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: Background : Obesity is a well-known cause of cardiovascular disease burden and premature death , but effects on depressive symptoms remain equivocal . Depressive symptoms may be more common among the obese individuals who perceive themselves as overweight , rather than those who perceive themselves as having an acceptable weight . Our aim was to determine whether weight status and weight perceptions are independently associated with psychological distress . Methods : We conducted a cross-sectional study  using data from the Australian National Health Survey 2004–2005 ( N=17 253 ) . All variables were collected by self-report . Adjusted multinomial logistic regression analysis was conducted to generate prevalence odds ratios with 95 % confidence intervals ( 95 % CI ) for medium ( Kessler Psychological Distress Scale ( K10 ) scores of 20–29 ) and high ( K10 scores of 30–50 ) psychological distress ( compared with K10 scores of 10–19 as the reference ) associated with weight status ( st and ard body mass index ( BMI ) cutoffs for underweight , overweight and obesity vs normal weight ) , weight perception ( perceived underweight and overweight vs acceptable weight ) and weight misperception ( incorrect with BMI vs correct with BMI ) adjusting for numerous important covariates . Results : Overweight and underweight perception increased the odds of medium ( 40 and 50 % ) and high ( 50 and 120 % ) psychological distress , whereas weight status and weight misperception were not associated with psychological distress in adjusted analysis . Gender , alcohol consumed per week and post-school education were not significant covariates ( at P<0.10 level ) . Conclusions : Overweight and underweight perception rather than weight status or weight misperception are significant risk factors associated with medium and high psychological distress prevalence and effects appear to be uniform for men and women . Well- design ed prospect i ve studies are still needed to determine whether weight perceptions cause psychological distress , and if so , whether symptoms are significantly reduced following effective intervention OBJECTIVE To estimate the prevalence of abnormal eating attitudes among Greek adolescents and identify possible risk factors associated with these attitudes . DESIGN Cross-sectional , school-based study . SETTING Six r and omly selected schools in Patras , southern Greece . PARTICIPANTS The study population consisted of 540 Greek students aged 13 - 18 years , and the response rate was 97 % . MAIN OUTCOME MEASURE The dependent variable was scores on the Eating Attitudes Test-26  , with scores > or = 20 indicating abnormal eating attitudes . ANALYSIS Bivariate analysis included independent Student t test , chi-square test , and Fisher 's exact test . Multivariate logistic regression analysis was applied for the identification of the predictive factors , which were associated independently with abnormal eating attitudes . A 2-sided P value of less than .05 was considered statistically significant . RESULTS The prevalence of abnormal eating attitudes was 16.7 % . Multivariate logistic regression analysis demonstrated that females , urban residents , and those with a body mass index outside normal range , a perception of being overweight , body dissatisfaction , and a family member on a diet were independently related to abnormal eating attitudes . CONCLUSIONS AND IMPLICATION S The results indicate that a proportion of Greek adolescents report abnormal eating attitudes and suggest that multiple factors contribute to the development of these attitudes . These findings are useful for further research into this topic and would be valuable in design ing preventive interventions Background There exists a dearth of prospect i ve adolescent eating disorder studies with sample s that are large enough to detect small or medium sized effects for risk factors , that are generalizable to the broader population , and that follow adolescents long enough to fully capture the period of development when the risk of eating disorder symptoms occurring is highest . As a result , the purpose of this study was to examine psychosocial risk factors for purging for weight control in a nationally representative sample of adolescents . Data were extracted from the restricted-use data sets of the National Longitudinal Study of Adolescent Health ( Waves I-III ) , selecting females with valid demographic and purging information ( N = 5,670 ) . Results The prevalence of purging was 0.88 % at Wave II and 0.56 % at Wave III . In multivariable multinomial logistic regressions , purging at Wave II was predicted by parental poverty and low levels of self-esteem at Wave I ; purging at Wave III was predicted by body mass index and the frequency of delinquent behaviors at Wave I. Conclusions Individuals with high body mass index , individuals with low self-esteem , and individuals in families experiencing economic hardship appear specifically at risk for the development of purging behaviors in later years and may benefit from more targeted prevention efforts Background / Objective : The purpose of this study was to examine the longitudinal effects of body size over- and underestimation and other psychosocial factors on the risk for onset of overweight ( OW ) or obesity ( OB ) 1 year later among US adolescents . Subjects/ Methods : Participants with non-missing height and weight were drawn from the first two waves of the National Longitudinal Study of Adolescent to Adult Health ( n=13 568 ) .  