Integrative therapy proven effective for treating obesity and depression
An integrated collaborative care intervention, combining behavioral weight loss treatments, problem-solving therapy, and an as-needed antidepressant medication improved weight loss and depressive symptoms more than routine physician care for patients with co-occurring obesity and depression, according to a new study published in the Journal of the American Medical Association.
In the Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized clinical trial, which included 409 patients with obesity and depression, the 204 patients participating in the integrated treatment plan over 12 months saw significant reductions in body mass index (BMI), from 36.7 to 35.9, when compared to the conventional care plan participants who saw no reduction in BMI. In addition, patients experienced reduced depressive symptoms, reporting a decline in depression severity scores from 1.5 to 1.1, compared with a change from 1.5 to 1.4 among those in the control group, on the 20-item Depression Symptom Checklist.
The study was conducted by researchers at the University of Illinois at Chicago College of Medicine, who analyzed the results under the direction of principal investigator Jun Ma, MD, PhD, FAHA, FABMR, a professor of academic internal medicine and geriatrics and associate head for research in the Department of Medicine. The university announced the study results on its website on March 5.
Delivered by trained health coaches, the RAINBOW weight loss intervention promotes health eating and physical activity, while the psychotherapy portion focuses on problem-solving skills. A psychiatrist can recommend adding antidepressant medication if needed, which the participant’s personal physician would prescribe and manage, researchers say.
Health coaches trained to deliver the 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, according to the study abstract. 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.
Obesity and depression commonly occur together, according to previous research, which estimates 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, including, but not limited to, dieticians, wellness coaches, and psychiatrists. The burden of visiting multiple practitioners consistently over long periods of time can lead to dropping out of therapy altogether, experts say, or the 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.
Ma and colleagues are currently investigating ways to tailor the integrated therapy for individual patients by targeting underlying neurobehavioral mechanisms to further improve outcomes.
“We have some preliminary data that suggests if we can tailor therapy based on the patient’s engagement and response early in the treatment, we may further improve the effectiveness of the therapy,” Ma said. “In addition, a better understanding of the mechanisms of brain function and behavior change can guide targeted therapy.”
While the demonstrated improvements in obesity and depression among participants receiving the integrated therapy were modest, Ma said, 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.
“For patients,” Ma said, “this approach is an attractive alternative to seeing multiple practitioners each charging for their services as is done traditionally.”