***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: 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 OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors . METHODS In St Louis , Missouri from 2005 to 2006 , 151 employees ( 134 F , 17 M , 81 % overweight/obese ) participated in a cohort-r and omized trial comparing assessment s + intervention ( worksite A ) with assessment s only ( worksite B ) for 1 year . All participants received personal health reports containing their assessment results . The intervention was design ed to promote physical activity and favorable dietary patterns using pedometers , healthy snack cart , WeightWatchers(R ) meetings , group exercise classes , seminars , team competitions , and participation rewards . Outcomes included BMI , body composition , blood pressure , fitness , lipids , and Framingham 10-year coronary heart disease risk . RESULTS 123 participants , aged 45+/-9 yr , with BMI 32.9+/-8.8 kg/m(2 ) completed 1 year . Improvements ( P < or = 0.05 ) were observed at both worksites for fitness , blood pressure , and total- , HDL- , and LDL-cholesterol . Additional improvements occurred at worksite A in BMI , fat mass , Framingham risk score , and prevalence of the metabolic syndrome ; only the changes in BMI and fat mass were different between worksites . CONCLUSION A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors , but many of the improvements were achieved with worksite health assessment s and personalized health reports in the absence of an intervention BACKGROUND Studies of weight loss and changes in bone mineral density ( BMD ) have primarily been short-term trials in obese subjects . OBJECTIVE We examined the effects of a 5-yr intervention design ed to prevent menopausal weight gain or promote modest weight loss on BMD in premenopausal women participating in the Women 's Healthy Lifestyle Project . DESIGN We enrolled 373 premenopausal women ( age 44 - 50 yr ) and r and omly assigned them to either lifestyle intervention ( 175 women , low-fat dietary modification , weight loss , and physical activity intervention ) or control group ( 198 women ) .  BMD and body weight were measured at baseline , annual follow-up visits ( 18 , 30 , 42 , and 54 months ) , and two postintervention follow-ups ( 66 and 78 months ) . BMD was measured by dual x-ray absorptiometry . RESULTS Over the 54 months of intervention , women in the intervention group lost 0.4 kg , whereas control women gained 2.6 kg ( P = 0.011 ) . The intervention group experienced significantly greater hip bone loss ( -0.20%/yr ) than the control group ( -0.03%/yr ) . During the postintervention , differences in rates of bone loss disappeared . When considering both menopausal status and use of hormone therapy ( HT ) , the annualized BMD changes were lower in women reporting HT use ; nevertheless , among women on HT , those who lost more than 3 % body weight experienced greater total hip BMD loss ( -0.25%/yr ) compared with those who gained weight ( -0.02%/yr ) ( P = 0.025 ) . CONCLUSIONS Women r and omized to a lifestyle intervention aim ed at preventing menopausal weight gain or promoting modest weight loss experienced greater rates of hip bone loss than control women OBJECTIVE To evaluate the effectiveness of a lifestyle intervention for male workers in the construction industry at risk of cardiovascular disease ( CVD ) . METHODS In a r and omized controlled trial performed in the Netherl and s between 2007 and 2009 , usual care was compared to 6 months of individual counseling using motivational interviewing techniques , delivered face to face and by telephone . Participants aim ed at improving energy balance-related behavior or smoking cessation . Linear regression analyses were performed to determine the effects . RESULTS Body weight had significantly decreased at 6 ( β=-1.9 , 95 % CI -2.6 ; -1.2 ) and 12 months ( β=-1.8 , 95%CI -2.8 ; -1.1 ) . The intervention effects were also significant for diastolic blood pressure at 6 months ( β=-1.7 , 95 % CI -3.3 ; -0.1 ) . Among participants who had aim ed at energy balance , the intervention had a significant favorable effect on body weight at 6 ( β=-2.1 , 95 % CI -2.9 ; -1.3 ) and 12 months ( β=-2.2 , 95 % CI -3.1 ; -1.3 ) and at HDL cholesterol ( β=0.05 , 95 % CI 0.01 ; 0.10 ) and HbA1c ( β=-0.06 , 95%CI -0.12 ; -0.001 ) at 12 months , although there was no intervention effect on these variables over time . CONCLUSION Individual-based counseling result ed in significant beneficial long-term effects on body weight . This is an important finding for occupational health , considering the rising prevalence of obesity and CVD Obesity is associated with vascular endothelial dysfunction , as indicated by impaired endothelium-dependent dilation . Presently there is no direct evidence that energy intake – restricted weight loss alone improves conduit or resistance artery endothelium-dependent dilation , the mechanisms involved , or whether improvements differ with patient age . A total of 40 overweight or obese ( body mass index : ≥25<40 kg/m2 ) nondiabetic men and women aged 21 to 69 years completed 12 weeks of  reduced energy intake ( n=26 ; 15 male ) or attention control ( n=14 ; 9 male ) and 4 weeks of weight