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: OBJECTIVE To examine the effect of a large , long st and ing and intentional weight reduction on the incidence of diabetes , hypertension and lipid disturbances in severely obese individuals as compared to weight-stable obese controls . RESEARCH METHODS AND PROCEDURES The ongoing prospect i ve SOS ( Swedish Obese Subjects ) intervention consists of a surgically treated group and a matched control group obtaining conventional obesity treatment . This report is based on 845 surgically treated patients and 845 controls ( BMI 41.0+/-4.6 kg/m2 ( mean+/-st and ard deviation [ S ] ) ) followed for 2 years . RESULTS Surgically treated patients lost 28+/-15 kg and controls 0.5+/-8.9 kg ( p<0.0001 ) . Two-year incidence of hypertension , diabetes , hyperinsulinemia , and lipid disturbances was compared in the two treatment groups . Adjusted odds ratios ( 95 % CI ) for the surgically treated group versus controls were 0.38 ( 0.22 , 0.65 ) for hypertension , 0.02 ( 0.00 , 0.16 ) for diabetes , 0.10 ( 0.03 , 0.28 ) for hyperinsulinemia , 0 . 10 ( 0.04 , 0.25 ) for hypertriglyceridemia , 0.28 ( 0.16 , 0.49 ) for low HDL-cholesterol and 1.24 ( 0.84 , 1.8 ) for hypercholesterolemia . Compared to controls , the 2-year recovery rates from hypertension , diabetes , hypo-HDL , and hypertriglyceridemia were significantly higher in the surgically treated group . DISCUSSION Intentional weight loss in the obese causes a marked reduction in the 2-year incidence of hypertension , diabetes and some lipid disturbances . The results suggest that severe obesity can and should be treated Although 40 % of US women indicate they are currently trying to lose weight , the association between intentional weight loss and longevity is unknown . The authors analyzed prospect i ve data from 43,457 overweight , never-smoking US white women aged 40 - 64 years who in 1959 - 1960 completed a question naire  that included questions on weight change direction , amount , time interval , and intentionality . Vital status was determined in 1972 . Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight . Women who died within the first 3 years of follow-up were excluded . Analyses were stratified by preexisting illness and adjusted for age , beginning body mass index , alcohol intake , education , physical activity , and health conditions . In women with obesity-related health conditions ( n = 15,069 ) , intentional weight loss  of any amount was associated with a 20 % reduction in all-cause mortality , primarily due to a 40 - 50 % reduction in mortality from obesity-related cancers ; diabetes-associated mortality was also reduced by 30 - 40 % in those who intentionally lost weight . In women with no preexisting illness ( n = 28,388 ) ,  intentional weight loss  of > or = 20 lb ( > or = 9.1 kg ) that occurred within the previous year was associated with about a 25 % reduction in all-cause , cardiovascular , and cancer mortality ; however , loss of < 20 lb ( < 9.1 kg ) or loss that occurred over an interval of > or = 1 year was generally associated with small to modest increases in mortality . The association between  intentional weight loss  and longevity in middle-aged overweight women appears to depend on their health status . Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality , whereas among women with no preexisting illness , the association is equivocal OBJECTIVE : To examine the effects of weight loss on health-related quality of life ( HRQL ) in subjects with severe obesity . DESIGN : Controlled clinical trial of the outcomes of surgical vs conventional weight reduction treatment . SUBJECTS : The first 487 surgical cases and their conventionally treated , matched controls were followed for two years in the Swedish Obese Subjects ( SOS ) intervention study . MEASUREMENTS : A battery of generic and study -specific self- assessment instruments or subscales was used to characterize HRQL in the severely obese ( BMI ) ≥34 kg/m2 for males and BMI ≥38 kg/m2 for females ) . Measures of general health perceptions ( general health rating index ; current health ) , mental well-being ( mood adjective check list ; pleasantness , activation and calmness ) , mood disorders ( hospital anxiety and depression scale ; anxiety and depression ) and social interaction ( sickness impact profile ) , were supplemented by obesity-specific modules on obesity-related psychosocial problems and eating behavior ( three-factor eating question naire ; restrained eating , disinhibition and perceived hunger ) . Assessment s were conducted prior to treatment and repeated after 6 , 12 and 24 months . RESULTS : Poor HRQL before intervention was dramatically improved after gastric restriction surgery , while only minor fluctuations in HRQL scores were observed in the conventionally