Multinomial logistic regressions were conducted to assess longitudinal risk factors for OW and OB onset , controlling for baseline weight status , age , race/ethnicity , parent education and family structure . Analyses were stratified by sex . Results : Compared with accurate body size perception , body size overestimation increased the relative risk ( RR ) of OW onset among women and men ( RR=3.34 , confidence interval (CI)=2.39–4.68 ; RR=6.01 , CI=4.09–8.83 , respectively , P<0.001 ) in fully adjusted models including body mass index z-scores . Body size underestimation decreased the RR of OW onset among women and men ( RR= 0.08 , CI=0.03–0.20 ; RR=0.13 , CI=0.06–0.27 , respectively ) and OB onset ( RR=0.05 , CI=0.02–0.14 ; RR=0.19 , CI=0.08–0.47 , respectively , P<0.001 for all ) in fully adjusted models . Dieting , extreme weight loss behaviors and skipping breakfast at Wave 1 increased the risk of OB onset by Wave 2 . Conclusions : Contrary to a common assumption , body size underestimation did not increase , but in fact decreased , the RR for the onset of OW and of OB  among adolescents using a prospect i ve longitudinal design . However , body size overestimation predicted onset of OW 1 year later . Body size self-concept and other psychosocial factors have an important role in risk for OW and for OB among both males and females during adolescence BackgroudThe purpose of this study was to describe actual measured weight and perceived weight and to explore associations with  depressive , anxiety symptoms in school adolescents in China . Methods A sample of 1144 Chinese adolescents was r and omly selected from four schools in Wuhan , China , including 665 boys and 479 girls with ages ranging between 10 and 17 years .  Actual measured weight and height and perceived weight status were compared to anxiety and depressive symptoms measured using the revised Self-Rating Anxiety Scale and Children 's Depression Inventory . A general linear model was used to compare differences in psychological symptoms among the teenagers with different measured and perceived weights . Results When compared with st and ardized weight tables ( WHO age- and gender-specific body mass index ( BMI ) cutoffs ( 2007 reference ) ) , girls were more likely to misperceive themselves as overweight , whereas more boys misclassified their weight status as underweight . The adolescents who perceived themselves as overweight were more likely to experience depressive and anxiety symptoms ( except girls ) than those who perceived themselves as normal and /or underweight . However , no significant association was found between depressive and anxiety symptoms actual measured weight status . Conclusions Perceived weight status , but not the actual weight status , was associated with psychological symptoms OBJECTIVE To examine the association between perceived overweight in adolescents and the development of overweight or obesity later in life . METHODS This paper uses data from a prospect i ve , two-wave cohort study . Participants are 2445 adolescents 11 - 17years of age who reported perceived weight at baseline and also had height and weight measured at baseline and at follow-up six years later sample d from managed care groups in a large metropolitan area . RESULTS Youths who perceived themselves as overweight at baseline were approximately 2.5 times as likely to be overweight or obese six years later compared to youths who perceived themselves as average weight ( OR=2.45 , 95 % CI=1.77 - 3.39 ) , after adjusting for weight status at baseline , demographic characteristics , major depression , physical activity and dieting behaviors . Those who perceived themselves as skinny were less likely to be overweight or obese later ( OR=0.36 , 95 % CI=0.27 - 0.49 ) . CONCLUSIONS Perceived overweight was associated with overweight or obesity later in life . This relationship was not fully explained by extreme weight control behaviors or major depression . Further research is needed to explore the mechanism involved OBJECTIVES This study aim ed to investigate the association between body-weight ( BW ) perception , weight preoccupation and behaviour , including weight control practice s and compulsive over-eating episodes , across gender and actual BW classes . DESIGN This study used a cross-sectional observational study . PARTICIPANTS A large , nationally