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Behavioral Intervention May Reduce Depression, Anxiety in Adults with Obesity

Jim Windell

             Both obesity and depression can be tricky to treat. But can an integrated behavioral intervention lead to weight loss and reduced depression?

            That was a question posed by researchers at the University of Illinois Chicago. In a recently published paper in Biological Psychiatry: Global Open Science, scientists from UIC described the findings of a study involving more than 100 people who were provided either usual care or a behavioral intervention.  

           The participants in the study were mostly women (76%) around 47 years old and more than two-thirds of them self-identified as Black (55%) or Latino (20%). Study participants who received usual care (35 participants) were advised to continue routine medical care and were provided with a summary of behavioral health and weight management services, as well as a wearable activity tracker. The participants (71 people) who received the integrated behavioral intervention received therapy from a trained health coach and a weight loss video program. The therapy involved a seven-step problem-solving and behavioral activation strategy, delivered as first-line treatment, along with antidepressant medications as needed for depression management.  

           The weight loss video program was adapted from the highly successful Diabetes Prevention Program lifestyle intervention, which lead author Dr. Jun Ma previously demonstrated was effective in obese patients without depression. The integrated intervention is seen as innovative because it combines problem-solving therapy and the weight loss video program, given that obesity is highly comorbid with depression and anxiety. 

           Symptoms of depression were assessed with a 20-item symptom checklist and symptoms of anxiety through a seven-item scale, and weight was measured by research staff. Baseline results were compared with six-month results. Brain activity was measured with functional MRI in response to research standardized photos of threatening, sad or happy faces, for example, at baseline and two months. 

           Results from this study show that an integrated behavioral intervention was more effective than usual care at reducing depression and associated anxiety symptoms than it was at promoting weight loss. The researchers also found that among those participating in the intervention, neural processes involved in cognitive control changed and were predictive of anxiety symptom reductions. 

           According to Jun Ma, the Beth and George Vitoux Professor of Medicine and director of Vitoux Program on Aging and Prevention at the UIC College of Medicine, “The link between our brain and behavior is powerful, and this growing body of evidence shows us that whole-person, integrated behavioral therapy can offer hope for some of our most challenging health conditions – obesity and depression, for example, being both highly prevalent and notoriously tricky to treat.”

           Dr. Olusola Ajilore, associate professor of psychiatry and a co-first author of the study, added that “Consistent with our hypothesis, we found that clinical improvements in anxiety were preceded by changes in activation and connectivity improvements in brain regions involved in emotion regulation and furthermore are targeted by treatments like repetitive transcranial stimulation and cognitive behavioral therapy.”

           A significantly higher percentage of participants in the intervention group compared with usual care group achieved remission of depressive symptoms (43% vs. 22%) and anxiety symptoms (63% vs. 39%) at six months, but percentages of participants achieving 3% or 5% weight loss at six months did not differ significantly by group. 

           Anxiety score changes significantly correlated with brain activity changes in specific regions of the prefrontal cortex that are responsible for cognitive control, and the correlations differed between the intervention and usual care groups.  

                 “Taken together, these and our previous results imply the potential for enhancing the innovative integrated behavioral intervention we developed with other treatment strategies targeted at the specific regions of the brain involved in cognition and emotion regulation in order to combat obesity and depression and anxiety,” said Dr. Ma. 

                   To read the original paper, find it with this reference:

Nan Lv, Olusola A. Ajilore, Lan Xiao, Elizabeth M. Venditti, Philip W. Lavori, Ben S. Gerber, Mark B. Snowden, Nancy E. Wittels, Corina R. Ronneberg, Patrick Stetz, Amruta Barve, Rohit Shrestha, Sushanth Dosala, Vikas Kumar, Tessa L. Eckley, Andrea N. Goldstein-Piekarski, Joshua M. Smyth, Lisa G. Rosas, Thomas Kannampallil, John Zulueta, Trisha Suppes, Leanne M. Williams, & Jun Ma. (2022). Mediating Effects of Neural Targets on Depression, Weight, and Anxiety Outcomes of an Integrated Collaborative Care Intervention: The ENGAGE-2 Mechanistic Pilot Randomized Clinical Trial. Biological Psychiatry Global Open Science, 2022, https://doi.org/10.1016/j.bpsgos.2022.03.012