***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: Background Obesity rates in adults continue to rise and effective treatment programs with a broad reach are urgently required . This paper describes the study protocol for a web-based r and omized controlled trial ( RCT ) of a commercially available program for overweight and obese adult males and females . The aim of this RCT was to determine and compare the efficacy of two web-based interventions for weight loss and maintenance of lost weight . Methods / Design Overweight and obese adult males and females were stratified by gender and BMI and r and omly assigned to one of three groups for 12-weeks : waitlist control , or basic or enhanced online weight-loss . Control participants were re-r and omized to the two weight loss groups at the end of the 12-week period . The basic and enhanced group participants had an option to continue or repeat the 12-week program . If the weight loss goal was achieved at the end of 12 , otherwise on completion of 24 weeks of weight loss , participants were re-r and omized to one of two online maintenance programs ( maintenance basic or maintenance enhanced ) , until 18 months from commencing the weight loss program . Assessment s took place at baseline , three , six , and 18 months after commencing the initial weight loss intervention with control participants repeating the initial assessment after three month of waiting . The primary outcome is body mass index ( BMI ) . Other outcomes include weight , waist circumference , blood pressure , plasma markers of cardiovascular disease risk , dietary intake , eating behaviours , physical activity and quality of life . Both the weight loss and maintenance of lost weight programs were based on social cognitive theory with participants advised to set goals , self-monitor weight , dietary intake and physical activity levels . The enhanced weight loss and maintenance programs provided additional personalized , system-generated feedback on progress and use of the program . Details of the method ological aspects of recruitment , inclusion criteria , r and omization , intervention programs , assessment s and statistical analyses are described . Discussion Importantly , this paper describes how an RCT of a currently available commercial online program in Australia addresses some of the short falls in the current literature pertaining to the efficacy of web-based weight loss programs . Australian New Zeal and Clinical Trials Registry ( ANZCTR ) number : Background Developed countries are facing a huge rise in the prevalence of obesity and its associated chronic medical problems . In the UK Primary Care Trusts are charged with addressing this in the population s they serve , but evidence about the most effective ways of delivering services is not available . The aim of this study is to determine the effectiveness of a range of weight loss programmes for obese patients in primary care and to determine the characteristics of patients who respond to an invitation to a free  weight  management programme . Methods / Design Lighten Up is a r and omised controlled trial comparing a range of 12-week commercial and NHS weight reduction programmes with a comparator group who are provided with 12 vouchers enabling free entrance to a local leisure centre . The weight reduction programmes are : ( i ) Weight Watchers , ( ii ) Slimming World , ( iii ) Rosemary Conley , ( iv ) a group-based dietetics-led programme ( Size Down ) , ( v ) general practice one-to-one counselling , ( vi ) pharmacy-led one-to-one counselling , ( vii ) choice of any of the 6 programmes .  