Both obesity and depression are conditions that are on the rise. But when combined, it becomes more difficult for an individual to undertake and succeed at programs that will help them to achieve their weight loss goals. So is an integrative approach that combines a weight loss program with therapy a more effective way to manage these two conditions?
Background
Obesity and depression commonly occur together. Adults with obesity are more likely to experience depression compared to adults with a normal body weight.
Obesity and depression also share co-morbidities such as type 2 diabetes and depression. The combination is associated with poor response to therapy, making them more difficult to manage.
There are treatments that treat the two conditions individually. However, there is a lack of exploration into an integrative approach to treatment. There are few effective treatments that address both concerns at once. As the combination on the rise in the population, it is essential to look to management strategies that are effective for both conditions.
The study
A 12-month randomised clinical trial named RAINBOW was designed to explore the effects of a collaborative care intervention on obesity and depression. Inclusion criteria for participation were age of 18+, a BMI of 30+ (27+ for Asian adults), depressive symptoms as indicated by a patient health questionnaire (PHQ-9) of 10 or greater. Exclusion criteria included serious co-morbidities, pregnancy and inability to speak or read English. A total of 409 participants were enrolled.
Participants were randomly assigned to one of two groups. The intervention group received a combination of a Diabetes Prevention Program-based weight loss program, along with problem-solving therapy for depression. They also received antidepressant medications if indicated.
The usual care control group received standard medical services from their personal physician, along with information about routine services for obesity and depression. Both groups received wireless physical activity trackers.
The main outcomes measured were BMI and the results of a Depression Symptom Checklist.
The findings
344 participants completed the trial including the 12-month follow-up. At conclusion of the trial, the mean BMI in the intervention group dropped from 36.7 to 35.9, compared to no change in the mean BMI for the usual care group. The mean weight of the intervention group saw a reduction of 2.6kg, compared to a 0.2kg increase in the usual care group.
For the Depression Symptom Checklist, the intervention group saw a change from 1.5 to 1.1, whereas the usual care group only saw a change from 1.5 to 1.4. More participants in the intervention group saw a checklist improvement of at least 50% by 6 months, and more saw full depression admission. However, by 12 months, these outcomes did not show a significant difference between the two groups.
Conclusions
Among adults with obesity and depression, a collaborative approach using behavioural weight loss treatment, problem-solving therapy and as-required antidepressants significantly improved weight loss and depressive symptoms.
However, the researchers did note that the effect sizes were modest. Other limitations included the likely high socio-economic status of participants and the exclusion of 47 participants from the analysis due to missing data sets. Therefore, further research is needed to confirm these findings.
Reference
Ma, J., Rosas, L.G., Lv, N., Xiao, L., Snowden, M.B., Venditti, E.M., Lewis, M.A., Goldhaber-Fiebert, J.D. and Lavori, P.W., 2019. Effect of integrated behavioral weight loss treatment and problem-solving therapy on body mass index and depressive symptoms among patients with obesity and depression: the RAINBOW randomized clinical trial. Jama, 321(9), pp.869-879.