treated controls . Peak values were observed in the surgical group at 6 or 12 months after intervention with a slight to moderate decrease at the two-year follow-up . The positive changes in HRQL after two years were related to the magnitude of weight loss , that is , the greater the weight reduction , the greater the HRQL improvements . Eating behavior improved accordingly . CONCLUSION : Quality of life in the severely obese is improved by substantial weight loss . Most patients benefit from weight reduction surgery , while HRQL in surgical patients with minor reduction in overweight is less positive . Further research is needed to determine outcome predictors of the surgical management of severe obesity and to ensure that HRQL improvements are maintained The efficacy of three gastric restriction operations were compared in a prospect i ve r and omized study of 310 morbidly obese subjects . The median patient age was 34 years ( range , 18 to 62 years ) . They were predominantly female ( 13:1 ) and had a median pre-operative weight that was 198 % of their ideal weight ( range , 160 % to 318 % ) . There was an equitable dispersion of perceived risk factors between the groups under study and there were no deaths during the perioperative period . Compliance with follow-up at 3 years was 91 % . When success was defined as a loss of more than 50 % of excess weight or a current pregnancy , the success rates at 3 years were 17 % for gastrogastrostomy , 48 % for vertical gastroplasty , and 67 % for Roux-en-Y gastric bypass ( p less than 0.001 ) . Although the gastric bypass operation took longer to perform , there were similar outcome patterns for the three groups during the postoperative period . We conclude that the Roux-en-Y gastric bypass is the preferred procedure for the surgical treatment of morbid obesity Objective This report documents that the gastric bypass operation provides long-term control for obesity and diabetes .  Summary Background Data Obesity and diabetes , both notoriously resistant to medical therapy , continue to be two of our most common and serious diseases . Methods Over the last 14 years , 608 morbidly obese patients underwent gastric bypass  , an operation that restricts caloric intake by ( 1 ) reducing the functional stomach to approximately 30 mL , ( 2 ) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet , and ( 3 ) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy . Even though many of the patients were seriously ill , the operation was performed with a perioperative mortality and complication rate of 1.5 % and 8.5 % , respectively . Seventeen of the 608 patients ( <3 % ) were lost to follow-up . Results Gastric bypass provides durable weight control . Weights fell from a preoperative mean of 304.4 lb ( range , 198 to 615 lb ) to 192.2 lb ( range , 104 to 466 ) by 1 year and were maintained at 205.4 lb ( range , 107 to 512 lb ) at 5 years , 206.5 lb ( 130 to 388 lb ) at 10 years , and 204.7 lb ( 158 to 270 lb ) at 14 years . The operation provides long-term control of non-insulin-dependent diabetes mellitus ( NIDDM ) . In those patients with adequate follow-up , 121 of 146 patients ( 82.9 % ) with NIDDM and 150 of 152 patients ( 98.7 % ) with glucose impairment maintained normal levels of plasma glucose , glycosylated hemoglobin , and insulin . These antidiabetic effects appear to be due primarily to a reduction in caloric intake , suggesting that insulin resistance is a secondary protective effect rather than the initial lesion . In addition to the control of weight and NIDDM , gastric bypass also corrected or alleviated a number of other comorbidities of obesity , including hypertension , sleep apnea , cardiopulmonary failure , arthritis , and infertility Background : We have demonstrated that obstructive sleep apnea ( OSA ) is prevalent in 60 % of patients undergoing bariatric surgery .  A study was conducted to determine whether weight loss following bariatric surgery ameliorates OSA . Methods : All 100 consecutive patients with symptoms of OSA were prospect ively evaluated by polysomnography before gastric bypass . Preoperative and postoperative scores of Epworth Sleepiness Scale ( ESS ) , Respiratory Disturbance Index ( RDI ) , and other parameters of sleep quality were compared using t-test . Results : Preoperative RDI was 40±4 ( normal 5 events/hour , n=100 ) . 