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Ronneberg CR, Lv N, Ajilore OA, Kannampallil T, Smyth J, Kumar V, Barve A, Garcia C, Dosala S, Wittels N, Xiao L, Aborisade G, Zhang A, Tang Z, Johnson J, Ma J. Study of a PST-trained voice-enabled artificial intelligence counselor for adults with emotional distress (SPEAC-2): Design and methods. Contemp Clin Trials 2024; 142:107574. [PMID: 38763307 DOI: 10.1016/j.cct.2024.107574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/29/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Novel and scalable psychotherapies are urgently needed to address the depression and anxiety epidemic. Leveraging artificial intelligence (AI), a voice-based virtual coach named Lumen was developed to deliver problem solving treatment (PST). The first pilot trial showed promising changes in cognitive control measured by functional neuroimaging and improvements in depression and anxiety symptoms. METHODS To further validate Lumen in a 3-arm randomized clinical trial, 200 participants with mild-to-moderate depression and/or anxiety will be randomly assigned in a 2:1:1 ratio to receive Lumen-coached PST, human-coached PST as active treatment comparison, or a waitlist control condition where participants can receive Lumen after the trial period. Participants will be assessed at baseline and 18 weeks. The primary aim is to confirm neural target engagement by testing whether compared with waitlist controls, Lumen participants will show significantly greater improvements from baseline to 18 weeks in the a priori neural target for cognitive control, right dorsal lateral prefrontal cortex engaged by the go/nogo task (primary superiority hypothesis). A secondary hypothesis will test whether compared with human-coached PST participants, Lumen participants will show equivalent improvements (i.e., noninferiority) in the same neural target from baseline to 18 weeks. The second aim is to examine (1) treatment effects on depression and anxiety symptoms, psychosocial functioning, and quality of life outcomes, and (2) relationships of neural target engagement to these patient-reported outcomes. CONCLUSIONS This study offers potential to improve the reach and impact of psychotherapy, mitigating access, cost, and stigma barriers for people with depression and/or anxiety. CLINICALTRIALS gov #: NCT05603923.
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Affiliation(s)
- Corina R Ronneberg
- Department of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, United States of America.
| | - Nan Lv
- Department of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, United States of America.
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois Chicago, 1601 W. Taylor St., Chicago, IL 60612, United States of America.
| | - Thomas Kannampallil
- Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, United States of America.
| | - Joshua Smyth
- Department of Psychology, The Ohio State University, 1835 Neil Ave., Columbus, OH 43210, United States of America.
| | - Vikas Kumar
- Department of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, United States of America.
| | - Amruta Barve
- Department of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, United States of America.
| | - Claudia Garcia
- Department of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, United States of America.
| | - Sushanth Dosala
- Department of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, United States of America.
| | - Nancy Wittels
- Department of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, United States of America.
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, United States of America.
| | - Gbenga Aborisade
- Department of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, United States of America.
| | - Aifeng Zhang
- Department of Psychiatry, University of Illinois Chicago, 1601 W. Taylor St., Chicago, IL 60612, United States of America.
| | - Zhengxin Tang
- University of Illinois College of Medicine, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Jillian Johnson
- Comprehensive Cancer Center, Atrium Health Wake Forest Baptist, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America.
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, United States of America.
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Tozzi L, Zhang X, Pines A, Olmsted AM, Zhai ES, Anene ET, Chesnut M, Holt-Gosselin B, Chang S, Stetz PC, Ramirez CA, Hack LM, Korgaonkar MS, Wintermark M, Gotlib IH, Ma J, Williams LM. Personalized brain circuit scores identify clinically distinct biotypes in depression and anxiety. Nat Med 2024; 30:2076-2087. [PMID: 38886626 PMCID: PMC11271415 DOI: 10.1038/s41591-024-03057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/09/2024] [Indexed: 06/20/2024]
Abstract
There is an urgent need to derive quantitative measures based on coherent neurobiological dysfunctions or 'biotypes' to enable stratification of patients with depression and anxiety. We used task-free and task-evoked data from a standardized functional magnetic resonance imaging protocol conducted across multiple studies in patients with depression and anxiety when treatment free (n = 801) and after randomization to pharmacotherapy or behavioral therapy (n = 250). From these patients, we derived personalized and interpretable scores of brain circuit dysfunction grounded in a theoretical taxonomy. Participants were subdivided into six biotypes defined by distinct profiles of intrinsic task-free functional connectivity within the default mode, salience and frontoparietal attention circuits, and of activation and connectivity within frontal and subcortical regions elicited by emotional and cognitive tasks. The six biotypes showed consistency with our theoretical taxonomy and were distinguished by symptoms, behavioral performance on general and emotional cognitive computerized tests, and response to pharmacotherapy as well as behavioral therapy. Our results provide a new, theory-driven, clinically validated and interpretable quantitative method to parse the biological heterogeneity of depression and anxiety. Thus, they represent a promising approach to advance precision clinical care in psychiatry.
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Affiliation(s)
- Leonardo Tozzi
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Xue Zhang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Adam Pines
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Alisa M Olmsted
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Emily S Zhai
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Esther T Anene
- Department of Counseling and Clinical Psychology, Teacher's College, Columbia University, New York, NY, USA
| | - Megan Chesnut
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Bailey Holt-Gosselin
- Interdepartmental Neuroscience Graduate Program, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Chang
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Patrick C Stetz
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Carolina A Ramirez
- Center for Intelligent Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Laura M Hack
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
- Department of Radiology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Max Wintermark
- Department of Neuroradiology, the University of Texas MD Anderson Center, Houston, TX, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Jun Ma
- Department of Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Sierra-Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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Echeveste-Navarrete J, Zavaleta-Ramírez P, Castilla-Peon MF. Trajectory of the body mass index of children and adolescents attending a reference mental health center. J Pediatr Endocrinol Metab 2024; 37:559-568. [PMID: 38634616 DOI: 10.1515/jpem-2024-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES The primary objective was to describe the standardized body mass index (z-BMI) trajectory of children and adolescents admitted to a psychiatric reference center in Mexico City according to their diagnosis and medication use. The secondary objective was to compare z-BMI between antipsychotic users and non-users. METHODS This is a retrospective cohort study. The psychiatric diagnosis, prescribed medications, serial heights, and weights were collected from the medical records. RESULTS The median baseline z-BMI of the 129 analyzed cases was 0.88 (interquartile range [IQR]: 0-1.92), and the prevalence of excessive weight (obesity or overweight) was 46.8 %. At the end of follow-up (median 50.3 weeks), the median change in z-BMI was -0.09 (IQR: -0.68 to 0.42). New long-term users of antipsychotics (n=29) had an increase in their z-BMI, in contrast to never-users (median difference 0.73, p=0.01) and to previous users (median difference 0.92, p=0.047). The 59 subjects with excessive weight at admission had a median z-BMI change of -0.39 (IQR: -0.81 to -0.04). Among patients with excessive weight and depression, there was a greater decrease in z-BMI in sertraline users (n=13) compared with fluoxetine users (n=15) (median -0.65 vs. 0.21, p<0.001). CONCLUSIONS New long-term users of antipsychotics showed a significant increase in their z-BMI. Patients with depressive disorders and obesity on sertraline therapy tended to show a decrease in their z-BMI.
