Depression Leads to Obesity
If you want to lose weight, you may need to solve your depression first. That’s the conclusion reached by a new study featured in the Journal of the American Medical Association.
An intervention combining behavioral weight loss treatment and problem-solving therapy with as-needed antidepressant medication for participants with co-occurring obesity and depression improved weight loss and depressive symptoms compared with routine physician care
Obesity and depression commonly occur together.
Depression and Obesity: Associated Disorders
Approximately 43 percent of adults with depression are obese, and adults with obesity are at increased risk of experiencing depression.
To treat both conditions, patients must visit multiple practitioners usually including dietitians, wellness coaches and mental health counselors or psychiatrists.
The burden associated with visiting multiple health care providers consistently over the long periods of time required to treat obesity and depression can be significant and lead to dropping out of therapy altogether.
Approximately 43% of adults with depression are obese.
Additionally, these health services may not be available due to a lack of trained providers or reimbursement, and the cost of seeing numerous specialists can be prohibitive.
“Treatments exist that are effective at treating obesity and depression separately, but none that address both conditions in concert, which is a critical unmet need because of the high prevalence of obesity and depression together,” said Dr. Jun Ma, professor of medicine in the University of Illinois at Chicago College of Medicine and principal investigator on the study.
“We have shown that delivering obesity and depression therapy in one integrated program using dually trained health coaches who work within a care team that includes a primary care physician and a psychiatrist, is effective at reducing weight and improving depressive symptoms.”
Studying Depression and Weight Loss
Ma and colleagues analyzed results of the Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized clinical trial, which compared an integrated collaborative care program to treat co-occurring obesity and depression — delivered by trained health coaches — with usual care provided by a personal physician in primary care settings.
The RAINBOW weight loss intervention promotes healthy eating and physical activity, while the psychotherapy portion focuses on problem-solving skills. A psychiatrist is able to recommend adding antidepressant medication if needed, which the participant’s personal physician would prescribe and manage.
Health coaches trained to deliver this integrated program worked in consultation with a primary care physician and a psychiatrist who jointly reviewed the clinical status of patients and advised on treatment adjustments for patients who were not progressing.
The primary care physician and psychiatrist did not have direct contact with patients, nor did they prescribe medications or furnish other treatment to patients in the program directly.
Their role was supportive and consultative to the health coaches with whom they worked as a team.
This care team communicated and collaborated with patients’ personal physicians who oversaw the patients’ care, including prescribing medications, providing treatments for medical conditions and making referrals to specialty care when needed.
Participants Had Both Obesity and Depression
Participants in the RAINBOW trial included 409 patients with obesity and depression.
All participants received usual medical care from their personal physicians and were provided with information on health care services for obesity and depression at their clinic as well as wireless physical activity trackers.
The trial included 409 patients with obesity and depression.
Two hundred and four participants were randomly assigned to receive the integrated collaborative care program and were seen by a health coach for one year.
In the first six months, they participated in nine individual counseling sessions and watched 11 videos on healthy lifestyles.
In the following six months, participants had monthly telephone calls with their health coach. Two hundred and five participants randomly assigned to the usual care control group did not receive any additional intervention.
Treating Depression For Better Weight Loss
Participants in the integrated care program experienced more weight loss and decline in the severity of depressive symptoms over one year compared with control participants receiving usual care.
On average, patients in the integrated program experienced a decline in body mass index from 36.7 to 35.9 while participants in the usual care group had no change in BMI.
Participants treated for depression lost significantly more weight.
Participants receiving integrated therapy reported a decline in depression severity scores based on responses to a questionnaire from 1.5 to 1.1, compared with a change from 1.5 to 1.4 among those in the control group.
Depression is Proven to Cause Weight Gain
A previous study at the University of Alabama at Birmingham (UAB) confirms the relationship between depression and abdominal obesity, which has been linked to an increased risk for cancer and cardiovascular disease.