13 patients had no OSA , 29 had mild OSA , while the remaining 58 patients were treated preoperatively for moderate-severe OSA . At a median of 6 months follow-up , BMI and ESS scores improved ( 38±1 vs 54±1 kg/m2 , 6±1 vs 12±0.1 , P<0.001 , postoperatively vs preoperatively ) . To date , 11 patients have completed postoperative polysomnography ( 3 - 21 months ) after losing weight ( BMI 40±2 vs 62±3 kg/m2 , P<0.001).There was significant improvement in ESS ( 3±1 vs 14±2 ) , minimum O2 saturation ( SpO2 86±2 vs 77±5 ) , sleep efficiency ( 85±2 % vs 65±5 % ) , all P<0.001 , postop vs preop ; and RDI ( 56±13 vs 23±7 , P=0.041 ) . Regression analysis demonstrated no correlation between preoperative BMI , ESS score and the severity of OSA ; and no correlation between % excess body weight loss and postoperative RDI . Conclusion : Weight loss following gastric bypass results in profound improvement in OSA . The severity of apnea can not be reliably predicted by preoperative BMI and ESS ; therefore , patients with symptoms of OSA should undergo polysomnography The purpose of the study was to examine the gastrointestinal hormone responses to meals in morbidly obese patients before and after Roux-en-Y gastric bypass ( GBP ; n = 9 ) or vertical b and ed gastroplasty ( VBG ; n = 7 ) . On consecutive days before and after operation , we measured changes in peripheral blood levels of glucose , insulin , enteroglucagon , serotonin , vasoactive intestinal polypeptide ( VIP ) , and cholecystokinin ( CCK ) in response to a st and ardized glucose or protein-fat meal . The percentage of excess weight lost at 6 months after operation was 66.3 % + /- 4 % and 41.8 % + /- 5 % for GBP and VBG , respectively ( p less than 0.01 ) . The 3-hour integrated glucose response to a glucose meal decreased from 145.3 + /- 33.7 to 75.8 + /- 15.7 g min/L ( p less than 0.02 ) after GBP . This was associated with a decrease in 3-hour integrated insulin response from 22.8 + /- 8.2 to 10.5 + /- 4.9 mU min/L. Vertical b and ed gastroplasty patients had lesser reductions of hyperglycemia and hyperinsulinemia . Neither the CCK , serotonin , nor VIP responses to meals were altered by either operation . The 3-hour integrated enteroglucagon response to glucose increased markedly in GBP patients after operation from 11.8 + /- 6 to 133.4 + /- 38 nmol min/mL ( p less than 0.02 ) . This increase in enteroglucagon occurred at the same time as development of dumping symptoms , which occurred exclusively in GBP patients after glucose but not protein . We conclude that ( 1 ) GBP surgery for morbid obesity results in amelioration of glucose intolerance and hyperinsulinemia , ( 2 ) CCK does not mediate an endocrine satiety effect of surgery , ( 3 ) 
    Output:
    
agent
Effective weight loss was achieved in morbidly obese patients after undergoing  bariatric surgery .
A substantial majority of patients with diabetes , hyperlipidemia , hypertension , and obstructive sleep apnea experienced complete resolution or improvement
***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: OBJECTIVE To examine the effect of a large , long st and ing and intentional weight reduction on the incidence of diabetes , hypertension and lipid disturbances in severely obese individuals as compared to weight-stable obese controls . RESEARCH METHODS AND PROCEDURES The ongoing prospect i ve SOS ( Swedish Obese Subjects ) intervention consists of a surgically treated group and a matched control group obtaining conventional obesity treatment . This report is based on 845 surgically treated patients and 845 controls ( BMI 41.0+/-4.6 kg/m2 ( mean+/-st and ard deviation [ S ] ) ) followed for 2 years . RESULTS Surgically treated patients lost 28+/-15 kg and controls 0.5+/-8.9 kg ( p<0.0001 ) . Two-year incidence of hypertension , diabetes , hyperinsulinemia , and lipid disturbances was compared in the two treatment groups . Adjusted odds ratios ( 95 % CI ) for the surgically treated group versus controls were 0.38 ( 0.22 , 0.65 ) for hypertension , 0.02 ( 0.00 , 0.16 ) for diabetes , 0.10 ( 0.03 , 0.28 ) for hyperinsulinemia , 0 . 10 ( 0.04 , 0.25 ) for hypertriglyceridemia , 0.28 ( 0.16 , 0.49 ) for low HDL-cholesterol and 1.24 ( 0.84 , 1.8 ) for hypercholesterolemia . Compared to controls , the 2-year recovery rates from hypertension , diabetes , hypo-HDL , and hypertriglyceridemia were significantly higher in the surgically treated group . DISCUSSION Intentional weight loss in the obese causes a marked reduction in the 2-year incidence of hypertension , diabetes and some lipid disturbances . The results suggest that severe obesity can and should be treated Although 40 % of US women indicate they are currently trying to lose weight , the association between intentional weight loss and longevity is unknown . The authors analyzed prospect i ve data from 43,457 overweight , never-smoking US white women aged 40 - 64 years who in 1959 - 1960 completed a question naire  that included questions on weight change direction , amount , time interval , and intentionality . Vital status was determined in 1972 . Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight . Women who died within the first 3 years of follow-up were excluded . Analyses were stratified by preexisting illness and adjusted for age , beginning body mass index , alcohol intake , education , physical activity , and health conditions . In women with obesity-related health conditions ( n = 15,069 ) , intentional weight loss  of any amount was associated with a 20 % reduction in all-cause mortality , primarily due to a 40 - 50 % reduction in mortality from obesity-related cancers ; diabetes-associated mortality was also reduced by 30 - 40 % in those who intentionally lost weight . In women with no preexisting illness ( n = 28,388 ) ,  intentional weight loss  of > or = 20 lb ( > or = 9.1 kg ) that occurred within the previous year was associated with about a 25 % reduction in all-cause , cardiovascular , and cancer mortality ; however , loss of < 20 lb ( < 9.1 kg ) or loss that occurred over an interval of > or = 1 year was generally associated with small to modest increases in mortality . The association between  intentional weight loss  and longevity in middle-aged overweight women appears to depend on their health status . Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality , whereas among women with no preexisting illness , the association is equivocal OBJECTIVE : To examine the effects of weight loss on health-related quality of life ( HRQL ) in subjects with severe obesity . DESIGN : Controlled clinical trial of the outcomes of surgical vs conventional weight reduction treatment . SUBJECTS : The first 487 surgical cases and their conventionally treated , matched controls were followed for two years in the Swedish Obese Subjects ( SOS ) intervention study . MEASUREMENTS : A battery of generic and study -specific self- assessment instruments or subscales was used to characterize HRQL in the severely obese ( BMI ) ≥34 kg/m2 for males and BMI ≥38 kg/m2 for females ) . Measures of general health perceptions ( general health rating index ; current health ) , mental well-being ( mood adjective check list ; pleasantness , activation and calmness ) , mood disorders ( hospital anxiety and depression scale ; anxiety and depression ) and social interaction ( sickness impact profile ) , were supplemented by obesity-specific modules on obesity-related psychosocial problems and eating behavior ( three-factor eating question naire ; restrained eating , disinhibition and perceived hunger ) . Assessment s were conducted prior to treatment and repeated after 6 , 12 and 24 months . RESULTS : Poor HRQL before intervention was dramatically improved after gastric restriction surgery , while only minor fluctuations in HRQL scores were observed in the conventionally treated controls . Peak values were observed in the surgical group at 6 or 12 months after intervention with a slight to moderate decrease at the two-year follow-up . The positive changes in HRQL after two years were related to the magnitude of weight loss , that is , the greater the weight reduction , the greater the HRQL improvements . Eating behavior improved accordingly . CONCLUSION : Quality of life in the severely obese is improved by substantial weight loss . Most patients benefit from weight reduction surgery , while HRQL in surgical patients with minor reduction in overweight is less positive . Further research is needed to determine outcome predictors of the surgical management of severe obesity and to ensure that HRQL improvements are maintained The efficacy of three gastric restriction operations were compared in a prospect i ve r and omized study of 310 morbidly obese subjects . The median patient age was 34 years ( range , 18 to 62 years ) . They were predominantly female ( 13:1 ) and had a median pre-operative weight that was 198 % of their ideal weight ( range , 160 % to 318 % ) . There was an equitable dispersion of perceived risk factors between the groups under study and there were no deaths during the perioperative period . Compliance with follow-up at 3 years was 91 % . When success was defined as a loss of more than 50 % of excess weight or a current pregnancy , the success rates at 3 years were 17 % for gastrogastrostomy , 48 % for vertical gastroplasty , and 67 % for Roux-en-Y gastric bypass ( p less than 0.001 ) . Although the gastric bypass operation took longer to perform , there were similar outcome patterns for the three groups during the postoperative period . We conclude that the Roux-en-Y gastric bypass is the preferred procedure for the surgical treatment of morbid obesity Objective This report documents that the gastric bypass operation provides long-term control for obesity and diabetes .  