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Affiliation(s)
- Juliana Echeveste-Navarrete
- Pharmacist, Hospital Psiquiátrico Infantil 'Dr. Juan N. Navarro', Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Patricia Zavaleta-Ramírez
- Child and Adolescent Psychiatrist, Research Division Director, Hospital Psiquiátrico Infantil 'Dr. Juan N. Navarro', Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Maria Fernanda Castilla-Peon
- Pediatric Endocrinologist, Researcher at Hospital Psiquiátrico Infantil 'Dr. Juan N. Navarro', Comisión Nacional de Salud Mental y Adicciones, Mexico City, México
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Shen Y, Wu Y, Luo P, Fu M, Zhu K, Wang J. Association between weight-adjusted-waist index and depression in US adults: A cross-sectional study. J Affect Disord 2024; 355:299-307. [PMID: 38548206 DOI: 10.1016/j.jad.2024.03.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Current evidence implicates a significant association between depression and obesity and related metabolic dysfunction. The weight-adjusted-waist index (WWI) was recently identified as an ideal index that integrates total body fat, muscle mass, and bone mass. This study investigated the relationship between WWI and depressive symptoms in adults. METHODS Participants from the National Health and Nutrition Examination Survey (2005-2018) were enrolled. Depressive symptom severity was measured with the Patient Health Questionnaire-9 (PHQ-9). Survey-weighted multivariable logistic regression, subgroup analysis, and generalized additive models were used to determine the relationship between WWI and depressive symptoms. RESULTS A total of 34,575 participants were included, with a mean WWI of 11.01; 2,979 participants were suspected of having depressive symptoms (PHQ-9 score ≥ 10). A significant positive association was identified between WWI and depressive symptoms (odds ratio = 1.416, 95 % confidence interval: 1.303-1.539, P < 0.0001). Subgroup analyses suggested that the association between WWI and depressive symptoms was stronger in individuals who were female, overweight, divorced, middle-aged or older (over 40 years old), and had diabetes. Furthermore, the non-linear multivariable regression revealed an inflection point for the WWI at 11.438, and the association was only significant when the WWI was higher than this point. LIMITATIONS This study was retrospective and only included participants from the United States; therefore, further validation is needed from studies in other countries, especially middle-to-low-income countries, using longitudinal cohorts. CONCLUSIONS This study identified a significant positive association between WWI and depressive symptoms.
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Affiliation(s)
- Yun Shen
- Department of Pathology, People's Hospital of Tongling City, Tongling, Anhui, China
| | - Yahui Wu
- Department of Pathology, The First Clinical College of Changzhi Medical College, Changzhi, Shanxi, China; Department of Pathology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Panru Luo
- Department of Pathology, The First Clinical College of Changzhi Medical College, Changzhi, Shanxi, China; Department of Pathology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Minghan Fu
- Department of Pathology, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Kai Zhu
- Department of Pathology, The First Clinical College of Changzhi Medical College, Changzhi, Shanxi, China; Department of Pathology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Jinsheng Wang
- Department of Pathology, The First Clinical College of Changzhi Medical College, Changzhi, Shanxi, China; Department of Pathology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China.
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Applewhite B, Penninx BWJH, Young AH, Schmidt U, Himmerich H, Keeler JL. The effect of a low-calorie diet on depressive symptoms in individuals with overweight or obesity: a systematic review and meta-analysis of interventional studies. Psychol Med 2024; 54:1671-1683. [PMID: 38084632 DOI: 10.1017/s0033291723003586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Individuals with overweight or obesity are at a high risk for so-called 'atypical' or immunometabolic depression, with associated neurovegetative symptoms including overeating, fatigue, weight gain, and a poor metabolic profile evidenced e.g. by dyslipidemia or hyperglycemia. Research has generated preliminary evidence for a low-calorie diet (LCD) in reducing depressive symptoms. The aim of the current systematic review and meta-analysis is to examine this evidence to determine whether a LCD reduces depressive symptoms in people with overweight or obesity. METHODS Eligible studies were identified through PubMed, ISI Web of Science, and PsycINFO until August 2023. Standardized mean differences (SMDs) were derived using random-effects meta-analyses for (1) pre-post LCD comparisons of depression outcomes, and (2) LCD v. no-diet-control group comparisons of depression outcomes. RESULTS A total of 25 studies were included in the pre-post meta-analysis, finding that depression scores were significantly lower following a LCD (SMD = -0.47), which was not significantly moderated by the addition of exercise or behavioral therapy as a non-diet adjunct. Meta-regressions indicated that a higher baseline BMI and greater weight reduction were associated with a greater reduction in depression scores. The intervention-control meta-analysis (n = 4) found that overweight or obese participants adhering to a LCD showed a nominally lower depression score compared with those given no intervention (SMD = -0.29). CONCLUSIONS There is evidence that LCDs may reduce depressive symptoms in people with overweight or obesity in the short term. Future well-controlled intervention studies, including a non-active control group, and longer-term follow-ups, are warranted in order to make more definitive conclusions.
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Affiliation(s)
- Briana Applewhite
- Department of Psychological Medicine, Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, UK
| | - Brenda W J H Penninx
- Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Allan H Young
- Department of Psychological Medicine, Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Hubertus Himmerich
- Department of Psychological Medicine, Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Johanna L Keeler
- Department of Psychological Medicine, Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Chen P, Song Q, Wang X, Li M, Liu L, Ning J, Song Y, Yu C, Guan Q. Combined association of abdominal obesity and depressive symptoms with risk of type 2 diabetes: A cohort study. J Psychosom Res 2024; 179:111627. [PMID: 38422717 DOI: 10.1016/j.jpsychores.2024.111627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To explore the combined effect of abdominal obesity and depressive symptoms on the risk to type 2 diabetes, while also assessing the potential influence of various glycemic states and gender on this combined relationship. METHODS Data is acquired from the China Health and Retirement Longitudinal Study, and 5949 participants were included for analysis. Participants were divided into four groups: neither have abdominal obesity nor depressive symptoms (AO-/DS-), only have depressive symptoms (AO-/DS+), only have abdominal obesity (AO+/DS-), and have both abdominal obesity and depressive symptoms (AO+/DS+). Stratified analyses differentiating the glycemic statuses and sex of the participants were also carried out. RESULTS After adjusting for the confounders, the AO-/DS+, AO+/DS- and AO+/DS+ phenotypes were all discovered to be risk factors for type 2 diabetes (OR = 1.38, 95%CI: 1.06-1.79; OR = 2.07, 95%CI: 1.63-2.63; OR = 2.38, 95%CI: 1.83-3.11, respectively) compared with the AO-/DS- phenotype in the overall population. In further stratified analyses, we arrived at the same conclusion for normoglycemic individuals, especially in females. For prediabetes and males, the AO+/DS- and AO+/DS+ phenotypes are risk factors for type 2 diabetes compared with the AO-/DS- phenotype, but not with AO-/DS+. CONCLUSION Regardless of glycemic status and sex, the coexistence of abdominal obesity and depressive symptoms were associated with an increased risk of type 2 diabetes. Depressive symptoms were independent risk factors for type 2 diabetes only in normoglycemic individuals and females.