People with obesity or overweight with a co-morbid disorder are invited to take part by a letter from their general practitioner . The sample size is 740 participants .The primary outcome is weight loss at programme-end ( 3 months ) . Secondary outcomes are weight-loss at one year , self-reported physical activity at 3 and 12 months follow-up and percentage weight-loss at 3 months and one year . Discussion This trial will provide evidence about the effectiveness of a range of different weight management programmes in a primary care population .Trial registration Current Controlled Trials IS RCT OBJECTIVE To test whether a weight loss program promotes greater weight loss , glycemic control , and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake . RESEARCH DESIGN AND METHODS This r and omized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling , with prepackaged foods in a planned menu during the initial phase , or to usual care ( UC ; two weight loss counseling sessions and monthly contacts ) . RESULTS Relative weight loss was 7.4 % ( 95 % CI 5.7–9.2 % ) , 9.0 % ( 7.1–10.9 % ) , and 2.5 % ( 1.3–3.8 % ) for the lower fat , lower carbohydrate , and UC groups ( P < 0.001 intervention effect ) . Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year ( fasting glucose 141 [ 95 % CI 133–149 ] vs. 159 [ 144–174 ] mg/dL , P = 0.023 ; hemoglobin A1c 6.9 % [ 6.6–7.1 % ] vs. 7.5 % [ 7.1–7.9 % ] or 52 [ 49–54 ] vs. 58 [ 54–63 ] mmol/mol , P = 0.001 ; triglycerides 148 [ 134–163 ] vs. 204 [ 173–234 ] mg/dL , P < 0.001 ) . The lower versus higher carbohydrate groups maintained lower hemoglobin A1c ( 6.6 % [ 95 % CI 6.3–6.8 % ] vs. 7.2 % [ 6.8–7.5 % ] or 49 [ 45–51 ] vs. 55 [ 51–58 ] mmol/mol ) at 1 year ( P = 0.008 ) . CONCLUSIONS The weight loss program result ed in greater weight loss and improved glycemic control in type 2 diabetes PURPOSE There have been few r and omized controlled trials of commercial weight-loss programs . This ongoing study compares the effects of a self-help program and a commercial program on weight loss and other measures of obesity in overweight and obese men and women . SUBJECTS AND METHODS We report the results of the first 26 weeks of a multicenter , r and omized , 2-year study of 423 subjects who had a body mass index of 27 to 40 kg/m(2 ) . Subjects were r and omly assigned to either a self-help program , consisting of two 20-minute sessions with a nutritionist and provision of printed material s and other self-help re sources , or to attendance at meetings of a commercial program ( Weight Watchers ) . Outcome measures were changes in body weight , body mass index , waist circumference , and body fat . Changes in serum homocysteine levels were measured in a sub sample of participants during the first 12 weeks . RESULTS After 26 weeks , subjects in the commercial program , as compared with those in the self-help program , had greater decreases in body weight [ mean ( + /- SD ) -4.8+/-5.6 vs -1.4+/-4.7 kg ] and body mass index ( -1.7+/-1.9 vs -0.5+/-1.6 kg/m(2 ) , both P<0.001 ) in intention-to-treat analyses . Among subjects measured at week 26 , mean waist circumference ( -4.3+/-10.5 vs -0.7+/-12.7 cm ) and fat mass ( -3.8 + /-7.0 vs -1.5+/-7.6 kg , both P<0.05 ) also decreased more among subjects in the commercial program .  Mean serum homocysteine levels improved in the commercial program compared with self-help ( -0.5+/-1.3 vs 0.9+/-1.8 microM , P<0.05 ) . CONCLUSIONS A structured commercial weight-loss program is more likely to be effective for managing moderately overweight patients than brief counseling and self-help OBJECTIVE To investigate the relative efficacy of four popular weight-loss programmes on plasma lipids and lipoproteins as measures of CVD risk . DESIGN A multi-centred , r and omised , controlled trial of four diets - Dr Atkins ' New Diet Revolution , The Slim-Fast Plan , Weight Watchers Pure Points programme and Rosemary Conley 's ' Eat yourself Slim ' Diet and Fitness Plan - against a control diet , in parallel for 6 months . SETTING AND SUBJECTS The trial was conducted at five universities across the UK ( Surrey , Nottingham , Ulster ( Coleraine ) , Bristol and Edinburgh ( Queen Margaret University College ) ) and involved the participation of 300 overweight and obese males and females aged 21 - 60 years in a community setting . RESULTS Significant weight loss was achieved by all dieting groups ( 5 - 9 kg at 6 months ) but no significant difference was observed between diets at 6 months . The Weight Watchers and Rosemary Conley ( low-fat ) diets were followed by significant reductions in plasma LDL cholesterol ( both -12.2 % after 6 months , P < 0.01 ) , whereas the Atkins ( low-carbohydrate ) and Weight Watchers diets were followed by marked