representative sample of 6404 ninth- grade French adolescents was r and omly selected from schools throughout France . METHODS Weight and height were measured , and BW preoccupation , BW control practice s and compulsive over-eating  were self-reported using st and ardized question naires . RESULTS Nearly one-third of adolescents misperceived their BW . Misperception was more frequent among girls than boys ( 42.2 % vs. 27.3 % , P < 0.01 ) . Underestimation of BW among overweight adolescents , like BW overestimation among underweight adolescents , was associated with less preoccupation with weight and fewer weight control practice s than accurate perception of BW . Normal weight adolescents who overestimated their BW were more likely to declare weight preoccupations ( ORa = 8.66 [ 6.67 - 11.25 ] ) , dieting ( ORa = 4.81 [ 3.68 - 6.27 ] ) and recurrent compulsive over-eating episodes ( ORa = 2.36 [ 1.72 - 3.23 ] ) compared with their counterparts who correctly estimated their BW . CONCLUSION Our study underlines the role of these associations in each category of actual BW ( underweight , normal weight and overweight ) in a large national sample Observational longitudinal research is particularly useful for assessing etiology and prognosis and for providing evidence for clinical decision making . However , there are no structured reporting requirements for studies of this design to assist authors , editors , and readers . The authors developed and tested a checklist of criteria related to threats to the internal and external validity of observational longitudinal studies . The checklist criteria concerned recruitment , data collection , biases , and data analysis and descriptive issues relevant to study rationale , study population , and generalizability . Two raters independently assessed 49 r and omly selected articles describing stroke research published from 1999 to 2003 in six journals : American Journal of Epidemiology , Journal of Epidemiology and Community Health , Stroke , Annals of Neurology , Archives of Physical Medicine and Rehabilitation , and American Journal of Physical Medicine and Rehabilitation . On average , 17 of the 33 checklist criteria were reported . Criteria describing the study design were better reported than those related to internal validity . No relation was found between study type ( etiologic or prognostic ) or word count and quality of reporting . A flow diagram for summarizing participant flow through a study was developed . Editors and authors should consider using a checklist and flow diagram when reporting on observational longitudinal research OBJECTIVES We examined whether factors associated with attempting to lose weight in a hospital-based employee workforce varied by race/ethnicity . METHODS We conducted a cross-sectional survey in 6 hospitals in a health system in central Massachusetts . The stratified r and om sample included 813 employees ; men and and non-White employees were over sample d. The primary outcome measure was current evidence -based weight loss attempts . RESULTS Factors positively associated with attempting to lose weight among non-Hispanic Blacks included self-perceived overweight , female sex , higher education , physician recommendation to lose weight , and having a chronic medical condition . Among Hispanics , body mass index and self-perceived overweight were associated with attempts to lose weight , while working full time and second or third shift were associated with lower likelihood of weight loss attempts . Among non-Hispanic Whites , self-perceived overweight , female sex , higher education , and physician recommendation to lose weight were positively associated with attempting to lose weight , while working full time and working third shift were negatively associated . CONCLUSIONS Rates of overweight and obesity were high among hospital employees . Findings suggest that factors associated with attempting to lose weight vary across racial and ethnic groups . Workplace-based interventions for weight control should include strategies tailored to these differences Adolescence obesity and depression are increasingly prevalent and are associated with various health complications . The aim of this study was to examine the association between weight status ( normal weight , overweight , and obese ) and depressive symptoms in adolescents and to explore the probable mediators , including overweight perception , greater weight concern , and dietary restraint . During the period October 2010 to January 2011 , we recruited 869 adolescents ( 47 % girls ; median age , 15.7 
    Output:
    
agent
Results indicated that perceived overweight was associated with an increased likelihood of attempting weight loss and with healthy and unhealthy weight control strategies in some participant groups .
However , perceived overweight was not reliably associated with physical activity or healthy eating and was associated with greater disordered eating in some groups .