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Affiliation(s)
- Pengcheng Chen
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Qianmei Song
- Department of General Medicine, Zaozhuang Municipal Hospital, Zaozhuang, Shandong 277100, China
| | - Xinning Wang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Man Li
- Department of Geratology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Luna Liu
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China
| | - Jing Ning
- Department of Endocrinology, Shandong Rongjun General Hospital, Jinan, Shandong 250013, China
| | - Yongfeng Song
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China; Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China.
| | - Chunxiao Yu
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China; Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China.
| | - Qingbo Guan
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China; Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong 250021, China; Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China; Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong 250021, China.
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Kocol D, Bäuerle A, Schadendorf T, Geiger S, Krakowczyk JB, Skoda EM, Teufel M. Efficacy of eHealth interventions to reduce depression symptoms in individuals with obesity: a systematic review of randomized controlled trials. Front Psychiatry 2024; 15:1296433. [PMID: 38516265 PMCID: PMC10954845 DOI: 10.3389/fpsyt.2024.1296433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/07/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Obesity and depression are inter-related health concerns, demanding a high level of treatment and costs in the health care system. The development of eHealth interventions that simultaneously address obesity and mental health can be supportive in this regard. However, evidence of the efficacy of eHealth interventions in the treatment of depression symptoms in individuals with obesity is lacking. The aim of this systematic literature review is to evaluate the efficacy of existing eHealth interventions for individuals with obesity that target depression symptoms. Methods We systematically searched electronic databases (Cochrane Library, PubMed, Scopus) to identify studies published in English between January 2016 and January 2023, that focused on eHealth interventions, targeting depression symptoms in individuals with obesity people. Exclusion criteria were study objectives that (1) focused specifically on one or more metabolic comorbidities of individuals with obesity, e.g., hypertension, hyperlipidemia, diabetes; (2) focused specifically on eating disorders comorbidities e.g., binge eating disorder, and (3) focused specifically on patients before or after bariatric surgery. Results The database search identified 214 records. Six articles were included in this review. Sample sizes ranged from 70 to 1267 participants of ages 18-60 years. All included studies were randomized controlled trials. Two of the six included studies were web-based interventions guided either by medical doctors or psychologists. All interventions included video, printed materials, and interactive parts of which two studies integrated elements of Cognitive Behavioural Therapy and Social Cognitive Therapy. The findings showed that eHealth treatment services, supported and guided throughout the intervention had high acceptance and efficacy in the reduction of depression symptoms among individuals with obesity. Conclusion EHealth interventions that address and target both mental and physical health with interactive strategies calls for better efficacy in the reduction of depression symptoms. Future eHealth interventions that target depression symptoms in individuals with obesity should integrate digital strategies that address both mental and physical health through interactive modules.
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Affiliation(s)
- Dilara Kocol
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Theresa Schadendorf
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Sheila Geiger
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Julia Barbara Krakowczyk
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Kocol D, Geiger S, Schweda A, Beckord J, Schadendorf T, Jansen C, Robitzsch A, Skoda EM, Teufel M, Bäuerle A. An e-mental health intervention to reduce depression symptoms in individuals with obesity: study protocol for the randomized, controlled, two-armed, confirmatory LightMood trial. Trials 2024; 25:149. [PMID: 38419096 PMCID: PMC10900592 DOI: 10.1186/s13063-024-07970-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Patients with obesity often experience psychological distress, specifically depression symptoms. Due to various barriers, such as limitations of healthcare offers, digital interventions, for example medical apps, can provide a suitable approach to support affected people. In the envisaged prospective randomized controlled trial, we aim to examine the efficacy of the LightMood intervention. The LightMood intervention is a manualized and user-centered, digital intervention for patients with obesity, with a duration of 4 months, which contains elements of cognitive behavioral therapy and mindfulness-based and skills-based exercises. We expect the LightMood intervention to be superior to treatment as usual (TAU) in terms of reducing depression symptoms. METHODS The trial incorporates four distinct measurement time points: the baseline assessment, the post-treatment assessment, and 1- and 3-month follow-up assessments. Furthermore, we implemented in-treatment assessments for both groups. Participants will be randomized into two groups (LightMood intervention vs TAU). The aim is to include 128 participants (64 per group) in the study. Inclusion criteria are patients who are obese, at least 18 years old, with a private Internet access, and with adequate digital literacy and show depression symptoms (PHQ ≥ 10). Exclusion criteria are weekly outpatient individual psychotherapy, obesity surgery within the last year or planned within the next 7 months, no private Internet access, and the prescription of a new psychotropic drug within the last 2 weeks. The primary outcome is the post-assessment reduction in depression symptoms. Secondary outcomes will include the improvement in self-efficacy, quality of life, mindfulness, reduction in eating disorder symptoms, and body mass index (BMI). Furthermore, we expect a positive development of depression symptoms throughout the different time points (T1, T2, and T3) in patients with obesity. DISCUSSION LightMood is an evidence-based, efficient, low-threshold online intervention that aims to reduce depression symptoms in people with obesity. Online interventions could offer a promising alternative to conventional face-to-face therapy. The primary objective of the current study is to add essential insight into the feasibility, efficacy, effectiveness, and acceptance of e-mental health interventions for people with obesity and depression symptoms. TRIAL REGISTRATION German Clinical Trial Register (DRKS), DRKS00029219. Registered on May 19, 2023.
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Affiliation(s)
- Dilara Kocol
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany.
| | - Sheila Geiger
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Adam Schweda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Jil Beckord
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Theresa Schadendorf
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Christoph Jansen
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Anita Robitzsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Hallihan H, Abboud S, Lee S, Rospenda K, Srimoragot M, Fink A, Ma J. A qualitative exploration of young adults' perceptions of a new intervention for alcohol use disorder. Ann Med 2024; 55:2295983. [PMID: 38175792 PMCID: PMC10769559 DOI: 10.1080/07853890.2023.2295983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Due to the rising prevalence of alcohol use disorders among young adults, the need for effective and accessible interventions has become increasingly imperative. In acknowledgment of this issue, we developed a novel intervention known as contingency management plus problem solving therapy (CM-PST). The aim of the current study was to gain insight into the perspectives on the effectiveness of the newly developed CM-PST using focus group discussion among young adults who consume alcohol regularly. MATERIALS AND METHODS The study employed a qualitative research design, utilizing focus group discussions as the primary data collection method. Participants described their perceptions regarding the newly developed CM-PST. Semi-structured focus group sessions were conducted via Zoom in November 2022. A total of 19 young adults, aged 18-24 years old, participated in five focus group sessions. Data were analyzed using deductive content analysis. RESULTS Participants demonstrated overall positive attitudes toward the novel intervention, recognizing the potential benefits, it could offer in terms of alcohol use reduction and emotional well-being. They emphasized the importance of incentives in motivating behavioral changes, as well as the practicality of problem-solving techniques in addressing everyday challenges. Additionally, participants provided valuable insights into potential barriers and implementation challenges, highlighting the need for flexible and personalized approaches to accommodate individual preferences and needs. CONCLUSIONS The results of this study contribute to the growing body of literature on innovative intervention approaches for young adults facing alcohol use issues. The findings shed light on the acceptability and perceived effectiveness of the CM-PST intervention from the perspective of the target population.
