human
***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 aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity ( PA ) and nutrition . In total , 924 participants enrolled in a 2-year cluster r and omized controlled trial , with departments ( n = 74 ) within companies ( n = 6 ) as the unit of r and omization . The intervention was compared with a st and ard programme consisting of a physical health check with face-to-face advice and personal feedback on a website . The intervention consisted of several additional website functionalities : action-oriented feedback , self-monitoring , possibility to ask questions and monthly e-mail messages . Primary outcomes were meeting the guidelines for PA and fruit and vegetable intake . Secondary outcomes were self-perceived health , obesity , elevated blood pressure , elevated cholesterol level and maximum oxygen uptake . Direct and indirect costs were calculated from a societal perspective , and a process evaluation was performed . Of the 924 participants , 72 % participated in the first and 60 % in the second follow-up . No statistically significant differences were found on primary and secondary outcomes , nor on costs . Average direct costs per participant over the 2-year period were € 376 , and average indirect costs were € 9476 . In conclusion , no additional benefits were found in effects or cost savings . Therefore , the programme in its current form can not be recommended for implementation OBJECTIVES We assessed the effects of a  worksite multiple-component intervention addressing diet and physical activity on employees ' mean body mass index ( BMI ) and the percentage of employees who were overweight or obese . METHODS This group-r and omized trial ( n = 3799 ) was conducted at 10 worksites in the northeastern United States . Worksites were paired and allocated into intervention and control conditions . Within- and between-groups changes in mean BMI s and in the percentage of overweight or obese employees were examined in a volunteer sample . RESULTS Within-group mean BMI s decreased by 0.54 kilograms per meter squared ( P = .02 ) and 0.12 kilograms per meter squared ( P = .73 ) at the intervention and control worksites , respectively , result ing in a difference in differences ( DID ) decrease of 0.42 kilograms per meter squared ( P = .33 ) . The within-group percentage of overweight or obese employees decreased by 3.7 % ( P = .07 ) at the intervention worksites and increased by 4.9 % ( P = .1 ) at the control worksites , result ing in a DID decline of 8.6 % ( P = .02 ) . CONCLUSIONS Our findings support a worksite population strategy that might eventually reduce the prevalence of overweight and obesity by minimizing environmental exposures to calorically dense foods and increasing exposures to opportunities for energy expenditure within worksite setting Background U.S. adults are at unprecedented risk of becoming overweight or obese , and most scientists believe the primary cause is an obesogenic environment . Worksites provide an opportunity to shape the environments of adults to reduce obesity risk . The goal of this group-r and omized trial was to implement a four-component environmental intervention at the worksite level to positively influence weight gain among employees over a two-year period . Environmental components focused on food availability and price , physical activity promotion , scale access , and media enhancements . Methods Six worksites in a U.S. metropolitan area were recruited and r and omized in pairs at the worksite level to either a two-year intervention or a no-contact control . Evaluations at baseline and two years included : 1 ) measured height and weight ; 2 ) online surveys of individual dietary intake and physical activity behaviors ; and 3 ) detailed worksite environment assessment . Results Mean participant age was 42.9 years ( range 18 - 75 ) , 62.6 % were women , 68.5 % were married or cohabiting , 88.6 % were white , 2.1 % Hispanic . Mean  baseline BMI  was 28.5 kg/m2 ( range 16.9 - 61.2 kg/m2 ) . A majority of intervention components were successfully implemented . However , there were no differences between sites in the key outcome of weight change over the two-year study period ( p = .36 ) . Conclusions Body mass was not significantly affected by environmental changes implemented for the trial . Results raise questions about whether environmental change at worksites is sufficient for population weight gain prevention . Trial Registration Clinical Trials.gov : OBJECTIVE To describe effects of 2 worksite health promotion programs for firefighters , both immediate outcomes and the long-term consequences for 4 years following the interventions . METHODS At baseline , 599 firefighters were assessed , r and omized by fire station to control and 2 different intervention conditions , and reevaluated with 6 annual follow-up measurements . RESULTS Both a team-centered peer-taught