Rather than being associated with improved weight management , there was consistent evidence that perceived overweight was predictive of increased weight gain over time .
Individuals who perceive their weight status as overweight are more likely to report attempting weight loss but over time gain more weight
***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 is a well-known cause of cardiovascular disease burden and premature death , but effects on depressive symptoms remain equivocal . Depressive symptoms may be more common among the obese individuals who perceive themselves as overweight , rather than those who perceive themselves as having an acceptable weight . Our aim was to determine whether weight status and weight perceptions are independently associated with psychological distress . Methods : We conducted a cross-sectional study  using data from the Australian National Health Survey 2004–2005 ( N=17 253 ) . All variables were collected by self-report . Adjusted multinomial logistic regression analysis was conducted to generate prevalence odds ratios with 95 % confidence intervals ( 95 % CI ) for medium ( Kessler Psychological Distress Scale ( K10 ) scores of 20–29 ) and high ( K10 scores of 30–50 ) psychological distress ( compared with K10 scores of 10–19 as the reference ) associated with weight status ( st and ard body mass index ( BMI ) cutoffs for underweight , overweight and obesity vs normal weight ) , weight perception ( perceived underweight and overweight vs acceptable weight ) and weight misperception ( incorrect with BMI vs correct with BMI ) adjusting for numerous important covariates . Results : Overweight and underweight perception increased the odds of medium ( 40 and 50 % ) and high ( 50 and 120 % ) psychological distress , whereas weight status and weight misperception were not associated with psychological distress in adjusted analysis . Gender , alcohol consumed per week and post-school education were not significant covariates ( at P<0.10 level ) . Conclusions : Overweight and underweight perception rather than weight status or weight misperception are significant risk factors associated with medium and high psychological distress prevalence and effects appear to be uniform for men and women . Well- design ed prospect i ve studies are still needed to determine whether weight perceptions cause psychological distress , and if so , whether symptoms are significantly reduced following effective intervention OBJECTIVE To estimate the prevalence of abnormal eating attitudes among Greek adolescents and identify possible risk factors associated with these attitudes . DESIGN Cross-sectional , school-based study . SETTING Six r and omly selected schools in Patras , southern Greece . PARTICIPANTS The study population consisted of 540 Greek students aged 13 - 18 years , and the response rate was 97 % . MAIN OUTCOME MEASURE The dependent variable was scores on the Eating Attitudes Test-26  , with scores > or = 20 indicating abnormal eating attitudes . ANALYSIS Bivariate analysis included independent Student t test , chi-square test , and Fisher 's exact test . Multivariate logistic regression analysis was applied for the identification of the predictive factors , which were associated independently with abnormal eating attitudes . A 2-sided P value of less than .05 was considered statistically significant . RESULTS The prevalence of abnormal eating attitudes was 16.7 % . Multivariate logistic regression analysis demonstrated that females , urban residents , and those with a body mass index outside normal range , a perception of being overweight , body dissatisfaction , and a family member on a diet were independently related to abnormal eating attitudes . CONCLUSIONS AND IMPLICATION S The results indicate that a proportion of Greek adolescents report abnormal eating attitudes and suggest that multiple factors contribute to the development of these attitudes . These findings are useful for further research into this topic and would be valuable in design ing preventive interventions Background There exists a dearth of prospect i ve adolescent eating disorder studies with sample s that are large enough to detect small or medium sized effects for risk factors , that are generalizable to the broader population , and that follow adolescents long enough to fully capture the period of development when the risk of eating disorder symptoms occurring is highest . As a result , the purpose of this study was to examine psychosocial risk factors for purging for weight control in a nationally representative sample of adolescents . Data were extracted from the restricted-use data sets of the National Longitudinal Study of Adolescent Health ( Waves I-III ) , selecting females with valid demographic and purging information ( N = 5,670 ) . Results The prevalence of purging was 0.88 % at Wave II and 0.56 % at Wave III . In multivariable multinomial logistic regressions , purging