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Affiliation(s)
- Hagar Hallihan
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Sangeun Lee
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Kathleen Rospenda
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | | | - Anne Fink
- Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
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10
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Chirinos DA, Kershaw KN, Allen NB, Carroll AJ, Lewis TT, Schreiner PJ, Lewis CE, Kiefe CI, Mezuk B, Carnethon MR. Depressive Symptom Subgroups and Their Association with Prevalent and Incident Cardiovascular Risk Factors in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Int J Behav Med 2023; 30:891-903. [PMID: 36670342 DOI: 10.1007/s12529-022-10144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND We sought to identify depressive symptom subgroups in a community sample of young adults, investigate their stability over time, and determine their association with prevalent and incident cardiovascular disease (CVD) risk factors. METHOD Participants were 3377 adults from the Coronary Artery Risk Development in Young Adults study. Using latent class and latent transition analysis, we derived subgroups based on items of the 20-item version of the Center for Epidemiologic Studies Depression Scale in 1990, and examined patterns of change over a 10-year period (1990-2000). Cox regression models were used to examine associations between subgroup membership and prevalent (2000) and incident (2000 to 2016) obesity, hypertension, and diabetes. RESULTS Three baseline subgroups were identified and labeled: "No Symptoms" (63.5%), "Lack of Positive Affect" (PA, 25.6%), and "Depressed Mood" (10.9%). At 10-year follow-up, individuals in "No Symptoms" subgroup had the highest probability (0.84) of being classified within the same subgroup. Participants classified as "Lack of PA" were likely (0.46) to remain in the same subgroup or be classified as "No Symptoms." Participants in the "Depressed Mood" were most likely to transition to the "Lack of PA" subgroup (0.38). Overall, 30.5% of participants transitioned between subgroups, with 11.4% classified as "Worsening" and 19.1% as "Improving." Relative to the "No Symptoms Stable," other subgroups ("Depressed Stable," "Worsening," and "Improving") were associated with prevalent obesity and hypertension. CONCLUSION We identified distinct depressive symptom subgroups that are variably stable over time, and their change patterns were differentially associated with CVD risk factor prevalence.
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Affiliation(s)
- Diana A Chirinos
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Allison J Carroll
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Cora E Lewis
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA
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11
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Au DH, Gleason E, Hunter-Merrill R, Barón AE, Collins M, Ronneberg C, Lv N, Rise P, Wai TH, Plumley R, Wisniewski SR, Sciurba FC, Kim DY, Simonelli P, Krishnan JA, Wendt CH, Feemster LC, Criner GJ, Maddipati V, Mohan A, Ma J. Lifestyle Intervention and Excess Weight in Chronic Obstructive Pulmonary Disease (COPD): INSIGHT COPD Randomized Clinical Trial. Ann Am Thorac Soc 2023; 20:1743-1751. [PMID: 37769182 PMCID: PMC10704228 DOI: 10.1513/annalsats.202305-458oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023] Open
Abstract
Rationale: Being overweight or obese is common among patients with chronic obstructive pulmonary disease (COPD), but whether interventions targeted at weight loss improve functional impairments is unknown. Objectives: INSIGHT (Intervention Study in Overweight Patients with COPD) tested whether a pragmatic low-intensity lifestyle intervention would lead to better physical functional status among overweight or obese participants with COPD. Methods: The trial was a 12-month, multicenter, patient-level pragmatic clinical trial. Participants were recruited from April 2017 to August 2019 from 38 sites across the United States and randomized to receive usual care or usual care plus lifestyle intervention. The intervention was a self-directed video program delivering the Diabetes Prevention Program's Group Lifestyle Balance curriculum. Results: The primary outcome was 6-minute-walk test distance at 12 months. Priority secondary outcomes were postwalk modified Borg dyspnea at 12 months and weight at 12 months. Participants (N = 684; mean age, 67.0 ± 8.0 yr [standard deviation]; 41.2% female) on average were obese (body mass index, 33.0 ± 4.6 kg/m2) with moderate COPD (forced expiratory volume in 1 second % predicted, 58.1 ± 15.7%). At 12 months, participants randomized to the intervention arm walked farther (adjusted difference, 42.3 ft [95% confidence interval (CI), 7.9-76.7 ft]; P = 0.02), had less dyspnea at the end of the 6-minute-walk test (adjusted difference, -0.36 [95% CI, -0.63 to -0.09]; P = 0.008), and had greater weight loss (adjusted difference, -1.34 kg [95% CI, -2.33 to -0.34 kg]; P = 0.008) than control participants. The intervention did not improve the odds of achieving clinically meaningful thresholds of walk distance (98.4 ft) or dyspnea (1 unit) but did achieve meaningful thresholds of weight loss (3% and 5%). Conclusions: Among participants with COPD who were overweight or obese, a self-guided low-intensity video-based lifestyle intervention led to modest weight loss but did not lead to clinically important improvements in physical functional status and dyspnea. Clinical trial registered with www.clinicaltrials.gov (NCT02634268).
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Affiliation(s)
- David H. Au
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Emily Gleason
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Rachel Hunter-Merrill
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Anna E. Barón
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Margaret Collins
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | | | - Nan Lv
- Department of Medicine and
| | - Peter Rise
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Travis Hee Wai
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Robert Plumley
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | | | - Frank C. Sciurba
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul Simonelli
- Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Christine H. Wendt
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Laura C. Feemster
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Veeranna Maddipati
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, East Carolina University, Greenville, North Carolina
| | - Arjun Mohan
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, East Carolina University, Greenville, North Carolina
| | - Jun Ma
- Division of Academic Internal Medicine and Geriatrics, University of Illinois Chicago, Chicago, Illinois
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12
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Lv N, Kannampallil T, Xiao L, Ronneberg CR, Kumar V, Wittels NE, Ajilore OA, Smyth JM, Ma J. Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial. JMIR Hum Factors 2023; 10:e49715. [PMID: 37930781 PMCID: PMC10660207 DOI: 10.2196/49715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The quality of user interaction with therapeutic tools has been positively associated with treatment response; however, no studies have investigated these relationships for voice-based digital tools. OBJECTIVE This study evaluated the relationships between objective and subjective user interaction measures as well as treatment response on Lumen, a novel voice-based coach, delivering problem-solving treatment to patients with mild to moderate depression or anxiety or both. METHODS In a pilot trial, 42 adults with clinically significant depression (Patient Health Questionnaire-9 [PHQ-9]) or anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) symptoms or both received Lumen, a voice-based coach delivering 8 problem-solving treatment sessions. Objective (number of conversational breakdowns, ie, instances where a participant's voice input could not be interpreted by Lumen) and subjective user interaction measures (task-related workload, user experience, and treatment alliance) were obtained for each session. Changes in PHQ-9 and GAD-7 scores at each ensuing session after session 1 measured the treatment response. RESULTS Participants were 38.9 (SD 12.9) years old, 28 (67%) were women, 8 (19%) were Black, 12 (29%) were Latino, 5 (12%) were Asian, and 28 (67%) had a high school or college education. Mean (SD) across sessions showed breakdowns (mean 6.5, SD 4.4 to mean 2.3, SD 1.8) decreasing over sessions, favorable task-related workload (mean 14.5, SD 5.6 to mean 17.6, SD 5.6) decreasing over sessions, neutral-to-positive user experience (mean 0.5, SD 1.4 to mean 1.1, SD 1.3), and high treatment alliance (mean 5.0, SD 1.4 to mean 5.3, SD 0.9). PHQ-9 (Ptrend=.001) and GAD-7 scores (Ptrend=.01) improved significantly over sessions. Treatment alliance correlated with improvements in PHQ-9 (Pearson r=-0.02 to -0.46) and GAD-7 (r=0.03 to -0.57) scores across sessions, whereas breakdowns and task-related workload did not. Mixed models showed that participants with higher individual mean treatment alliance had greater improvements in PHQ-9 (β=-1.13, 95% CI -2.16 to -0.10) and GAD-7 (β=-1.17, 95% CI -2.13 to -0.20) scores. CONCLUSIONS The participants had fewer conversational breakdowns and largely favorable user interactions with Lumen across sessions. Conversational breakdowns were not associated with subjective user interaction measures or treatment responses, highlighting how participants adapted and effectively used Lumen. Individuals experiencing higher treatment alliance had greater improvements in depression and anxiety. Understanding treatment alliance can provide insights on improving treatment response for this new delivery modality, which provides accessibility, flexibility, comfort with disclosure, and cost-related advantages compared to conventional psychotherapy. TRIAL REGISTRATION ClinicalTrials.gov NCT04524104; https://clinicaltrials.gov/study/NCT04524104.