curriculum and an individual motivational interviewing intervention demonstrated positive effects on BMI , with team effects on nutrition behavior and physical activity at one year . Most differences between intervention and control groups dissipated at later annual assessment s. However , the trajectory of behaviors across time generally was positive for all groups , consistent with lasting effects and diffusion of program benefits across experimental groups within the worksites . CONCLUSIONS Although one-year programmatic effects did not remain over time , the long-term pattern of behaviors suggested these worksites as a whole were healthier more than 3 years following the interventions OBJECTIVE To describe the effectiveness , reach and implementation of a weight  gain  prevention intervention among public school employees . METHOD A multi-level intervention was tested in a cluster r and omized trial among 782 employees in 12 central Massachusetts public high schools from 2009 to 2012 . The intervention targeted the nutrition and physical activity environment and policies , the social environment and individual knowledge , attitudes and skills . The intervention was compared to a material s only condition . The primary outcome measures were change in weight and body mass index ( BMI ) at 24-month follow-up . Implementation of physical environment , policy and social environment strategies at the school and interpersonal levels , and intervention participation at the individual level were assessed . RESULTS At 24-month follow-up , there was a net change ( difference of the difference ) of -3.03 pounds ( p=.04 ) and of -.48 BMI units ( p=.05 ) between intervention and comparison conditions . The majority of intervention strategies were successfully implemented by all intervention schools , although establishing formal policies was challenging . Employee participation in programs targeting the physical and social environment was maintained over time . CONCLUSION This study supports that a multi-level intervention integrated within the organizational culture can be successfully implemented and prevent weight gain in public high school employees Background Insufficient PA has been shown to cluster with other CVD risk factors including insufficient fruit and vegetable intake , overweight , increased serum cholesterol concentrations and elevated blood pressure . This paper describes the development of Working on Wellness ( WOW ) , a worksite intervention program incorporating motivational interviewing by wellness specialists , targeting employees at risk . In addition , we describe the evaluation the effectiveness of the intervention among employees at increased risk for cardiovascular disease . Methods The intervention mapping ( IM ) protocol was used in the planning and design of WOW . Focus group discussion s and interviews with employees and managers identified the importance of addressing risk factors for CVD at the worksite . Based on the employees ’ preference for individual counselling , and previous evidence of the effectiveness of this approach in the worksite setting , we decided to use motivational interviewing as part of the intervention strategy . Thus , as a cluster-r and omised , controlled control trial , employees at increased risk for CVD ( N = 928 ) will be assigned to a control or an intervention group , based on company r and om allocation . The sessions will include motivational interviewing techniques , comprised of two face-to-face and four telephonic sessions , with the primary aim to increase habitual levels of PA .  Measures will take place at baseline , 6 and 12 months . Secondary outcomes include changes in nutritional habits , serum cholesterol and glucose concentrations , blood pressure and BMI . In addition , healthcare expenditure and absenteeism will be measured for the economic evaluation . Analysis of variance will be performed to determine whether there were significant changes in physical activity habits in the intervention and control groups at 6 and 12 months . Discussion The formative work on which this intervention is based suggests that the strategy of targeting employees at increased risk for CVD is preferred . Importantly , this study extends the work of a previous , similar study , Health Under Construction , in a different setting . Finally , this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders , who ultimately will be responsible for implementation of such an intervention . Trial registration United States Clinical Trails Register NCT Objective To determine the effectiveness of an individually-targeted Internet-based intervention with monetary incentives ( INCENT ) at reducing weight of overweight and obese employees when compared to a less-intensive intervention ( Livin ’ My Weigh [ LMW ] ) 6-months after program initiation . Design and Methods Twenty-eight worksites were r and omly assigned to either  INCENT  