at Wave II was predicted by parental poverty and low levels of self-esteem at Wave I ; purging at Wave III was predicted by body mass index and the frequency of delinquent behaviors at Wave I. Conclusions Individuals with high body mass index , individuals with low self-esteem , and individuals in families experiencing economic hardship appear specifically at risk for the development of purging behaviors in later years and may benefit from more targeted prevention efforts Background / Objective : The purpose of this study was to examine the longitudinal effects of body size over- and underestimation and other psychosocial factors on the risk for onset of overweight ( OW ) or obesity ( OB ) 1 year later among US adolescents . Subjects/ Methods : Participants with non-missing height and weight were drawn from the first two waves of the National Longitudinal Study of Adolescent to Adult Health ( n=13 568 ) .  Multinomial logistic regressions were conducted to assess longitudinal risk factors for OW and OB onset , controlling for baseline weight status , age , race/ethnicity , parent education and family structure . Analyses were stratified by sex . Results : Compared with accurate body size perception , body size overestimation increased the relative risk ( RR ) of OW onset among women and men ( RR=3.34 , confidence interval (CI)=2.39–4.68 ; RR=6.01 , CI=4.09–8.83 , respectively , P<0.001 ) in fully adjusted models including body mass index z-scores . Body size underestimation decreased the RR of OW onset among women and men ( RR= 0.08 , CI=0.03–0.20 ; RR=0.13 , CI=0.06–0.27 , respectively ) and OB onset ( RR=0.05 , CI=0.02–0.14 ; RR=0.19 , CI=0.08–0.47 , respectively , P<0.001 for all ) in fully adjusted models . Dieting , extreme weight loss behaviors and skipping breakfast at Wave 1 increased the risk of OB onset by Wave 2 . Conclusions : Contrary to a common assumption , body size underestimation did not increase , but in fact decreased , the RR for the onset of OW and of OB  among adolescents using a prospect i ve longitudinal design . However , body size overestimation predicted onset of OW 1 year later . Body size self-concept and other psychosocial factors have an important role in risk for OW and for OB among both males and females during adolescence BackgroudThe purpose of this study was to describe actual measured weight and perceived weight and to explore associations with  depressive , anxiety symptoms in school adolescents in China . Methods A sample of 1144 Chinese adolescents was r and omly selected from four schools in Wuhan , China , including 665 boys and 479 girls with ages ranging between 10 and 17 years .  Actual measured weight and height and perceived weight status were compared to anxiety and depressive symptoms measured using the revised Self-Rating Anxiety Scale and Children 's Depression Inventory . A general linear model was used to compare differences in psychological symptoms among the teenagers with different measured and perceived weights . Results When compared with st and ardized weight tables ( WHO age- and gender-specific body mass index ( BMI ) cutoffs ( 2007 reference ) ) , girls were more likely to misperceive themselves as overweight , whereas more boys misclassified their weight status as underweight . The adolescents who perceived themselves as overweight were more likely to experience depressive and anxiety symptoms ( except girls ) than those who perceived themselves as normal and /or underweight . However , no significant association was found between depressive and anxiety symptoms actual measured weight status . Conclusions Perceived weight status , but not the actual weight status , was associated with psychological symptoms OBJECTIVE To examine the association between perceived overweight in adolescents and the development of overweight or obesity later in life . METHODS This paper uses data from a prospect i ve , two-wave cohort study . Participants are 2445 adolescents 11 - 17years of age who reported perceived weight at baseline and also had height and weight measured at baseline and at follow-up six years later sample d from managed care groups in a large metropolitan area . RESULTS Youths who perceived themselves as overweight at baseline were approximately 2.5 times as likely to be overweight or obese six years later compared to youths who perceived themselves as average weight ( OR=2.45 , 95 % CI=1.77 - 3.39 ) , after adjusting for weight status at baseline , demographic characteristics , major depression , physical activity and dieting behaviors . Those who perceived themselves as skinny were less likely to be overweight or obese later ( OR=0.36 , 95 % CI=0.27 - 0.49 ) . CONCLUSIONS Perceived overweight was associated with overweight or obesity later in life . This relationship was not fully explained by extreme weight control behaviors or major depression . Further research is needed to explore the mechanism involved