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Affiliation(s)
- Nan Lv
- Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University, St. Louis, MO, United States
- Institute for Informatics, Washington University, St. Louis, MO, United States
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States
| | - Corina R Ronneberg
- Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Vikas Kumar
- Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Nancy E Wittels
- Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States
| | - Joshua M Smyth
- Department of Psychology, The Ohio State University, Columbus, OH, United States
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
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Magzal F, Turroni S, Fabbrini M, Barone M, Vitman Schorr A, Ofran A, Tamir S. A personalized diet intervention improves depression symptoms and changes microbiota and metabolite profiles among community-dwelling older adults. Front Nutr 2023; 10:1234549. [PMID: 37794974 PMCID: PMC10547149 DOI: 10.3389/fnut.2023.1234549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/21/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction The impact of diet on mental well-being and gut microorganisms in humans is well recognized. However, research on the connections between food nutrients, gut microbiota, and mental health remains limited. To address this, the present study aimed to assess the effects of a personalized diet, based on individual needs and aligned with the Mediterranean diet principles, on depression symptoms, quality of life, nutritional intake, and gut microbiota changes among older adults living in the community. Methods The intervention involved regular visits from a registered dietitian, who provided tailored dietary recommendations. During the 6-month study, participants completed questionnaires to evaluate their depression levels, quality of life, and dietary habits. Additionally, they provided stool samples for analysis of gut microbiota and metabolites. Results The results demonstrated that the personalized dietary intervention reduced depression symptoms and improved the quality of life among older adults. Furthermore, significant changes in the intake of certain nutrients, such as folate, lutein, zeaxanthin, EPA, and DHA, were observed following the intervention. Moreover, the intervention was associated with increased diversity in the gut microbiome and reduced total short-chain fatty acids, the main metabolites produced by gut microorganisms. The study also revealed correlations between food nutrients, gut microbiota, and mental health parameters. Discussion In conclusion, this research highlights the potential advantages of personalized dietary interventions in managing depression and enhancing overall well-being among older populations. It also sheds light on the role of gut microbiota and its metabolites in these effects. The findings offer valuable insights into the significance of nutrition and gut health for mental well-being in older adults.
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Affiliation(s)
- Faiga Magzal
- Laboratory of Human Health and Nutrition Sciences, MIGAL-Galilee Research Institute, Kiryat Shmona, Israel
- Department of Nutrition, Tel Hai College, Upper Galilee, Israel
| | - Silvia Turroni
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Marco Fabbrini
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
- Microbiomics Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Monica Barone
- Microbiomics Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | - Snait Tamir
- Laboratory of Human Health and Nutrition Sciences, MIGAL-Galilee Research Institute, Kiryat Shmona, Israel
- Department of Nutrition, Tel Hai College, Upper Galilee, Israel
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Pruccoli J, Mack I, Klos B, Schild S, Stengel A, Zipfel S, Giel KE, Schag K. Mental Health Variables Impact Weight Loss, Especially in Patients with Obesity and Binge Eating: A Mediation Model on the Role of Eating Disorder Pathology. Nutrients 2023; 15:3915. [PMID: 37764699 PMCID: PMC10537364 DOI: 10.3390/nu15183915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Various mental health and eating behavior variables have been independently associated with predicting weight loss in individuals with obesity. This study aims to investigate a mediation model that assesses the distinct contributions of these variables in predicting weight changes in patients with obesity following an outpatient behavioral weight loss intervention (BWLI). METHODS General mental health (depression, anxiety, stress, impulsivity), eating behavior (cognitive restraint, disinhibition, hunger), eating disorder pathology, and body mass index (BMI) were assessed in a group of 297 patients with obesity at the admission of a BWLI program. BMI was re-evaluated during the final treatment session. A mediation model was employed to examine whether mental health and eating behavior variables predicted BMI changes, with eating disorder pathology serving as a mediator. The model was tested both overall and within two patient subgroups: those with regular binge eating (≥four episodes/month) and those without. RESULTS In the overall sample (n = 238), the relationships between depression, impulsivity, and cognitive restraint with BMI change were mediated by eating disorder pathology. In the subgroup with regular binge eating (n = 99, 41.6%), the associations between stress and disinhibition with BMI change were additionally mediated by eating disorder pathology. In the subgroup without regular binge eating, eating disorder pathology showed no mediating effect. DISCUSSION Multiple mental health and eating behavior variables assessed at admission predicted BMI changes, particularly when mediated by eating disorder pathology in patients with regular binge eating. A comprehensive psychopathological assessment prior to starting BWLI may help identify multiple factors affecting prognosis and treatment outcomes. Long-term follow-up studies in this field are required.
