A new study takes a holistic approach.
Physicians want to approach patients more holistically. Getty Images
A new intervention helps people lose weight and improve their depression symptoms at the same time.
Millions of Americans have been diagnosed with depression. Even more have obesity.
For many people, these conditions go hand in hand, increasing their risk for other health conditions and decreasing their quality of life.
But in the healthcare system, these conditions are generally treated separately.
Now a group of researchers have developed a more holistic approach that aims to help people lose weight and reduce their symptoms of depression at the same time.
“We tested an integrated intervention compared with usual care and demonstrated the effectiveness of the integrated approach,” said study author Dr. Jun Ma, a professor of internal medicine and geriatrics at the University of Illinois at Chicago.
Modest effects on weight and depression
Researchers enrolled more than 400 people in a 12-month study, which was published March 5 in JAMA.
Half of the people took part in a behavioral weight loss program along with problem-solving therapy for depression. People also received antidepressant medications as needed.
The program included six months of intensive treatment followed by six months of maintenance. People did both face-to-face and telephone sessions.
The weight loss component consisted of dietary changes, increased physical activity, and videos for self-study. People aimed to lose 5 to 10 percent of their weight.
The other people in the study — the control group — continued with their usual care, which meant treatment from their regular doctor.
After 12 months, people in the intervention group saw “modest” reductions in both weight and depression symptoms, compared to the control group. The differences between the two groups showed up as early as six months.
The benefits for the intervention group, though, were of “uncertain clinical importance,” wrote the authors in the paper.
People in the study were recruited from one healthcare system and were mainly well-educated, non-Hispanic white women, so the results may not apply to other groups.
The researchers also said it’s unclear whether the benefits seen in the new study will translate to long-term health benefits, or if people will be able to sustain those changes.
Link between obesity and depression
Researchers are increasingly trying to address multiple conditions, acknowledging they’re often intertwined.
According to the Centers for Disease Control and Prevention (CDC), 43 percent of adults with depression have obesity, compared to 33 percent of adults without depression.
Also, adults with obesity are more likely to have depression than those who aren’t overweight.
Jennifer Linde, PhD, an associate professor of epidemiology and community health at the University of Minnesota, who wasn’t involved in the study, says the relationship between the two conditions is “bidirectional.”
For example, one of the side effects of certain medications for depression is weight gain. Also, people with depression sometimes overeat to manage their emotions.
“In other cases,” Linde said, “people with higher body weights experience discrimination or stigma related to their physical appearance that may lead to feelings of depression or diminished self-worth.”
This can result in emotional eating or avoiding exercise in public, which can promote further weight gain.
Some research even suggests that depression and obesity may be driven by some of the same biological mechanisms — things like genetics, brain circuits, hormonal regulation, or gut bacteria.
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Holistic treatment programs
People may feel a boost in their mood after they lose weight. But Linde says weight management programs aren’t intended as treatments for depression. They also don’t usually include mental health professionals trained in treating depression.
More studies, though, have been looking at the benefits of nutrition for improving depression symptoms. But a related editorial in the same issue of JAMA as the new study cautions against people using nutritional changes alone to treat depression.
“Given the modest effect sizes in these studies — notwithstanding larger ones in previous studies — dietary change is not likely to be a sole treatment for depression,” the editorial authors wrote.
However, healthcare in general is shifting toward a more holistic approach, especially in helping people with multiple health conditions. The CDC estimates 1 in 4 Americans fall in this category.
“Integrated treatment of coexisting health conditions is clinically sound and patient-centered,” Ma said.
Linde also thinks it’s important to look at ways to address both obesity and depression alongside each other, especially “in a clinic system where many primary care and psychiatric providers are not equipped with the time or training to deliver intensive weight management counseling to their patients,” she said.
This, though, needs to be done in a way that doesn’t increase body size bias or weight stigmatization among providers.
“Weight loss intervention, and clinical care in general,” Linde said, “should be delivered in ways that are sensitive to individual needs and that do not stigmatize people based on their body size.”
The bottom line
Researchers are looking for more holistic ways to treat patients. That means acknowledging that obesity and depression often go hand in hand.
In a new study, researchers focused on treating people for depression and encouraged them to lose weight. One group was enrolled in a behavioral weight loss program along with problem-solving therapy for depression. People also received antidepressant medications as needed.
The other group received normal care from their doctor.
After 12 months, people in the intervention group saw “modest” reductions in both weight and depression symptoms, compared to the control group. The differences between the two groups showed up as early as six months.
