietary interventions with either low-carbohydrate or low-fat diets may lead to some improvements in QOL in patients with type 2 diabetes Abstract Objective : As an adjunct to a reduced-calorie diet and increased physical activity , treatment with liraglutide 3.0 mg for weight management provides a statistically significant and clinical ly meaningful weight loss of 5.7%–8.0 % compared to 1.6%–2.6 % with placebo . The objective of this post hoc analysis was to quantify the relative contribution of weight loss to the treatment effects of liraglutide 3.0 mg on key efficacy endpoints . Methods : The analysis utilized data from 4725 participants across three r and omized , placebo-controlled , double-blind trials that evaluated the efficacy and safety of liraglutide 3.0 mg versus placebo , as an adjunct to a reduced-calorie diet and increased physical activity ( Clinical Trials.gov identifiers : NCT01272219 , NCT01272232 and NCT01557166 ) . The duration of two of the trials was 56 weeks ; one trial was of 32 weeks ’ duration . A mediation analysis was performed , which ranked the relative contribution of weight loss to the treatment effects of liraglutide 3.0 mg on key cardiometabolic efficacy endpoints , Apnea – Hypopnea Index ( AHI ) and health-related quality of life ( QoL ) . A limitation of this type of analysis is that it can not conclusively prove a causal relationship . Results : In individuals without type 2 diabetes mellitus ( T2DM ) , endpoints predominantly driven by liraglutide-induced weight loss included waist circumference , diastolic blood pressure , triglycerides , high density lipoprotein cholesterol , AHI , and Impact of Weight on Quality of Life – Lite total and physical function scores . Endpoints predominantly independent of weight loss included the glycemic endpoints hemoglobin A1c and fasting plasma glucose in individuals with and without T2DM . Regard 
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We found that in all population s , obesity was associated with significantly lower generic and obesity-specific HRQoL. The relationship between weight loss and improved HRQoL was consistently demonstrated after bariatric surgery , perhaps due to a greater than average weight loss compared with other treatments .
Improved HRQoL was evident after non-surgical weight loss , but was not consistently demonstrated , even in r and omized controlled trials .