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Affiliation(s)
- Jacopo Pruccoli
- Pediatric Neurology and Psychiatry Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Regional Center for Feeding and Eating Disorders in the Developmental Age, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
| | - Bea Klos
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
| | - Sandra Schild
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
- DZPG (German Center for Mental Health), 72076 Tübingen, Germany
- Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität at Berlin, and Berlin Institute of Health, 12203 Berlin, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
- DZPG (German Center for Mental Health), 72076 Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
- DZPG (German Center for Mental Health), 72076 Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
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Robinson J, Nitschke E, Tovar A, Mattar L, Gottesman K, Hamlett P, Rozga M. Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the General Population: An Evidence-Based Practice Guideline From the Academy of Nutrition and Dietetics and American Council on Exercise. J Acad Nutr Diet 2023; 123:1215-1237.e5. [PMID: 37061182 DOI: 10.1016/j.jand.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
A nutritious diet and adequate physical activity vitally contribute to disease prevention, but most adults do not meet population-based dietary and physical activity recommendations. Qualified nutrition and exercise practitioners can address challenges to adopting healthy lifestyle behaviors by providing consistent, individualized, and evidence-based education and programming within their professional scopes of practice to improve client outcomes. The objective of this evidence-based practice guideline is to inform practice decisions for nutrition and exercise practitioners providing nutrition and physical activity interventions for adults who are healthy or have cardiometabolic risk factors, but no diagnosed disease. Evidence from a systematic review was translated to practice recommendations using an evidence-to-decision framework by an interdisciplinary team of nutrition and exercise practitioners and researchers. This evidence-based practice guideline does not provide specific dietary or physical activity recommendations but rather informs nutrition and exercise practitioners how they may utilize existing guidelines for the general population to individualize programming for a range of clients. This evidence-based practice guideline provides widely applicable recommendation statements and a detailed framework to help practitioners implement the recommendations into practice. Common barriers and facilitators encountered when delivering nutrition and physical activity interventions, such as adherence to professional scopes of practice; methods to support behavior change; and methods to support inclusion, diversity, equity, and access, are discussed. Nutrition and exercise practitioners can consistently provide individualized, practical, and evidence-based interventions by seeking to understand their clients' needs, circumstances, and values and by co-creating interventions with the client and their allied health team.
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Affiliation(s)
- Justin Robinson
- Kinesiology Department, Point Loma Nazarene University, San Diego, California
| | - Erin Nitschke
- Department of Exercise Science, Laramie County Community College, Cheyenne, Wyoming
| | | | - Lama Mattar
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Lebanon
| | - Kimberly Gottesman
- Department of Nutrition and Food Science, California State University Los Angeles, Los Angeles, California
| | - Peggy Hamlett
- Department of Kinesiology, Washington State University Pullman, Washington
| | - Mary Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, Illinois.
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16
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Lv N, Ajilore OA, Xiao L, Venditti EM, Lavori PW, Gerber BS, Snowden MB, Wittels NE, Ronneberg CR, Stetz P, Barve A, Shrestha R, Dosala S, Kumar V, Eckley TL, Goldstein-Piekarski AN, Smyth JM, Rosas LG, Kannampallil T, Zulueta J, Suppes T, Williams LM, Ma J. 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 2023; 3:430-442. [PMID: 37519462 PMCID: PMC10382700 DOI: 10.1016/j.bpsgos.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/25/2022] [Accepted: 03/24/2022] [Indexed: 12/28/2022] Open
Abstract
Background Integrated treatments for comorbid depression (often with anxiety) and obesity are lacking; mechanisms are poorly investigated. Methods In a mechanistic pilot trial, adults with body mass index ≥30 and Patient Health Questionnaire-9 scores ≥10 were randomized to usual care (n = 35) or an integrated behavioral intervention (n = 71). Changes at 6 months in body mass index and Depression Symptom Checklist-20 scores were co-primary outcomes, and Generalized Anxiety Disorder Scale-7 score was a secondary outcome. Changes at 2 months in the activation and functional connectivity of regions of interest in the negative affect circuit were primary neural targets, and secondary targets were in the cognitive control, default mode, and positive affect circuits. Results Participants were 47.0 years (SD = 11.9 years), 76% women, 55% Black, and 20% Latino. Depression Symptom Checklist-20 (between-group difference, -0.3 [95% CI: -0.6 to -0.1]) and Generalized Anxiety Disorder Scale-7 (-2.9 [-4.7 to -1.1]) scores, but not body mass index, decreased significantly at 6 months in the intervention versus usual care groups. Only Generalized Anxiety Disorder Scale-7 score changes at 6 months significantly correlated with neural target changes at 2 months in the negative affect (anterior insula, subgenual/pregenual anterior cingulate cortex, amygdala) and cognitive control circuits (dorsal lateral prefrontal cortex, dorsal anterior cingulate cortex). Effects were medium to large (0.41-1.18 SDs). Neural target changes at 2 months in the cognitive control circuit only differed by treatment group. Effects were medium (0.58-0.79 SDs). Conclusions Compared with usual care, the study intervention led to significantly improved depression but not weight loss, and the results on neural targets were null for both outcomes. The significant intervention effect on anxiety might be mediated through changes in the cognitive control circuit, but this warrants replication.
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Affiliation(s)
- Nan Lv
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Olusola A. Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Elizabeth M. Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Philip W. Lavori
- Department of Biomedical Data Science, Stanford University, Palo Alto, California
| | - Ben S. Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts, Worcester, Massachusetts
| | - Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Nancy E. Wittels
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Corina R. Ronneberg
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Patrick Stetz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Amruta Barve
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Rohit Shrestha
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Sushanth Dosala
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Vikas Kumar
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Tessa L. Eckley
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Andrea N. Goldstein-Piekarski
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
- MIRECC VISN21, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Joshua M. Smyth
- Departments of Biobehavioral Health and Medicine, Pennsylvania State University, State College, Pennsylvania
| | - Lisa G. Rosas
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Thomas Kannampallil
- Department of Anesthesiology and Institute for Informatics, Washington University School of Medicine, St. Louis, Missouri
| | - John Zulueta
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
- MIRECC VISN21, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Leanne M. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
- MIRECC VISN21, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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17
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Kannampallil T, Ajilore OA, Lv N, Smyth JM, Wittels NE, Ronneberg CR, Kumar V, Xiao L, Dosala S, Barve A, Zhang A, Tan KC, Cao KK, Patel CR, Gerber BS, Johnson JA, Kringle EA, Ma J. Effects of a virtual voice-based coach delivering problem-solving treatment on emotional distress and brain function: a pilot RCT in depression and anxiety. Transl Psychiatry 2023; 13:166. [PMID: 37173334 PMCID: PMC10175049 DOI: 10.1038/s41398-023-02462-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Consumer-based voice assistants have the ability to deliver evidence-based treatment, but their therapeutic potential is largely unknown. In a pilot trial of a virtual voice-based coach, Lumen, delivering problem-solving treatment, adults with mild-to-moderate depression and/or anxiety were randomized to the Lumen intervention (n = 42) or waitlist control (n = 21). The main outcomes included changes in neural measures of emotional reactivity and cognitive control, and Hospital Anxiety and Depression Scale [HADS] symptom scores over 16 weeks. Participants were 37.8 years (SD = 12.4), 68% women, 25% Black, 24% Latino, and 11% Asian. Activation of the right dlPFC (neural region of interest in cognitive control) decreased in the intervention group but increased in the control group, with an effect size meeting the prespecified threshold for a meaningful effect (Cohen's d = 0.3). Between-group differences in the change in activation of the left dlPFC and bilateral amygdala were observed, but were of smaller magnitude (d = 0.2). Change in right dlPFC activation was also meaningfully associated (r ≥ 0.4) with changes in self-reported problem-solving ability and avoidance in the intervention. Lumen intervention also led to decreased HADS depression, anxiety, and overall psychological distress scores, with medium effect sizes (Cohen's d = 0.49, 0.51, and 0.55, respectively), compared with the waitlist control group. This pilot trial showed promising effects of a novel digital mental health intervention on cognitive control using neuroimaging and depression and anxiety symptoms, providing foundational evidence for a future confirmatory study.