OBJECTIVES This study aim ed to investigate the association between body-weight ( BW ) perception , weight preoccupation and behaviour , including weight control practice s and compulsive over-eating episodes , across gender and actual BW classes . DESIGN This study used a cross-sectional observational study . PARTICIPANTS A large , nationally representative sample of 6404 ninth- grade French adolescents was r and omly selected from schools throughout France . METHODS Weight and height were measured , and BW preoccupation , BW control practice s and compulsive over-eating  were self-reported using st and ardized question naires . RESULTS Nearly one-third of adolescents misperceived their BW . Misperception was more frequent among girls than boys ( 42.2 % vs. 27.3 % , P < 0.01 ) . Underestimation of BW among overweight adolescents , like BW overestimation among underweight adolescents , was associated with less preoccupation with weight and fewer weight control practice s than accurate perception of BW . Normal weight adolescents who overestimated their BW were more likely to declare weight preoccupations ( ORa = 8.66 [ 6.67 - 11.25 ] ) , dieting ( ORa = 4.81 [ 3.68 - 6.27 ] ) and recurrent compulsive over-eating episodes ( ORa = 2.36 [ 1.72 - 3.23 ] ) compared with their counterparts who correctly estimated their BW . CONCLUSION Our study underlines the role of these associations in each category of actual BW ( underweight , normal weight and overweight ) in a large national sample Observational longitudinal research is particularly useful for assessing etiology and prognosis and for providing evidence for clinical decision making . However , there are no structured reporting requirements for studies of this design to assist authors , editors , and readers . The authors developed and tested a checklist of criteria related to threats to the internal and external validity of observational longitudinal studies . The checklist criteria concerned recruitment , data collection , biases , and data analysis and descriptive issues relevant to study rationale , study population , and generalizability . Two raters independently assessed 49 r and omly selected articles describing stroke research published from 1999 to 2003 in six journals : American Journal of Epidemiology , Journal of Epidemiology and Community Health , Stroke , Annals of Neurology , Archives of Physical Medicine and Rehabilitation , and American Journal of Physical Medicine and Rehabilitation . On average , 17 of the 33 checklist criteria were reported . Criteria describing the study design were better reported than those related to internal validity . No relation was found between study type ( etiologic or prognostic ) or word count and quality of reporting . A flow diagram for summarizing participant flow through a study was developed . Editors and authors should consider using a checklist and flow diagram when reporting on observational longitudinal research OBJECTIVES We examined whether factors associated with attempting to lose weight in a hospital-based employee workforce varied by race/ethnicity . METHODS We conducted a cross-sectional survey in 6 hospitals in a health system in central Massachusetts . The stratified r and om sample included 813 employees ; men and and non-White employees were over sample d. The primary outcome measure was current evidence -based weight loss attempts . RESULTS Factors positively associated with attempting to lose weight among non-Hispanic Blacks included self-perceived overweight , female sex , higher education , physician recommendation to lose weight , and having a chronic medical condition . Among Hispanics , body mass index and self-perceived overweight were associated with attempts to lose weight , while working full time and second or third shift were associated with lower likelihood of weight loss attempts . Among non-Hispanic Whites , self-perceived overweight , female sex , higher education , and physician recommendation to lose weight were positively associated with attempting to lose weight , while working full time and working third shift were negatively associated . CONCLUSIONS Rates of overweight and obesity were high among hospital employees . Findings suggest that factors associated with attempting to lose weight vary across racial and ethnic groups . Workplace-based interventions for weight control should include strategies tailored to these differences Adolescence obesity and depression are increasingly prevalent and are associated with various health complications . The aim of this study was to examine the association between weight status ( normal weight , overweight , and obese ) and depressive symptoms in adolescents and to explore the probable mediators , including overweight perception , greater weight concern , and dietary restraint . During the period October 2010 to January 2011 , we recruited 869 adolescents ( 47 % girls ; median age , 15.7 
    Output:
    