reductions in plasma TAG ( -38.2 % and -22.6 % at 6 months respectively , P < 0.01 ) . These latter two diets were associated with an increase in LDL particle size , a change that has been linked to reduced CVD risk . CONCLUSIONS Overall , these results demonstrate the favourable effects of weight loss on lipid-mediated CVD risk factors that can be achieved through commercially available weight-loss programmes . No detrimental effects on lipid-based CVD risk factors were observed in participants consuming a low-carbohydrate diet OBJECTIVE : Cardiovascular disease is strongly associated with obesity and there is evidence that weight loss has positive effects on cardiovascular disease risk . The aims of this study were to compare meal replacements ( MR ) with a conventional low-fat diet as weight loss strategies and to examine the effect of weight loss on flow-mediated dilatation ( FMD ) and other markers of endothelial function in overweight Australians with raised triglycerides ( TG ) ( > 2 mmol/l ) . RESEARCH METHODS : Subjects matched for age , gender , fasting plasma TG and body mass index were r and omized to two low- fat high- carbohydrate weight loss strategies ( both < 6000 kJ ) , one using MR and the other a structured eating plan , control ( C ) . Subjects followed both diets for 3 months . In total , 55 subjects completed the study .  FMD , pulse wave velocity and blood pressure ( BP ) were measured at baseline and at 3 months , as were fasting blood sample s for lipids , glucose , insulin , C reactive protein ( CRP ) and endothelium-derived factors . RESULTS : Mean weight loss was 6.3±3.7 kg ( 6.0±4.2 vs 6.63±3.35 kg , MR vs C ) with no difference between diet groups . TG , insulin , CRP , plasminogen activator inhibitor 1 ( PAI-1 ) and soluble intracellular adhesion molecule-1 ( sICAM1 ) fell after weight loss , but FMD did not change . Systolic BP fell by 8 mmHg and pulse wave velocity improved . DISCUSSION : In subjects with elevated TG , weight loss result ed in significant improvements in cardiovascular risk markers , particularly endothelium-derived factors ( PAI-1 and sICAM1 ) . However , FMD did not improve with weight loss Commercial weight loss programs such as Weight Watchers ( WW ) offer widely recognized and accessible treatment , but typically produce weight losses that are modest relative to professionally delivered programs . This study tested the hypothesis that a novel weight loss approach that combined the fundamental components of professionally delivered behavioral weight loss ( BWL ) treatment with the existing WW program would produce better weight losses than WW alone ; no differences were expected between the novel treatment and BWL alone . Participants were 141 overweight and obese adults ( 90 % women , 67 % non-White , mean age = 49.7 ± 9.2 years , mean BMI = 36.2 ± 5.5 kg/m2 ) r and omly assigned to 48 weeks of BWL , 48 weeks of WW , or 12 weeks of BWL followed by 36 weeks of WW ( Combined Treatment , CT ) . Assessment s were conducted at baseline and weeks 12 , 24 , and 48 , with weight change as the primary outcome . Linear mixed model analysis showed that 24-week weight losses did not differ significantly between treatment groups ; however , weight losses at 48 weeks were greater in the WW group ( M=6.0 kg , SE=0.8 ) compared to the CT group ( M=3.6 kg , SE=0.8 ; p=0.032 ) , with BWL not significantly different from either ( M=5.4 kg , SE=0.8 ) . Further , a greater proportion of WW participants lost 10 % of baseline weight by 48 weeks compared to BWL or CT ( 36.7 % , 13.0 % , and 15.2 % , respectively , p’s<0.05 ) . This study shows that the WW program can produce clinical ly meaningful weight losses and provides no evidence that adding brief BWL to the WW program improves outcome Aims /hypothesisA diet low in saturated fatty acids and rich in wholegrains , vegetables and fruit is recommended in order to reduce the risk of obesity , cardiovascular disease and type 2 diabetes mellitus . However there is widespread interest 
    Output:
    
Results for SlimFast were mixed .
We found limited evidence to evaluate adherence or harms for all programs and weight outcomes for other commercial programs .