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Affiliation(s)
- Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
- Institute for Informatics, Washington University School of Medicine, St Louis, MO, USA
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Nan Lv
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Joshua M Smyth
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Nancy E Wittels
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Corina R Ronneberg
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Vikas Kumar
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Stanford, USA
| | - Susanth Dosala
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Amruta Barve
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Aifeng Zhang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Kevin C Tan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Kevin K Cao
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Charmi R Patel
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ben S Gerber
- Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jillian A Johnson
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Emily A Kringle
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
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Golovaty I, Ritchie ND, Tuomilehto J, Mohan V, Ali MK, Gregg EW, Bergman M, Moin T. Two decades of diabetes prevention efforts: A call to innovate and revitalize our approach to lifestyle change. Diabetes Res Clin Pract 2023; 198:110195. [PMID: 36470316 PMCID: PMC10079599 DOI: 10.1016/j.diabres.2022.110195] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
The impact of global diabetes prevention efforts has been modest despite the promise of landmark diabetes prevention trials nearly twenty years ago. While national and regional initiatives show potential, challenges remain to adapt large-scale strategies in the real-world that fits individuals and their communities. Additionally, the sedentary lifestyle changes during the COVID-19 pandemic and guidelines that now call for earlier screening (e.g., US Preventative Task Force) will increase the pool of eligible adults worldwide. Thus, a more adaptable, person-centered approach that expands the current toolkit is urgently needed to innovate and revitalize our approach to diabetes prevention. This review identifies key priorities to optimize the population-level delivery of diabetes prevention based on a consensus-based evaluation of the current evidence among experts in global translational programs; key priorities identified include (1) participant eligibility, (2) intervention intensity, (3) delivery components, (4) behavioral economics, (5) technology, and (6) the role of pharmacotherapy. We offer a conceptual framework for a broader, person-centered approach to better address an individual's risk, readiness, barriers, and digital competency.
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Affiliation(s)
- Ilya Golovaty
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA; General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Natalie D Ritchie
- Office of Research, Denver Health and Hospital Authority, Denver, CO. Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. University of Colorado College of Nursing, Aurora, CO, USA
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Saudi Diabetes Research Group, King Abdulaziz University Jeddah, Saudi Arabia; Department of International Health, National School of Public Health, Instituto de Salud Carlos III. Madrid, Spain
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Chairman, Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Michael Bergman
- Division of Endocrinology and Metabolism, Department of Medicine and of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA
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19
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Hallihan H, Tsai P, Lv N, Xiao L, Peñalver Bernabé B, Wu Y, Pandey GN, Williams LM, Ajilore OA, Ma J. Affective neural circuits and inflammatory markers linked to depression and anxiety symptoms in patients with comorbid obesity. J Psychiatr Res 2023; 160:9-18. [PMID: 36764197 PMCID: PMC10023437 DOI: 10.1016/j.jpsychires.2023.01.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
Although we have effective treatments for depression and anxiety, we lack mechanistic understanding or evidence-based strategies to tailor these treatments in the context of major comorbidities such as obesity. The current feasibility study uses functional neuroimaging and biospecimen data to determine if changes in inflammatory markers, fecal short-chain fatty acids, and neural circuit-based targets can predict depression and anxiety outcomes among participants with comorbid obesity. Blood and stool samples and functional magnetic resonance imaging data were obtained at baseline and 2 months, during the parent ENGAGE-2 trial. From 30 participants with both biospecimen and fMRI data, this subsample study explored the relationship among changes in inflammatory markers and fecal short-chain fatty acids and changes in neural targets, and their joint relationship with depression and anxiety symptoms. Bivariate and partial correlation, canonical correlation, and partial least squares analyses were conducted, with adjustments for age, sex, and treatment group. Initial correlation analyses revealed three inflammatory markers (IL-1RA, IL-6, and TNF-α) and five neural targets (in Negative Affect, Positive Affect, and Default Mode Circuits) with significantly associated changes at 2 months. Partial least squares analyses then showed that changes in IL-1RA and TNF-α and changes in three neural targets (in Negative Affect and Positive Affect Circuits) at 2 months were associated with changes in depression and anxiety symptoms at 6 months. This study sheds light on the plausibility of incorporation of inflammatory and gastrointestinal biomarkers with neural targets as predictors of depression and comorbid anxiety outcomes among patients with obesity.
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Affiliation(s)
- Hagar Hallihan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, 60608, USA
| | - Perry Tsai
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Nan Lv
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, 60608, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
| | | | - Yichao Wu
- Department of Mathematics, Statistics, and Computer Science, College of Liberal Arts and Sciences, Chicago, IL, 60607, USA
| | - Ghanshyam N Pandey
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, 60608, USA.
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20
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Burton TC, Lv N, Tsai P, Peñalver Bernabé B, Tussing-Humphreys L, Xiao L, Pandey GN, Wu Y, Ajilore OA, Ma J. Associations between fecal short-chain fatty acids, plasma inflammatory cytokines, and dietary markers with depression and anxiety: Post hoc analysis of the ENGAGE-2 pilot trial. Am J Clin Nutr 2023; 117:717-730. [PMID: 36796440 PMCID: PMC10273083 DOI: 10.1016/j.ajcnut.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The microbiome-gut-brain-axis (MGBA) is emerging as an important mechanistic link between diet and mental health. The role of significant modifiers of the MGBA, including gut microbial metabolites and systemic inflammation, in individuals comorbid with obesity and mental disorders, is under-investigated. OBJECTIVES This exploratory analysis examined associations among microbial metabolites-fecal SCFAs, plasma inflammatory cytokines, and diet with depression and anxiety scores in adults comorbid with obesity and depression. METHODS Stool and blood were obtained from a subsample (n = 34) of participants enrolled in an integrated behavioral intervention for weight loss and depression. Pearson partial correlation and multivariate analyses determined associations among changes in fecal SCFAs (propionic, butyric, acetic, and isovaleric acids), plasma cytokines [C-reactive protein, interleukin 1 beta, interleukin 1 receptor antagonist (IL-1RA), interleukin 6, and TNF-α], and 35 dietary markers over 2 mo, and changes in SCL-20 (Depression Symptom Checklist 20-item) and GAD-7 (Generalized Anxiety Disorder 7-Item) scores over 6 mo. RESULTS Changes in the SCFAs and TNF-α at 2 mo were positively associated (standardized coefficients: 0.06-0.40; 0.03-0.34) with changes in depression and anxiety scores at 6 mo, whereas changes in IL-1RA at 2 mo were inversely associated (standardized coefficients: -0.24; -0.05). After 2 mo, changes in 12 dietary markers, including animal protein, were associated with changes in SCFAs, TNF-α, or IL-1RA at 2 mo (standardized coefficients: -0.27 to 0.20). Changes in 11 dietary markers, including animal protein, at 2 mo were associated with changes in depression or anxiety symptom scores at 6 mo (standardized coefficients: -0.24 to 0.20; -0.16 to 0.15). CONCLUSIONS Gut microbial metabolites and systemic inflammation may be biomarkers of importance within the MGBA, linking dietary markers, such as animal protein intake, to depression and anxiety for individuals with comorbid obesity. These findings are exploratory and warrant replication.
