Integrated Care Method Proves Effective in Treating Adults with Obesity and Depression

Adults battling a combination of obesity and depression saw their weight loss and depressive symptoms modestly improved from a collaborative care intervention integrating behavioral weight loss treatment, problem-solving therapy, and anti-depressant medications, according to a new study published in JAMA.

The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized clinical trial recruited 409 adults (mean age, 51; 70% female) years with body mass indexes (BMIs) of 30 or greater (≥27 for Asian adults), and 9-item Patient Health Questionnaire (PHQ-9) scores of 10 or greater. Primary care patients at a health system in Northern California were recruited from September 30, 2014, to January 12, 2017. The final date of the 12-month follow-up was January 17, 2018.

All trial enrollees were arbitrarily assigned to interventions (n=204), or usual care as control (n=205). Participants received medical care from their personal physicians as usual, were provided with information on routine services for obesity and depression at their clinic and were supplied wireless physical activity trackers. The intervention group subjects also received a 12-month intervention that integrated a Diabetes Prevention Program-based behavioral weight loss treatment with problem-solving therapy for depression, and antidepressant medications (if indicated). The primary outcome measures were BMI and 20-item Depression Symptoms Checklist (SCL-20) scores (range, 0 [best] to 4 [worst]) at 12 months. Among all randomized participants, 344 (84.1%) completed a 12-month follow-up.

Integrated Approach Proves Modestly Effective

According to the study results, mean BMI declined from 36.7 to 35.9 among the intervention participants compared with a small change in average BMI from 36.6 to 36.6 among participants in the usual care (between-group mean difference, -0.7 (95% CI, -1.1 to -0.2; P=0.01). Moreover, the average SCL-20 score declined from 1.5 to 1.1 at 12 months among participants receiving the intervention juxtaposed with a change in average SCL-20 score from 1.5 to 1.4 among control group subjects (between-group average mean difference, -0.2 (95% CI, -0.4 to 0; P=0.01). Researchers reported 47 adverse to serious adverse events that involved musculoskeletal injuries (27 in the intervention group and 20 in control).

A Bright Sign for the Future

“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,” stated Dr. Jun Ma, Professor of Medicine in the University of Illinois at Chicago College of Medicine and the study’s principal researcher, in a press release.

Regarding the future, Dr. Ma added that the “demonstrated improvements in obesity and depression among participants were modest, [and] the study represents a step forward because it points to an effective, practical way to integrate fragmented obesity and depression care into one combined therapy, with good potential for implementation in primary care settings.”