Meeting NewsPerspective

Short-term cognitive behavioral therapy may reduce BMI in girls with overweight, moderate depression

Lauren Shomaker
Lauren B. Shomaker

WASHINGTON — Cognitive behavioral therapy over 6 weeks may decrease depressive symptoms and, in turn, reduce BMI, fat gain and insulin resistance 1 year after treatment in adolescent girls with overweight and moderate depressive symptoms, according to findings presented here.

“Adolescent depressive symptoms are common, especially in girls, with 25% to 33% reporting elevated depressive symptoms,” Lauren B. Shomaker, PhD, assistant professor of human development and family services at Colorado State University, said during her presentation. “Depressive symptoms in adolescents are related cross-sectionally and prospectively to higher BMI and subsequent onset of obesity to greater insulin resistance and worsening insulin resistance over time and to the onset of type 2 diabetes in young adulthood.”

Shomaker and colleagues evaluated 119 girls with overweight aged 12 to 17 years predisposed to insulin resistance with mild to moderate depressive symptoms to determine the efficacy of cognitive behavioral therapy for decreasing insulin resistance. Researchers also sought to determine whether decreasing depressive symptoms may be an explanatory mediator.

“If elevated depressive symptoms play a role in the etiology of type 2 diabetes, then intervening with an evidence-based program such as cognitive behavioral therapy for depressive symptoms would be anticipated to decrease type 2 diabetes risk by decreasing depressive symptoms and subsequently reducing insulin resistance,” Shomaker said.

Participants were randomly assigned to 6 weeks of cognitive behavioral therapy (n = 61) or health education (n = 58; control group); depressive symptoms were self-reported and insulin resistance was estimated at baseline, after treatment and 1 year.

The indirect effects of cognitive behavioral therapy were tested on posttreatment to 1-year change in BMI, fat mass and insulin resistance via decreasing depression from baseline to after treatment.

No direct effects were observed for the total sample. However, in a subset of participants with moderate baseline depression (42 in cognitive behavioral therapy group; 36 in control group), cognitive behavioral therapy conferred greater reduction in depression at the end of treatment compared with health education (P = .04).

Lower BMI (P = .003) and fat gain (P = .03) and greater decreases in homeostasis model of assessment for insulin resistance (HOMA-IR; P = .002), fasting insulin (P = .001) and 2-hour insulin (P = .03) from end of treatment to 1 year were predicted by decreases in depressive symptoms.

During treatment, decreases in depressive symptoms were an explanatory mediator of the effect of cognitive behavioral therapy on improved insulin, fat and BMI (P < .05).

“In other words, the decreases that we observed in depression, which was the target of cognitive behavioral therapy intervention, explained the later improvement in insulin outcomes. These results potentially have some implications for addressing type 2 diabetes prevention in adolescents with insulin resistance and moderately elevated depression,” Shomaker said. – by Amber Cox

Reference:

Shomaker LB. T-OR-2041. Presented at: ObesityWeek 2017; Oct. 29-Nov. 2, 2017; Washington, D.C.

Disclosure: Shomaker reports no relevant financial disclosures.

Lauren Shomaker
Lauren B. Shomaker

WASHINGTON — Cognitive behavioral therapy over 6 weeks may decrease depressive symptoms and, in turn, reduce BMI, fat gain and insulin resistance 1 year after treatment in adolescent girls with overweight and moderate depressive symptoms, according to findings presented here.

“Adolescent depressive symptoms are common, especially in girls, with 25% to 33% reporting elevated depressive symptoms,” Lauren B. Shomaker, PhD, assistant professor of human development and family services at Colorado State University, said during her presentation. “Depressive symptoms in adolescents are related cross-sectionally and prospectively to higher BMI and subsequent onset of obesity to greater insulin resistance and worsening insulin resistance over time and to the onset of type 2 diabetes in young adulthood.”

Shomaker and colleagues evaluated 119 girls with overweight aged 12 to 17 years predisposed to insulin resistance with mild to moderate depressive symptoms to determine the efficacy of cognitive behavioral therapy for decreasing insulin resistance. Researchers also sought to determine whether decreasing depressive symptoms may be an explanatory mediator.

“If elevated depressive symptoms play a role in the etiology of type 2 diabetes, then intervening with an evidence-based program such as cognitive behavioral therapy for depressive symptoms would be anticipated to decrease type 2 diabetes risk by decreasing depressive symptoms and subsequently reducing insulin resistance,” Shomaker said.

Participants were randomly assigned to 6 weeks of cognitive behavioral therapy (n = 61) or health education (n = 58; control group); depressive symptoms were self-reported and insulin resistance was estimated at baseline, after treatment and 1 year.

The indirect effects of cognitive behavioral therapy were tested on posttreatment to 1-year change in BMI, fat mass and insulin resistance via decreasing depression from baseline to after treatment.

No direct effects were observed for the total sample. However, in a subset of participants with moderate baseline depression (42 in cognitive behavioral therapy group; 36 in control group), cognitive behavioral therapy conferred greater reduction in depression at the end of treatment compared with health education (P = .04).

Lower BMI (P = .003) and fat gain (P = .03) and greater decreases in homeostasis model of assessment for insulin resistance (HOMA-IR; P = .002), fasting insulin (P = .001) and 2-hour insulin (P = .03) from end of treatment to 1 year were predicted by decreases in depressive symptoms.

During treatment, decreases in depressive symptoms were an explanatory mediator of the effect of cognitive behavioral therapy on improved insulin, fat and BMI (P < .05).

“In other words, the decreases that we observed in depression, which was the target of cognitive behavioral therapy intervention, explained the later improvement in insulin outcomes. These results potentially have some implications for addressing type 2 diabetes prevention in adolescents with insulin resistance and moderately elevated depression,” Shomaker said. – by Amber Cox

Reference:

Shomaker LB. T-OR-2041. Presented at: ObesityWeek 2017; Oct. 29-Nov. 2, 2017; Washington, D.C.

Disclosure: Shomaker reports no relevant financial disclosures.

    Perspective
    Eliot LeBow

    Eliot LeBow

    There are many causes of developing type 2 diabetes, from a long list of genetic and environmental factors. If a parent or family member has type 2 diabetes, then children growing up in those families have a high risk. Over the past several decades, research has not explored the impact of an individual's psychological state on the development of diabetes. This study examines a missing piece to the landscape of diabetes research, emotional health, and how depression directly impacts insulin sensitivity. 

    The findings are relevant to diabetes prevention. Mind and body are intertwined, and how we feel emotionally dictates how we feel physically and vice-versa. As clients in my private practice resolve their emotional issues, their insulin sensitivity seems to increase.

    All the latest research on depression shows us that it is two to three times more prevalent in people living with type 2 diabetes compared with the general population. More research needs to address the impact of mental health. If there is a causal relationship between depression and diabetes, maybe we can save the lives of future generations.

    Moving forward, society and the medical community as a whole need to pay more attention to mental health issues regardless of age.

    • Eliot LeBow, LCSW, CDE
    • New York, NY Founder of DiabeticTalks and Diabetes-Focused Psychotherapy

    Disclosures: LeBow reports no relevant financial disclosures.

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