“We found that in a sample of young adults during a 15-year period, those who started out reporting high levels of depression gained weight at a faster rate than others in the study, but starting out overweight did not lead to changes in depression,” said UAB Assistant Professor of Sociology Belinda Needham, PhD. The study appears in the June issue of the American Journal of Public Health.
Those with depression gained weight at a faster rate.
“Our study is important because if you are interested in controlling obesity, and ultimately eliminating the risk of obesity-related diseases, then it makes sense to treat people’s depression,” said Needham, who teaches in the UAB department of sociology and social work.
“It’s another reason to take depression seriously and not to think about it just in terms of mental health, but to also think about the physical consequences of mental health problems.”
Needham examined data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal study of 5,115 men and women ages 18-30 that aimed to identify the precursors of cardiovascular disease.
Needham studied the data to test whether body mass index (BMI) — weight divided by the square of one’s height — and waist circumference were associated with increases in depression or whether depression was associated with changes in BMI and waist circumference during a period of time.
CARDIA study scientists weighed and measured the waist circumference and BMI of study participants. The waist circumference was measured to the nearest half centimeter. CARDIA researchers also asked study participants in years five, 10, 15 and 20 to rank their own level of depression.
“Looking at the CARDIA sample data, we found that everyone, as a whole, gained weight during the 15-year period of time that we examined,” said Needham.
“However, the people who started out reporting high levels of depression increased in abdominal obesity and BMI at a faster rate than those who reported fewer symptoms of depression at year five. In year five, the waist circumference of the high-depression group was about 1.6 centimeters greater than those who reported low depression.”
She added, “By year 20, the waist circumference of the high-depression group was about 2.6 centimeters higher than those who reported lower levels of depression. In contrast, a high initial BMI and waist circumference did not influence the rate of change in symptoms of depression over time”.
Needham said there have been reports showing that cortisol, a stress hormone, is related to depression and abdominal obesity. “So, there is reason to suspect that people who are depressed would have higher levels of abdominal obesity versus other parts of the body because of elevated cortisol,” she said.
More studies are needed to determine the underlying causes for weight gain among those who reported being depressed, Needham said.
Has Your Depression Made You Fat?
Ongoing research shows there may be a biological link between depression and gaining weight.
While researchers still don’t understand fully the complex and tangled relationship between depression and weight gain, they do know “there are specific biological causes that link the weight gain with depression itself,” says Dr. Richard Shelton, vice chair for research at the University of Alabama at Birmingham’s School of Medicine’s Department of Psychiatry and Behavioral Neurobiology and a member of the UAB Nutrition Obesity Research Center. “It’s a reciprocal relationship.”
Specific biological changes link depression and weight gain.
In other words, the relationship between depression and obesity is interconnected. According to JAMA Psychiatry, a person who is depressed has an increased risk of becoming obese and a person who is obese has an increased risk of becoming depressed.
There are a lot of behavioral reasons why depression could contribute to weight gain — a person who is depressed might not feel motivated to exercise or might seek comfort in foods that are high in fat and sugar. They may take antidepressant medication, which according to research published in JAMA Psychiatry show can cause modest weight gain.
Likewise, social factors and physical problems associated with obesity – such as poor self-esteem, weight-related health problems, or trouble getting out to socialize – can negatively impact a person’s emotional state.
A person who is depressed has an increased risk of becoming obese.
But Dr. Shelton says the connection between obesity and depression appears to be biological, not behavioral. Researchers are still trying to understand exactly which biological mechanisms are to blame.
Some people with depression have elevated levels of cortisol, a hormone associated with stress, which may help explain the weight gain, Dr. Shelton says. Or, he says, it could be that the sympathetic nervous system, which is more active in people with depression and which helps regulate metabolism, is to blame.
The Connection between obesity and depression appears to be biological, not behavioral.
-Dr. Richard Shelton, vice chair for research at the University of Alabama at Birmingham’s School of Medicine’s Department of Psychiatry and Behavioral Neurobiology
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