or LMW conditions . Both programs used evidence -based strategies to support weight loss . INCENT was delivered via daily e-mails over 12 months while LMW was delivered quarterly via both newsletters and onsite educational sessions . Generalized linear mixed models were conducted for weight change from baseline to 6-month post program and using an intention-to-treat ( ITT ) analysis to include all participants with baseline weight measurements . Results Across 28 worksites , 1,790 employees ( M=47 years of age ; 79 % Caucasian ; 74 % women ) participated . Participants lost an average of 2.27 lbs ( p<0.001 ) with a BMI decrease of 0.36 kg/m2 ( p<0.001 ) and 1.30 lbs ( p<0.01 ) and a BMI decrease of 0.20 kg/m2 ( p<0.01 ) in INCENT and LMW , respectively . The difference between INCENT and LMW group in weight loss and BMI reduction were not statistically significant . Conclusion The current study suggests that INCENT and a minimal intervention alternative may be effective approaches to help decrease the overall obesity burden within worksites Background Weight management constitutes a substantial problem particularly among groups of low socio-economic status . Interventions at work places may be a solution , but high quality worksite interventions documenting prolonged weight loss are lacking . This paper presents results of an intervention aim ed to achieve a 12 months weight loss among overweight health care workers . Methods Ninety-eight overweight female health care workers were r and omized into an intervention or a reference group . The intervention consisted of diet , physical exercise and cognitive behavioral training during working hours 1 hour/week . The reference group was offered monthly oral presentations . Several anthropometric measures , blood pressure , cardiorespiratory fitness , maximal muscle strength , and musculoskeletal pain were measured before and after the 12-months intervention period . Data were analyzed by intention-to-treat analysis . Results The intervention group significantly reduced body weight by 6 kg ( p < 0.001 ) , BMI by 2.2 ( p < 0.001 ) and body fat percentage by 2.8 ( p < 0.001 ) . There were no statistical reductions in the control group , result ing in significant differences between the two groups over time . Conclusions The intervention generated substantial reductions in body weight , BMI and body fat percentage among overweight female health care workers over 12 months . The positive results support the workplace as an efficient arena for weight loss among overweight females . Trial registration NCT01015716 OBJECTIVES To improve nutrition and physical activity of county employees and promote weight loss . DESIGN R and om assignment to begin the program when first offered or after 3 months ( " wait control " group ) . SETTING Worksite . PARTICIPANTS Onondaga County employees ( n = 45 ) at risk for diabetes ( n = 35 ) or with diabetes ( n = 10 ) . Mean ( ±SD ) age = 51.2 ( ± 8.0 ) years and body mass index ( BMI ) = 37.3 ± ( 6.8 kg/m ) . INTERVENTION Twelve weekly healthy lifestyle sessions based on the Diabetes Prevention Program curriculum , followed by monthly sessions for up to 12 months . OUTCOMES Medical : Weight , BMI , waist circumference , blood pressure , fasting glucose , lipid , and hemoglobin A1c levels . Psychosocial/behavioral : Health-related quality of life Short Form-12 , Impact of Weight on Quality of Life Scale ) , physical activity ( International Physical Activity Question naire ) , eating behavior ( 3-Factor Eating Question naire , National Cancer Institute Fat Screener ) , job satisfaction . RESULTS The intervention group lost significant weight compared to the wait control group over the first 3 months ( mean [ 95 % CI ] , -2.23 kg [ -3.5 to 0.97 ] ) vs [ + 0.73 kg ( + 0.17 to + 1.28 ) ] , with a decrease in BMI ( P < .001 ) and waist circumference ( P = .004 ) , an increase in physical activity ( International Physical Activity Question naire , P = .011 ) and lower dietary fat intake ( P = .018 ) . Over 12 months , 22.5 % ( 9/40 ) lost more than 5 % body weight and 12.5 % ( 5/40 ) lost more than 7 % body weight . After the first 3 months , there was gradual partial weight regain but reduction in waist circumference was maintained . The intervention group demonstrated significant improvement in Impact of Weight on Quality of Life Scale ( P < .001 ) , 3-Factor Eating ( cognitive restraint P < .001 , uncontrolled eating P = .003 , and emotional eating P = .001 ) , International Physical Activity Question naire ( P = .011 ) , and Short Form- 
    Output:
    
agent
Programs that had professionals frequently interact with participants , regardless if the interactions were done daily , weekly , or monthly , led to a change in body composition .
Additionally , programs that incorporated a motivation theory and provided content relevant to participants ' needs result ed in a change in body composition .
