February 01, 2018
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Mental health status may influence weight loss with intensive lifestyle intervention

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Matthew O'Brien
Matthew O'Brien

Hispanic women with prediabetes and overweight or obesity who were assigned to an intensive lifestyle intervention for 1 year experienced a greater reduction in body weight if their mental health remained stable or improved vs. similar women whose mental health worsened during the same time, study data show.

“We found that all participants lost weight in the first 6 months, regardless of changes in their mental health measures,” Matthew O’Brien, MD, MSc, assistant professor of medicine and preventive medicine at Northwestern University’s Feinberg School of Medicine, told Endocrine Today. “However, weight trajectories diverged from 6 to 12 months, with weight regain among participants whose mental health worsened and continued weight loss among those whose mental health was improved or stable.”

O’Brien and colleagues analyzed data from 92 Hispanic women with prediabetes and overweight or obesity assigned to a group-based intensive lifestyle intervention (n = 33; mean age, 46 years; mean BMI, 34.4 kg/m²), 850 mg metformin twice daily (n = 29; mean age, 45 years; mean BMI, 32.7 kg/m²) or standard care (n = 30; mean age, 45 years; mean BMI, 32.2 kg/m²) for 12 months, as part of PREVENT-DM, a comparative effectiveness trial based on the Group Lifestyle Balance Program. Women assigned to the intensive lifestyle intervention attended 14 weekly sessions, followed by 10 biweekly or monthly sessions. Women in the metformin arm attended brief monthly study visits; women in the standard care arm attended two study visits over 12 months, in which they received written educational materials about diabetes prevention. Participants completed three questionnaires to measure mental health variables: Beck Depression Inventory (depression severity scores range from 0 to 28), Generalized Anxiety Disorder scale (anxiety severity score ranges from 0 to 21) and Perceived Stress Scale (perceived stress score ranges from 0 to 40). Primary outcome was weight change from baseline to 12 months and its association with changes in depression, anxiety and perceived stress. Women whose symptom scores worsened on any one of the of the three measures were considered to have worsened mental health; those whose scores improved or remained stable on all three measures were considered to have improved or stable mental health.

Weight Loss Scale
Hispanic women with prediabetes and overweight or obesity participating in a lifestyle intervention experienced weight loss when their mental health remained stable or improved.
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As Endocrine Today previously reported in March, women in O’Brien and colleagues’ study assigned to the intensive lifestyle intervention lost more weight at 12 months vs. those assigned to metformin (mean, –3.1 kg; P = .013) or standard care (mean, –4.8 kg; P = .001). There were no between-group differences in weight loss observed between the metformin and standard care arms.

In the intensive lifestyle intervention group, mean baseline scores for the Beck Depression Inventory, the Generalized Anxiety Disorder scale and the Perceived Stress Scale were 13.5, 4.7 and 23.9, respectively. Mean corresponding values in the combined metformin and standard care groups were 11.2, 4.3 and 22, respectively.

Researchers found that women assigned to the intensive lifestyle intervention experienced greater mean weight loss and larger mental health improvements overall vs. women assigned to metformin or standard care. Additionally, mean changes in weight and mental health measures were greater at 12 months for women assigned to the lifestyle intervention whose mental health status improved or remained stable when compared with women assigned to the lifestyle intervention whose mental health worsened.

Among the 30 women assigned to the lifestyle intervention who completed follow-up at 12 months, 17 experienced worsening mental health and 13 experienced stable or improved mental health. Those who experienced stable or improving mental health lost a mean 5.1 kg more vs. women assigned to the lifestyle intervention whose mental health worsened (95% CI, –7.9 to –2.3). However, among women assigned to the lifestyle intervention, those who worsened on only one mental health measure still experienced some weight loss (mean, –3 kg; 95% CI, –4.8 to –1.2). Women assigned to the lifestyle intervention who worsened on two or three mental health measures experienced nonstatistically significant weight loss or weight gain.

Mental health status was not associated with 12-month weight changes for the metformin and standard care arms, according to researchers.

“Our findings have implications for designing and implementing future behavioral weight-loss programs that include participants with common mental health problems,” O’Brien said. “Such programs might consider focusing on mental health explicitly.”

O’Brien said future studies should definitively examine the timing of changes in weight and mental health measures during behavioral weight-loss programs.

“We are also developing a behavioral weight-loss program that includes a focus on reducing perceived stress,” O’Brien said. “We hope that this will result in greater weight loss and improvements in mental health measures than behavioral weight-loss programs that do not include a focus on mental health content.” – by Regina Schaffer

For more information:

Matthew O’Brien, MD, MSc, can be reached at Northwestern University Center for Community Health, 750 N. Lakes Shore Drive, 6th Floor, Chicago, IL 60611; email: matthew.obrien@northwestern.edu.

Disclosures: The authors report no relevant financial disclosures.