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United States Department of Agriculture

Agricultural Research Service

Research Project: Dietary Guidelines Adherence and Healthy Body Weight Maintenance Title: One-year changes in symptoms of depression and weight in overweight/obese individuals with type 2 diabetes in the look AHEAD study

Authors
item Faulconbridge, Lucy -
item Wadden, Thomas -
item Rubin, Richard -
item Wing, Rena -
item Walkup, Michael -
item Fabricatore, Anthony -
item Coday, Mace -
item Van Dorsten, Brent -
item Mount, David -
item Ewing, Linda -
item Raatz, Susan

Submitted to: Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: September 11, 2011
Publication Date: October 20, 2011
Citation: Faulconbridge, L.F., Wadden, T.A., Rubin, R.R., Wing, R.R., Walkup, M.P., Fabricatore, A.N., Coday, M., Van Dorsten, B., Mount, D.L., Ewing, L.J., Raatz, S.K. 2011. One-year changes in symptoms of depression and weight in overweight/obese individuals with type 2 diabetes in the look AHEAD study. Obesity. DOI:10.1038/oby.2011.315.

Interpretive Summary: Depressed people are often not included in weight loss trials because of fears that weight reduction may precipitate mood disorders or that depressed participants will not lose weight as well as others. The present study examined participants in the Look AHEAD study to determine if moderate weight loss affected symptoms of depression and suicidal ideation, and whether depression at baseline would limit weight loss at 1 year. Overweight/obese adults with type 2 diabetes (n = 5,145) were randomly assigned to an Intensive Lifestyle Intervention (ILI) or a usual care group, Diabetes Support and Education (DSE). Of these, 5,129 participants completed the Beck Depression Inventory (BDI) and had their weight measured at baseline and 1 year. Potentially significant symptoms of depression were defined by a BDI score =10. Participants in ILI lost 8.6 ± 6.9% of initial weight at 1 year, compared to 0.7 ± 4.8% for DSE (and had a reduction of 1.4 ± 4.7 points on the BDI, compared to 0.4 ± 4.5 for DSE (P < 0.001, effect size = 0.23). At 1 year, the incidence of depression was significantly lower in the ILI than DSE group (6.3% vs. 9.6%). Intentional weight loss was not associated with the onset of depression, but instead appeared to protect against it. Mild (or greater) symptoms of depression at baseline did not prevent overweight/obese individuals with type 2 diabetes from achieving significant weight loss.

Technical Abstract: Depressed individuals are frequently excluded from weight loss trials because of fears that weight reduction may precipitate mood disorders, as well as concerns that depressed participants will not lose weight satisfactorily. The present study examined participants in the Look AHEAD study to determine whether moderate weight loss would be associated with incident symptoms of depression and suicidal ideation, and whether symptoms of depression at baseline would limit weight loss at 1 year. Overweight/obese adults with type 2 diabetes (n = 5,145) were randomly assigned to an Intensive Lifestyle Intervention (ILI) or a usual care group, Diabetes Support and Education (DSE). Of these, 5,129 participants completed the Beck Depression Inventory (BDI) and had their weight measured at baseline and 1 year. Potentially significant symptoms of depression were defined by a BDI score =10. Participants in ILI lost 8.6 ± 6.9% of initial weight at 1 year, compared to 0.7 ± 4.8% for DSE (P < 0.001, effect size = 1.33), and had a reduction of 1.4 ± 4.7 points on the BDI, compared to 0.4 ± 4.5 for DSE (P < 0.001, effect size = 0.23). At 1 year, the incidence of potentially significant symptoms of depression was significantly lower in the ILI than DSE group (6.3% vs. 9.6%) (relative risk (RR) = 0.66, 95% confidence interval (CI) = 0.5, 0.8; P < 0.001). In the ILI group, participants with and without symptoms of depression lost 7.8 ± 6.7% and 8.7 ± 6.9%, respectively, a difference not considered clinically meaningful. Intentional weight loss was not associated with the precipitation of symptoms of depression, but instead appeared to protect against this occurrence. Mild (or greater) symptoms of depression at baseline did not prevent overweight/obese individuals with type 2 diabetes from achieving significant weight loss.

Last Modified: 7/23/2014