maintenance ( r and omized trial ) . Energy intake restriction  reduced estimated total energy intake ( 33 % ) , body weight ( 10.5 % ) , total and abdominal body fat , plasma leptin , oxidized low-density lipoprotein , and improved several metabolic risk factors . Brachial artery flow-mediated dilation was increased by 30 % ( 6.0±0.7 % versus 7.9±0.7%&Dgr ; ; P=0.01 ; n=17 ) . Peak forearm blood flow during intrabrachial artery infusion of acetylcholine was increased by 26 % ( 16.8±1.4 versus 21.1±1.9 mL/100 mL per minute ; P<0.05 ; n=15 ) ; this was inversely related to the reduction in the abdominal visceral : subcutaneous fat ratio ( r=−0.46 ; P<0.05 ) and was abolished by inhibition of NO synthesis with NG-monomethyl-l-arginine . Improvements in endothelium-dependent dilation were not related to age : mean increases in subjects > 50 years of age were similar to or greater than those < 50 years of age . Energy intake – restricted weight loss alone is an effective intervention for improving peripheral conduit and resistance artery endothelial function in young and older overweight/obese adults . The improvements in resistance artery function are mediated by an increase in NO bioavailability and are related to reductions in abdominal visceral fat Background The increased prevalence of overweight and obesity warrants preventive actions , particularly among people in transitional stages associated with lifestyle changes , such as occupational retirement . The purpose is to investigate the effect of a one year low-intensity computer-tailored energy balance programme among recent retirees on waist circumference , body weight and body composition , blood pressure , physical activity and dietary intake . Methods A r and omised controlled trial was conducted among recent retirees ( N = 413 ; mean age 59.5 years ) . Outcome measures were assessed using anthropometry , bio-impedance , blood pressure measurement and question naires . Results Waist circumference , body weight and blood pressure decreased significantly in men of the intervention and control group , but no significant between-group-differences were observed at 12 or at 24-months follow-up . A significant effect of the programme was only observed on waist circumference ( -1.56 cm ( 95%CI : -2.91 to -0.21 ) ) at 12 month follow up among men with low education ( n = 85 ) . Physical activity and dietary behaviours improved in both the intervention and control group during the intervention period . Although , these behaviours changed more favourably in the intervention group , these between-group-differences were not statistically significant . Conclusions The multifaceted computer-tailored programme for recent retirees did not appear to be effective . Apparently the transition to occupational retirement and /or participation in the study had a greater impact than the intervention programme . Trial registration Clinical Trials NCT00122213 Background Rising levels of obesity coupled with the limited success of currently available weight control methods highlight the need for investigation of novel approaches to obesity treatment . This study aims to determine the effectiveness and cost-effectiveness of an Internet-based re source for obesity management . Methods A r and omised controlled trial conducted in a community setting , where obese volunteers ( n = 221 ) were r and omly assigned to  Internet group ( n = 111 ) or usual care group ( n = 110 ) . Objective measures of weight and height were obtained . Question naires were used to collect dietary , lifestyle , physical activity and quality of life data . Data were collected at baseline , six months and 12 months . Results Data were collected on 54 ( 49 % ) participants in the Internet group and 77 ( 70 % ) participants in the usual care group at 12 months . Based on analysis conducted on all available data , the Internet group lost 1.3 kg , compared with 1.9 kg weight loss in the usual care group at 12 months , a non-significant difference ( difference = 0.6 kg ; 95 % CI : -1.4 to 2.5 , p = 0.56 ) . No significant differences in change in secondary outcome measures between the two groups at six or 12 months were revealed . Total costs per person per year were higher in the Internet group than the usual care group ( £ 992.40 compared to £ 276.12 ) , primarily due to the fixed costs associated with setting up the website , and QALYs were similar ( 0.78 and 0.77 ) for both groups . Conclusion This trial failed to show any additional benefit of this website in terms of weight loss or secondary outcome measures compared with usual care . High attrition and low compliance limits the results of this research . The results suggest that the Internet-based weight control re source was not a cost-effective tool for weight loss in the obese sample studied . Trail Registration IS RCT N 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 . 
    Output:
    
While there was no change in control group weight , control groups receiving usual care lost 1 kg more than control groups that received no intervention , beyond measurement .
Conclusions There are several possible explanations why control group changes occur in intervention trials targeting other behaviours , but not for weight loss .