***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: STUDY OBJECTIVE To determine whether long term weight gain and weight loss  are associated with subsequent risk of type 2 diabetes in overweight , non-diabetic adults . DESIGN Prospect i ve cohort . Baseline overweight was defined as BMI ⩾27.3 for women and BMI ⩾27.8 for men . Annual weight change ( kg/year ) over 10 years was calculated using measured weight at subjects ' baseline and first follow up examinations . In the 10 years after measurement of weight change , incident cases of diabetes were ascertained by self report , hospital discharge records , and death certificates . SETTING Community . PARTICIPANTS 1929 overweight , non-diabetic adults . MAIN RESULTS Incident diabetes was ascertained in 251 subjects .  Age adjusted cumulative incidence increased from 9.6 % for BMI < 29 to 26.2 % for BMI ⩾37 . Annual weight change over 10 years was higher in subjects who become diabetic compared with those who did not for all BMI < 35 . Relative to overweight people with stable weight , each kg of weight gained annually over 10 years was associated with a 49 % increase in risk of developing diabetes in the subsequent 10 years . Each kg of weight lost annually over 10 years was associated with a 33 % lower risk of diabetes in the subsequent 10 years .  CONCLUSIONS Weight gain  was associated with substantially increased risk of diabetes among overweight adults , and even modest weight loss was associated with significantly reduced diabetes risk . Minor weight reductions may have major beneficial effects on subsequent diabetes risk in overweight adults at high risk of developing diabetes Background Significant regression of coronary and femoral atherosclerotic lesions has been documented by angiographic studies using aggressive lipid-lowering treatment . This study tested the applicability and effects of intensive physical exercise and low-fat diet on coronary morphology and myocardial perfusion in nonselected patients with stable angina pectoris . Methods and Results Patients were recruited after routine coronary angiography for stable angina pectoris ; they were r and omized to an  intervention group ( n = 56 ) and a  control group on “ usual care ” ( n = 57 ) . Treatment comprised intensive physical exercise in group training sessions ( minimum , 2 hr/wk ) , daily home exercise periods ( 20 min/d ) , and low-fat , low-cholesterol diet ( American Heart Association recommendation , phase 3 ) . No lipid-lowering agents were prescribed . After 12 months of participation , repeat coronary angiography was performed ; relative and minimal diameter reductions of coronary lesions were measured by digital image processing . Change in myocardial perfusion was assessed by 201TI scintigraphy . In patients participating in the intervention group , body weight decreased by 5 % ( p<0.001 ) , total cholesterol by 10 % ( p<0.001 ) , and triglycerides by 24 % ( p<0.001 ) ; high density lipoproteins increased by 3 % ( p = NS ) . Physical work capacity improved by 23 % ( p<0.0001 ) , and myocardial oxygen consumption , as estimated from maximal rate-pressure product , by 10 % , ( p<0.05 ) . Stress-induced myocardial ischemia decreased concurrently , indicating improvement of myocardial perfusion . Based on minimal lesion diameter , progression of coronary lesions was noted in nine patients ( 23 % ) , no change in 18 patients ( 45 % ) , and regression in 13 patients ( 32 % ) . In the control group , metabolic and hemodynamic variables remained essentially unchanged , whereas progression of coronary lesions was noted in 25 patients ( 48 % ) , no change in 18 patients ( 35 % ) , and regression in nine patients ( 17 % ) . These changes were significantly different from the intervention group ( p<0.05 ) . Conclusions In patients participating in regular physical exercise and low-fat diet , coronary artery disease progresses at a slower pace compared with a control group on usual care Weight reduction was compared with metoprolol ( 200 mg daily ) in a r and omised placebo-controlled trial of first-line treatment of mild hypertension ( diastolic blood pressure 90 - 109 mm Hg ) in 56 overweight patients aged under 55 years . After 21 weeks of follow up the weight-reduction group had lost an average of 7.4 kg . The fall in their systolic pressure of 13 mm Hg was significantly greater than that in the placebo group ( 7 mm Hg ) but not different from that in the metoprolol group ( 10 mm Hg ) . Their fall in diastolic pressure ( 10 mm Hg ) was greater than that in both the metoprolol ( 6 mm Hg ) and placebo ( 3 mm Hg ) groups . At the end of the follow-up period 50 % of patients in the weight-reduction group had a diastolic pressure of less than 90 mm Hg . In the metoprolol group there was a decrease in high density lipoprotein (HDL)-cholesterol and an increase in the ratio of total to HDL-cholesterol ; in the weight-reduction group there was a decrease both in total cholesterol and in the ratio of total to HDL-cholesterol . Thus in this study population weight reduction produced significant and clinical ly important reductions in blood pressure but not the adverse effects on plasma lipids commonly associated with antihypertensive drug therapy 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 The Trial of Antihypertensive Interventions and Management is a multicenter r and omized trial design ed to examine the diastolic blood pressure response of various combinations of pharmacological and dietary interventions in the treatment of mild hypertension ( diastolic blood pressure 90 - 100 mm Hg ) . Eight hundred and seventy-eight participants at 110 - 160 % of ideal weight were r and omly allocated to nine drug/diet treatment groups receiving either a placebo , chlorthalidone ( 25 mg ) , or atenolol ( 50 mg ) , combined with a usual , a weight loss , or a low sodium/high potassium diet The primary outcome was diastolic blood pressure change from baseline to 6 months . Seven hundred and eighty-seven participants had follow-up data . The mean baseline diastolic blood pressure  was 93.8 mm Hg ; 55.9 % of the participants were male , and the weight loss diet group lost an average of 4.7 kg . Multiple comparisons were accounted for in the analysis . A significantly greater lowering of diastolic blood pressure ( 12.4 mm Hg ) was achieved in the atenolol group compared with either the low sodium/high potassium diet group ( 7.9 mm Hg , p=0.001 ) or weight loss group ( 8.8 mm Hg , p=0.006 ) . Adding weight loss to chlorthalidone significantly enhanced blood pressure lowering ( 15.1 mm Hg ) when compared with the diuretic alone ( 10.8 mm Hg , p=0.002 ) , but adding a low sodium/high potassium diet ( 12.2 mm Hg , p=0.029 ) did not In the short-term treatment of mild hypertension where diastolic blood pressure is the sole consideration , drugs outperform diet , and weight loss is beneficial , especially with diuretics Abstract The longitudinal observations for ten years on 5209 men and women aged 30–62 in Framingham , Massachusetts , have been used for a prospect i ve investigation of the epidemiology of gallbladder disease . ‘ Definite ’ gallbladder disease was diagnosed in 427 persons on the evidence of pathology reports , surgery , X-ray and hospital admissions and 116 were ‘ doubtful ’ , having only the diagnosis suggested by a physician without further verification . The overall incidence of gallbladder disease was about twice as high in women as in men , and it increased with age in both sexes without any evidence of an excess in the forties . Gallbladder disease was not related to ‘ fairness ’ as measured by national origin . Increase in weight and number of pregnancies were each associated with increased incidence . Despite the presence of cholesterol in many gallstones and the elevation of serum cholesterol often noted with obesity and during pregnancy , no relationship was demonstrated between serum cholesterol level and gallbladder disease . Hemoglobin level was also not related in the population studied . Women with lower systolic blood pressures showed a somewhat reduced risk of gallbladder disease , but the possibility that a mutual relationship to weight could explain this has not been excluded . Slight negative correlations were noted between the disease incidence and height , and alcohol and cigarette consumption . These were small and in general not statistically significant .  Dietary fat , protein and cholesterol intake , level of physical activity , age at menopause , marital status and precinct of residence were not related to gallbladder disease . Nor was an excess incidence noted in persons whose spouses had gallbladder disease . Persons entering the study with gallbladder disease showed no excess mortality . It is not yet clear whether such persons develop coronary heart disease at an excess rate . Potent environmental factors influencing the rate of development of gallbladder disease have yet to be identified . On the basis of present evidence , it would appear that more attention should be devoted to the anatomy and pathological physiology of the biliary tract in seeking a better underst and ing of the pathogenesis of gallbladder disease OBJECTIVES : To assess the weight-reducing effects and tolerability of 5 mg , 10 mg and 15 mg daily doses of sibutramine , a novel serotonin and noradrenaline reuptake inhibitor ( SNRI ) . DESIGN : Multicentre , double-blind , and placebo-controlled study . After a one week run-in period , patients were r and omized to receive placebo or sibutramine over a 12-week period . Advice on diet and behaviour modification was provided . One follow-up was conducted four weeks after cessation of treatment . SUBJECTS : 235 obese out patients , aged 18–65 y with a body mass index ( BMI ) within the range 27–40 kg/m . MEASUREMENTS : Weight , height , waist and hip circumference , and medical history , assessment of hunger , satiety , appetite and craving for sweet , savoury and carbohydrate foods , and also for carbohydrate snacking , st and ard laboratory assessment s , blood pressure , heart rate and ECG . RESULTS : The group mean ( ±s.e.m . ) weight loss at end-point was 1.4±0.5 kg for placebo ( n=59 ) , 2.4±0.5 kg for 5 mg sibutramine ( n=56 ) , 5.1±0.5 kg for 10 mg sibutramine ( n=59 ) and 4.9±0.5 kg ( n=62 ) for 15 mg sibutramine . The difference observed between the placebo and the 10 mg and 15 mg groups was statistically significant from week 2 onwards ( P<0.01 ) , but there was no significant difference between these sibutramine groups . The percentage of patients losing > 5 % of initial bodyweight was significantly greater for 15 mg sibutramine ( 55 % ) and 10 mg sibutramine ( 49 % ) than for treatment with placebo ( 19 % ) , ( P<0.001 ) . During the double-blind period , 41 patients ( 17 % ) withdrew prematurely and 168 patients ( 71 % ) reported  453 adverse events . The incidence and type of adverse event and the rates of withdrawal , were not significantly different in the four groups . No significant differences between the groups were observed , in respect of changes in systolic and diastolic blood pressure , but a significant increase in heart rate ( about 4 beats/min ) was noted for patients who received 10 mg or 15 mg sibutramine , compared with the placebo ( P<0.001 ) . CONCLUSION : These data demonstrate dose-related weight loss with sibutramine treatment for up to 12 weeks in obese patients . Doses of 10 mg and 15 mg once daily were shown to be similarly effective , well tolerated and significantly more effective than the placebo OBJECTIVES : To examine the impact on early and late weight loss of three different , initial very low calorie diet ( VLCD ) approaches in a one-year obesity treatment program . DESIGN : R and omised clinical trial . SUBJECTS : 121 obese subjects , aged 21–60 y , BMI ≥30.0 kg/m2 . INTERVENTIONS : The VLCD-strict group was prescribed a strict outpatient VLCD for 16 weeks , followed by a 36-week hypocaloric diet . The VLCD-mw group received the same treatment , but were hospitalised in a metabolic ward for the initial week . The VLCD-plus group was allowed two small meals weekly , but received otherwise the same recommendations as the VLCD-strict group . RESULTS : After 16 
    Output:
    
RESULTS The addition of the drugs orlistat or sibutramine was associated with weight loss and generally improved risk factors , apart from diastolic blood pressure for sibutramine .
Metformin was associated with decreased mortality after 10 years in obese people with type 2 diabetes .
Low-fat diets were associated with continuing weight loss for 3 years and improvements in risk factors , as well as prevention of type 2 diabetes and improved control of hypertension .
Insufficient evidence was available to demonstrate the benefits of low calorie or very low calorie diets .
The addition of an exercise or behaviour programme to diet was associated with improved weight loss and risk factors for at least 1 year .
Studies combining low-fat diets , exercise and behaviour therapy suggested improved hypertension and cardiovascular disease .
Family therapy was associated with improved weight loss for 2 years compared to individual therapy .
There was insufficient evidence to conclude that individual therapy was more beneficial than group therapy .
Weight lost more quickly ( within 1 year ) , from the epidemiology review , may be more beneficial with respect to the risk of mortality .
Weight loss from surgical and non-surgical interventions for people suffering from obesity was associated with decreased risk of development of diabetes , and a reduction in low-density lipoprotein cholesterol , total cholesterol and blood pressure , in the long term .
There was also suggestive evidence of cost saving from treatment of people with type 2 diabetes with metformin .
Targeting surgery on people with severe obesity and impaired glucose tolerance was likely to be more cost-effective at 2329 British pounds per additional life-year .
The drugs orlistat and sibutramine appear beneficial for the treatment of adults with obesity , and metformin for obese patients with type 2 diabetes .
Exercise and /or behaviour therapy appear to improve weight loss when added to diet .
Low-fat diets with exercise , or with exercise and behaviour therapy are associated with the prevention of type 2 diabetes and hypertension .
Long-term weight loss in epidemiological studies was associated with reduced risk of type 2 diabetes , and may be beneficial for cardiovascular disease .
Low-fat diets and exercise interventions in individuals at risk of obesity-related illness are of comparable cost to drug treatments .