Summary Background Data Obesity and diabetes , both notoriously resistant to medical therapy , continue to be two of our most common and serious diseases . Methods Over the last 14 years , 608 morbidly obese patients underwent gastric bypass  , an operation that restricts caloric intake by ( 1 ) reducing the functional stomach to approximately 30 mL , ( 2 ) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet , and ( 3 ) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy . Even though many of the patients were seriously ill , the operation was performed with a perioperative mortality and complication rate of 1.5 % and 8.5 % , respectively . Seventeen of the 608 patients ( <3 % ) were lost to follow-up . Results Gastric bypass provides durable weight control . Weights fell from a preoperative mean of 304.4 lb ( range , 198 to 615 lb ) to 192.2 lb ( range , 104 to 466 ) by 1 year and were maintained at 205.4 lb ( range , 107 to 512 lb ) at 5 years , 206.5 lb ( 130 to 388 lb ) at 10 years , and 204.7 lb ( 158 to 270 lb ) at 14 years . The operation provides long-term control of non-insulin-dependent diabetes mellitus ( NIDDM ) . In those patients with adequate follow-up , 121 of 146 patients ( 82.9 % ) with NIDDM and 150 of 152 patients ( 98.7 % ) with glucose impairment maintained normal levels of plasma glucose , glycosylated hemoglobin , and insulin . These antidiabetic effects appear to be due primarily to a reduction in caloric intake , suggesting that insulin resistance is a secondary protective effect rather than the initial lesion . In addition to the control of weight and NIDDM , gastric bypass also corrected or alleviated a number of other comorbidities of obesity , including hypertension , sleep apnea , cardiopulmonary failure , arthritis , and infertility Background : We have demonstrated that obstructive sleep apnea ( OSA ) is prevalent in 60 % of patients undergoing bariatric surgery .  A study was conducted to determine whether weight loss following bariatric surgery ameliorates OSA . Methods : All 100 consecutive patients with symptoms of OSA were prospect ively evaluated by polysomnography before gastric bypass . Preoperative and postoperative scores of Epworth Sleepiness Scale ( ESS ) , Respiratory Disturbance Index ( RDI ) , and other parameters of sleep quality were compared using t-test . Results : Preoperative RDI was 40±4 ( normal 5 events/hour , n=100 ) . 13 patients had no OSA , 29 had mild OSA , while the remaining 58 patients were treated preoperatively for moderate-severe OSA . At a median of 6 months follow-up , BMI and ESS scores improved ( 38±1 vs 54±1 kg/m2 , 6±1 vs 12±0.1 , P<0.001 , postoperatively vs preoperatively ) . To date , 11 patients have completed postoperative polysomnography ( 3 - 21 months ) after losing weight ( BMI 40±2 vs 62±3 kg/m2 , P<0.001).There was significant improvement in ESS ( 3±1 vs 14±2 ) , minimum O2 saturation ( SpO2 86±2 vs 77±5 ) , sleep efficiency ( 85±2 % vs 65±5 % ) , all P<0.001 , postop vs preop ; and RDI ( 56±13 vs 23±7 , P=0.041 ) . Regression analysis demonstrated no correlation between preoperative BMI , ESS score and the severity of OSA ; and no correlation between % excess body weight loss and postoperative RDI . Conclusion : Weight loss following gastric bypass results in profound improvement in OSA . The severity of apnea can not be reliably predicted by preoperative BMI and ESS ; therefore , patients with symptoms of OSA should undergo polysomnography The purpose of the study was to examine the gastrointestinal hormone responses to meals in morbidly obese patients before and after Roux-en-Y gastric bypass ( GBP ; n = 9 ) or vertical b and ed gastroplasty ( VBG ; n = 7 ) . On consecutive days before and after operation , we measured changes in peripheral blood levels of glucose , insulin , enteroglucagon , serotonin , vasoactive intestinal polypeptide ( VIP ) , and cholecystokinin ( CCK ) in response to a st and ardized glucose or protein-fat meal . The percentage of excess weight lost at 6 months after operation was 66.3 % + /- 4 % and 41.8 % + /- 5 % for GBP and VBG , respectively ( p less than 0.01 ) . The 3-hour integrated glucose response to a glucose meal decreased from 145.3 + /- 33.7 to 75.8 + /- 15.7 g min/L ( p less than 0.02 ) after GBP . This was associated with a decrease in 3-hour integrated insulin response from 22.8 + /- 8.2 to 10.5 + /- 4.9 mU min/L. Vertical b and ed gastroplasty patients had lesser reductions of hyperglycemia and hyperinsulinemia . Neither the CCK , serotonin , nor VIP responses to meals were altered by either operation . The 3-hour integrated enteroglucagon response to glucose increased markedly in GBP patients after operation from 11.8 + /- 6 to 133.4 + /- 38 nmol min/mL ( p less than 0.02 ) . This increase in enteroglucagon occurred at the same time as development of dumping symptoms , which occurred exclusively in GBP patients after glucose but not protein . We conclude that ( 1 ) GBP surgery for morbid obesity results in amelioration of glucose intolerance and hyperinsulinemia , ( 2 ) CCK does not mediate an endocrine satiety effect of surgery , ( 3 ) 
    Output:
    