EMOTIONAL HEALTH
March 26, 2019

Overweight and Depressed?

Depression and obesity often occur together. Now there's a treatment that takes that into account.

Obesity and depression often occur together, and treatment for these conditions usually involves multiple office visits with a variety of healthcare professionals. Because these services are not always covered by insurance, the financial burden involved in treating both conditions separately means that patients often drop out of therapy. But a new study finds that a program that combines therapies to treat both depression and obesity can be more effective and cost-efficient.

The study compared the results of usual physician care to an integrated collaborative care program treating both weight loss and depression, using information from more than 400 patients with obesity and depression who were part of the RAINBOW clinical trial (Research Aimed at Improving Both Mood and Weight). All the patients received their usual medical care from their own physicians and were given information on services to treat obesity and depression at their local clinic. They were also given wireless physical activity trackers.

Making a therapy less expensive, less complicated, more effective and more cost efficient, is a win-win for patients and healthcare providers.

Half of the participants, randomly selected, were seen by a health coach for a 12-month intervention that integrated a Diabetes Prevention Program and behavioral weight loss treatment with problem-solving therapy for depression and, if indicated, antidepressant medications. The health coaches were trained to deliver the program, working as a team with a primary care physician and a psychiatrist. The primary care physician and psychiatrist did not have direct contact with the patients, but in cooperation with the health coaches reviewed patients' status, both in terms of weight-loss and depression; and advised on treatment when patients were not progressing satisfactorily. The patients’ personal physicians oversaw their care and prescribed any medications.

The weight-loss component of the RAINBOW program promoted healthy eating and exercise, while the psychotherapy portion taught problem-solving skills designed to help patients deal with depression. Antidepressant medications, if recommended by a psychiatrist and prescribed by the patient’s personal physician, were available to patients.

The integrated care program consisted of nine individual counseling sessions and 11 videos on healthy lifestyles delivered during the first six months. Over the next six months, patients talked with their health coaches by phone monthly. The patients assigned to the usual care group did not receive any such intervention.

Over the course of a year, patients in the integrated care program lost more weight compared to the patients who were receiving their usual physician care. The average body mass index among those in the integrated program decreased from 36.7 to 35.9, while patients in the usual care group saw no change in body mass index.

The scores for depression among those in the integrated care group also improved, with patients' scores on the same questionnaires before and after the treatment dropping from 1.5 to 1.1. Scores in the usual care group dropped far less, from 1.5 to 1.4.

“While the demonstrated improvements in obesity and depression among participants receiving the integrated therapy were modest, 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 setting, in part because the integrated mental health treatment in primary care settings is now also reimbursable by Medicare,” said researcher, Jun Ma, of the University of Illinois at Chicago College of Medicine. “For patients, this approach is an attractive alternative to seeing multiple practitioners each charging for their services as is done traditionally.”

Any time therapies can be made less expensive, less complicated, more effective and more cost efficient, it’s a win-win for both patients and healthcare providers.

The study is published in the Journal of the American Medical Association.

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