Conclusion Evidence supports that future worksite wellness programs that are design ed using a motivational theory and content that is created relevant to participants ' needs and that has frequent interactions with participants may result in a change in body composition
***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 aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity ( PA ) and nutrition . In total , 924 participants enrolled in a 2-year cluster r and omized controlled trial , with departments ( n = 74 ) within companies ( n = 6 ) as the unit of r and omization . The intervention was compared with a st and ard programme consisting of a physical health check with face-to-face advice and personal feedback on a website . The intervention consisted of several additional website functionalities : action-oriented feedback , self-monitoring , possibility to ask questions and monthly e-mail messages . Primary outcomes were meeting the guidelines for PA and fruit and vegetable intake . Secondary outcomes were self-perceived health , obesity , elevated blood pressure , elevated cholesterol level and maximum oxygen uptake . Direct and indirect costs were calculated from a societal perspective , and a process evaluation was performed . Of the 924 participants , 72 % participated in the first and 60 % in the second follow-up . No statistically significant differences were found on primary and secondary outcomes , nor on costs . Average direct costs per participant over the 2-year period were € 376 , and average indirect costs were € 9476 . In conclusion , no additional benefits were found in effects or cost savings . Therefore , the programme in its current form can not be recommended for implementation OBJECTIVES We assessed the effects of a  worksite multiple-component intervention addressing diet and physical activity on employees ' mean body mass index ( BMI ) and the percentage of employees who were overweight or obese . METHODS This group-r and omized trial ( n = 3799 ) was conducted at 10 worksites in the northeastern United States . Worksites were paired and allocated into intervention and control conditions . Within- and between-groups changes in mean BMI s and in the percentage of overweight or obese employees were examined in a volunteer sample . RESULTS Within-group mean BMI s decreased by 0.54 kilograms per meter squared ( P = .02 ) and 0.12 kilograms per meter squared ( P = .73 ) at the intervention and control worksites , respectively , result ing in a difference in differences ( DID ) decrease of 0.42 kilograms per meter squared ( P = .33 ) . The within-group percentage of overweight or obese employees decreased by 3.7 % ( P = .07 ) at the intervention worksites and increased by 4.9 % ( P = .1 ) at the control worksites , result ing in a DID decline of 8.6 % ( P = .02 ) . CONCLUSIONS Our findings support a worksite population strategy that might eventually reduce the prevalence of overweight and obesity by minimizing environmental exposures to calorically dense foods and increasing exposures to opportunities for energy expenditure within worksite setting Background U.S. adults are at unprecedented risk of becoming overweight or obese , and most scientists believe the primary cause is an obesogenic environment . Worksites provide an opportunity to shape the environments of adults to reduce obesity risk . The goal of this group-r and omized trial was to implement a four-component environmental intervention at the worksite level to positively influence weight gain among employees over a two-year period . Environmental components focused on food availability and price , physical activity promotion , scale access , and media enhancements . Methods Six worksites in a U.S. metropolitan area were recruited and r and omized in pairs at the worksite level to either a two-year intervention or a no-contact control . Evaluations at baseline and two years included : 1 ) measured height and weight ; 2 ) online surveys of individual dietary intake and physical activity behaviors ; and 3 ) detailed worksite environment assessment . Results Mean participant age was 42.9 years ( range 18 - 75 ) , 62.6 % were women , 68.5 % were married or cohabiting , 88.6 % were white , 2.1 % Hispanic . Mean  baseline BMI  was 28.5 kg/m2 ( range 16.9 - 61.2 kg/m2 ) . A majority of intervention components were successfully implemented . However , there were no differences between sites in the key outcome of weight change over the two-year study period ( p = .36 ) . Conclusions Body mass was not significantly affected by environmental changes implemented for the trial . Results raise questions about whether environmental change at worksites is sufficient for population weight gain prevention . Trial Registration Clinical Trials.gov : OBJECTIVE To describe effects of 2 worksite health promotion programs for firefighters , both immediate outcomes and the