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Title: One-year changes in symptoms of depression and weight in overweight/obese individuals with type 2 diabetes in the Look AHEAD study

Author
item FAULCONBRIDGE, LUCY - University Of Pennsylvania
item WADDEN, THOMAS - University Of Pennsylvania
item RUBIN, RICHARD - Johns Hopkins University School Of Medicine
item WING, RENA - Brown University School Of Medicine
item WALKUP, MICHAEL - Wake Forest School Of Medicine
item FABRICATORE, ANTHONY - University Of Pennsylvania
item CODAY, MACE - University Of Tennessee
item VAN DORSTEN, BRENT - University Of Colorado
item MOUNT, DAVID - Wake Forest School Of Medicine
item EWING, LINDA - University Of Pittsburgh
item FOREYT, JOHN - Children'S Nutrition Research Center (CNRC)

Submitted to: Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/11/2011
Publication Date: 10/20/2011
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., Look AHEAD Research Group. 2011. One-year changes in symptoms of depression and weight in overweight/obese individuals with type 2 diabetes in the Look AHEAD study. Obesity. 20(4):783-793.

Interpretive Summary: Depression and weight management have often been an issue when treating overweight and obese patients. Historically, many weight loss trials have excluded subjects suffering from depression for fear that weight loss in such studies might lead to further or intensified mood disorders and that such subjects might not lose weight satisfactorily while participating. This study looked to examine these factors and determine if moderate weight loss in depressed subjects led to higher symptoms of depression and thoughts of suicide, and whether initial symptoms of depression would limit weight loss after 1 year. Subjects in the Intensive Lifestyle Intervention (ILI) were found to have lost more weight and had a reduction of depression scores, as based on the Beck Depression Inventory (BDI), compared to subjects in a traditional Diabetes support and Education (DSE) group. The incidence of significant symptoms of depression was also found to be significantly lower in ILI subjects than in the DSE group. In the ILI group, both subjects with and without depression were not seen to have any significant differences in total weight loss. With these findings, it would seem that symptoms of depression were not worsened by intentional weight loss, but in fact seems to lower levels of depression. In addition, mild or greater symptoms of depression were not seen to hinder significant weight loss in overweight/obese subjects with type 2 diabetes. Based on these findings, it would seem that depressed individuals should not be excluded from similar weigh loss studies in the future. The inclusion of such subjects will offer data more representative of the general population and may lead to an improvement to the quality of life of such subjects.

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.