long-term consequences for 4 years following the interventions . METHODS At baseline , 599 firefighters were assessed , r and omized by fire station to control and 2 different intervention conditions , and reevaluated with 6 annual follow-up measurements . RESULTS Both a team-centered peer-taught curriculum and an individual motivational interviewing intervention demonstrated positive effects on BMI , with team effects on nutrition behavior and physical activity at one year . Most differences between intervention and control groups dissipated at later annual assessment s. However , the trajectory of behaviors across time generally was positive for all groups , consistent with lasting effects and diffusion of program benefits across experimental groups within the worksites . CONCLUSIONS Although one-year programmatic effects did not remain over time , the long-term pattern of behaviors suggested these worksites as a whole were healthier more than 3 years following the interventions OBJECTIVE To describe the effectiveness , reach and implementation of a weight  gain  prevention intervention among public school employees . METHOD A multi-level intervention was tested in a cluster r and omized trial among 782 employees in 12 central Massachusetts public high schools from 2009 to 2012 . The intervention targeted the nutrition and physical activity environment and policies , the social environment and individual knowledge , attitudes and skills . The intervention was compared to a material s only condition . The primary outcome measures were change in weight and body mass index ( BMI ) at 24-month follow-up . Implementation of physical environment , policy and social environment strategies at the school and interpersonal levels , and intervention participation at the individual level were assessed . RESULTS At 24-month follow-up , there was a net change ( difference of the difference ) of -3.03 pounds ( p=.04 ) and of -.48 BMI units ( p=.05 ) between intervention and comparison conditions . The majority of intervention strategies were successfully implemented by all intervention schools , although establishing formal policies was challenging . Employee participation in programs targeting the physical and social environment was maintained over time . CONCLUSION This study supports that a multi-level intervention integrated within the organizational culture can be successfully implemented and prevent weight gain in public high school employees Background Insufficient PA has been shown to cluster with other CVD risk factors including insufficient fruit and vegetable intake , overweight , increased serum cholesterol concentrations and elevated blood pressure . This paper describes the development of Working on Wellness ( WOW ) , a worksite intervention program incorporating motivational interviewing by wellness specialists , targeting employees at risk . In addition , we describe the evaluation the effectiveness of the intervention among employees at increased risk for cardiovascular disease . Methods The intervention mapping ( IM ) protocol was used in the planning and design of WOW . Focus group discussion s and interviews with employees and managers identified the importance of addressing risk factors for CVD at the worksite . Based on the employees ’ preference for individual counselling , and previous evidence of the effectiveness of this approach in the worksite setting , we decided to use motivational interviewing as part of the intervention strategy . Thus , as a cluster-r and omised , controlled control trial , employees at increased risk for CVD ( N = 928 ) will be assigned to a control or an intervention group , based on company r and om allocation . The sessions will include motivational interviewing techniques , comprised of two face-to-face and four telephonic sessions , with the primary aim to increase habitual levels of PA .  Measures will take place at baseline , 6 and 12 months . Secondary outcomes include changes in nutritional habits , serum cholesterol and glucose concentrations , blood pressure and BMI . In addition , healthcare expenditure and absenteeism will be measured for the economic evaluation . Analysis of variance will be performed to determine whether there were significant changes in physical activity habits in the intervention and control groups at 6 and 12 months . Discussion The formative work on which this intervention is based suggests that the strategy of targeting employees at increased risk for CVD is preferred . Importantly , this study extends the work of a previous , similar study , Health Under Construction , in a different setting . Finally , this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders , who ultimately will be responsible for implementation of such an intervention . Trial registration United States Clinical Trails Register NCT Objective To determine the effectiveness of an individually-targeted Internet-based intervention with monetary incentives ( INCENT ) at reducing weight of overweight and obese employees when compared to a less-intensive intervention ( Livin ’ My Weigh [ LMW ] ) 6-months after program initiation . Design and Methods Twenty-eight worksites were r and omly assigned to either  INCENT  or LMW conditions . Both programs used evidence -based strategies to support weight loss . INCENT was delivered via daily e-mails over 12 months while LMW was delivered quarterly via both newsletters and onsite educational sessions . Generalized linear mixed models were conducted for weight change from baseline to 6-month post program and using an intention-to-treat ( ITT ) analysis to include all participants with baseline weight measurements . Results Across 28 worksites , 1,790 employees ( M=47 years of age ; 79 % Caucasian ; 74 % women ) participated . Participants lost an average of 2.27 lbs ( p<0.001 ) with a BMI decrease of 0.36 kg/m2 ( p<0.001 ) and 1.30 lbs ( p<0.01 ) and a BMI decrease of 0.20 kg/m2 ( p<0.01 ) in INCENT and LMW , respectively . The difference between INCENT and LMW group in weight loss and BMI reduction were not statistically significant . Conclusion The current study suggests that INCENT and a minimal intervention alternative may be effective approaches to help decrease the overall obesity burden within worksites Background Weight management constitutes a substantial problem particularly among groups of low socio-economic status . Interventions at work places may be a solution , but high quality worksite interventions documenting prolonged weight loss are lacking . This paper presents results of an intervention aim ed to achieve a 12 months weight loss among overweight health care workers . Methods Ninety-eight overweight female health care workers were r and omized into an intervention or a reference group . The intervention consisted of diet , physical exercise and cognitive behavioral training during working hours 1 hour/week . The reference group was offered monthly oral presentations . Several anthropometric measures , blood pressure , cardiorespiratory fitness , maximal muscle strength , and musculoskeletal pain were measured before and after the 12-months intervention period . Data were analyzed by intention-to-treat analysis . Results The intervention group significantly reduced body weight by 6 kg ( p < 0.001 ) , BMI by 2.2 ( p < 0.001 ) and body fat percentage by 2.8 ( p < 0.001 ) . There were no statistical reductions in the control group , result ing in significant differences between the two groups over time . Conclusions The intervention generated substantial reductions in body weight , BMI and body fat percentage among overweight female health care workers over 12 months . The positive results support the workplace as an efficient arena for weight loss among overweight females . Trial registration NCT01015716 OBJECTIVES To improve nutrition and physical activity of county employees and promote weight loss . DESIGN R and om assignment to begin the program when first offered or after 3 months ( " wait control " group ) . SETTING Worksite . PARTICIPANTS Onondaga County employees ( n = 45 ) at risk for diabetes ( n = 35 ) or with diabetes ( n = 10 ) . Mean ( ±SD ) age = 51.2 ( ± 8.0 ) years and body mass index ( BMI ) = 37.3 ± ( 6.8 kg/m ) . INTERVENTION Twelve weekly healthy lifestyle sessions based on the Diabetes Prevention Program curriculum , followed by monthly sessions for up to 12 months . OUTCOMES Medical : Weight , BMI , waist circumference , blood pressure , fasting glucose , lipid , and hemoglobin A1c levels . Psychosocial/behavioral : Health-related quality of life Short Form-12 , Impact of Weight on Quality of Life Scale ) , physical activity ( International Physical Activity Question naire ) , eating behavior ( 3-Factor Eating Question naire , National Cancer Institute Fat Screener ) , job satisfaction . RESULTS The intervention group lost significant weight compared to the wait control group over the first 3 months ( mean [ 95 % CI ] , -2.23 kg [ -3.5 to 0.97 ] ) vs [ + 0.73 kg ( + 0.17 to + 1.28 ) ] , with a decrease in BMI ( P < .001 ) and waist circumference ( P = .004 ) , an increase in physical activity ( International Physical Activity Question naire , P = .011 ) and lower dietary fat intake ( P = .018 ) . Over 12 months , 22.5 % ( 9/40 ) lost more than 5 % body weight and 12.5 % ( 5/40 ) lost more than 7 % body weight . After the first 3 months , there was gradual partial weight regain but reduction in waist circumference was maintained . The intervention group demonstrated significant improvement in Impact of Weight on Quality of Life Scale ( P < .001 ) , 3-Factor Eating ( cognitive restraint P < .001 , uncontrolled eating P = .003 , and emotional eating P = .001 ) , International Physical Activity Question naire ( P = .011 ) , and Short Form- 
    Output:
    