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Affiliation(s)
- Tristesse Cj Burton
- Department of Pharmacy Practice, University of Illinois Chicago, Chicago, IL, United States
| | - Nan Lv
- Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Perry Tsai
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States
| | - Beatriz Peñalver Bernabé
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Lan Xiao
- Department of Epidemiology and Health, Stanford University, Stanford, CA, United States
| | - Ghanshyam N Pandey
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States
| | - Yichao Wu
- Department of Mathematics, Statistics, and Computer Science, University of Illinois Chicago, IL, United States
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, Chicago, IL, United States.
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21
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The impact of obesity and overweight on response to internet-delivered cognitive behavioural therapy for adults with chronic health conditions. Int J Obes (Lond) 2023; 47:487-495. [PMID: 36869151 DOI: 10.1038/s41366-023-01285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND There is growing evidence that internet-delivered cognitive behavioural therapy (iCBT) can improve functioning and reduce psychological distress in people with chronic health conditions. Obesity frequently co-occurs with chronic health conditions, yet its impact on response to psychological interventions in this population is not known. The current study examined associations between BMI and clinical outcomes (depression, anxiety, disability, and satisfaction with life) following a transdiagnostic iCBT program targeting adjustment to chronic illness. METHODS Participants from a large randomised controlled trial, who provided information on height and weight, were included (N = 234; mean age= 48.32, SD = 13.80; mean BMI = 30.43, SD = 8.30, range 16.18-67.52; 86.8% female). The influence of baseline BMI range on treatment outcomes at post-treatment and 3-month follow-up was examined using generalized estimating equations. We also examined changes in BMI and in participants' perceived impact of weight on their health. RESULTS Improvement in all outcomes occurred across BMI ranges; additionally, persons with obesity or overweight generally experienced greater symptom reductions than those within a healthy weight range. A greater proportion of participants with obesity achieved clinically significant change on key outcomes (e.g., depression: 32% [95% CI: 25%, 39%]) than participants with a healthy weight (21% [95% CI: 15%, 26%]) or overweight (24% [95% CI: 18%, 29%], p = 0.016). There were no significant changes in BMI from pre-treatment to 3-month follow-up, however there were significant reductions on the self-rated impact of weight on health. CONCLUSIONS Persons with chronic health conditions and with obesity or overweight benefit at least as much as those with a healthy BMI from iCBT programs targeting psychological adjustment to chronic illness, even without changes in BMI. iCBT programs may be an important component in the self-management of this population, and may address barriers implicated in health behaviour change.
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22
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Lv N, Hallihan H, Xiao L, Williams LM, Ajilore OA, Ma J. Association of Changes in Neural Targets and Dietary Outcomes among Patients with Comorbid Obesity and Depression: Post hoc Analysis of ENGAGE-2 Mechanistic Clinical Trial. J Nutr 2023; 153:880-896. [PMID: 36931755 PMCID: PMC10196721 DOI: 10.1016/j.tjnut.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/06/2022] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Disruptions in brain circuits that regulate cognition and emotion can hinder dietary change and weight loss among individuals with obesity and depression. OBJECTIVE The study aimed to investigate whether changes in brain targets in the cognitive control, negative affect, and positive affect circuits after 2-mo problem-solving therapy (PST) predict changes in dietary outcomes at 2 and 6 mo. METHODS Adults with obesity and depression from an academic health system were randomly assigned to receive PST (7-step problem-solving and behavioral activation strategies) over 2 mo or usual care. Seventy participants (mean age = 45.9 ± 11.6 y; 75.7% women, 55.7% Black, 17.1% Hispanic, 20.0% White; mean BMI = 36.5 ± 5.3 kg/m2; mean Patient Health Questionnaire-9 depression score = 12.7 ± 2.8) completed functional MRI and 24-h food recalls. Ordinary least square regression analyses were performed. RESULTS Among intervention participants, increased left dorsal lateral prefrontal cortex (dLPFC) activity of the cognitive control circuit at 2 mo was associated with increased diet quality (β: 0.20; 95% CI: -0.02, 0.42) and decreased calories (β: -0.19; 95% CI: -0.33, -0.04), fat levels (β: -0.22; 95% CI: -0.39, -0.06), and high-sugar food intake (β: -0.18; 95% CI: -0.37, 0.01) at 6 mo. For the negative affect circuit, increased right dLPFC-amygdala connectivity at 2 mo was associated with increased diet quality (β: 0.32; 95% CI: -0.93, 1.57) and fruit and vegetable intake (β: 0.38; 95% CI: -0.75, 1.50) and decreased calories (β: -0.37; 95% CI: -1.29, 0.54), fat levels (β: -0.37; 95% CI: -1.50, 0.76), sodium concentrations (β: -0.36; 95% CI: -1.32, 0.60), and alcohol intake (β: -0.71; 95% CI: -2.10, 0.68) at 2 but not at 6 mo. The usual care group showed opposing associations. The 95% CIs of all between-group differences did not overlap the null, suggesting a significant treatment effect. CONCLUSIONS Among adults with obesity and depression who underwent PST compared with those under usual care, improved dLPFC-amygdala regulation of negative affective brain states predicted dietary improvements at 2 mo, whereas improvements in dLPFC-based cognitive control predicted dietary improvements at 6 mo. These findings warrant confirmatory studies. This trial was at clinicaltrials.gov as NCT03841682.
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Affiliation(s)
- Nan Lv
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Hagar Hallihan
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
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23
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The Global, Regional, and National Uterine Cancer Burden Attributable to High BMI from 1990 to 2019: A Systematic Analysis of the Global Burden of Disease Study 2019. J Clin Med 2023; 12:jcm12051874. [PMID: 36902661 PMCID: PMC10003834 DOI: 10.3390/jcm12051874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
Uterine cancer (UC) is the most common gynecologic malignancy, and high body mass index (BMI) is a poor prognostic factor for UC. However, the associated burden has not been fully assessed, which is crucial for women's health management and the prevention and control of UC. Therefore, we utilized the Global Burden of Disease Study (GBD) 2019 to describe the global, regional, and national UC burden due to high BMI from 1990 to 2019. The data show that globally, women's high BMI exposure is increasing annually, with most regions having higher rates of high BMI exposure than the global average. In 2019, 36,486 [95% uncertainty interval (UI): 25,131 to 49,165] UC deaths were attributed to high BMI globally, accounting for 39.81% (95% UI: 27.64 to 52.67) of all UC deaths. The age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALY) rate (ASDR) for high BMI-associated UC remained stable globally from 1990 to 2019, with significant differences across regions. Higher ASDR and ASMR were found in higher socio-demographic index (SDI) regions, and lower SDI regions had the fastest estimated annual percentage changes (EAPCs) for both rates. Among all age groups, the fatal outcome of UC with high BMI occurs most frequently in women over 80 years old.
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Hachuła M, Kosowski M, Zielańska K, Basiak M, Okopień B. The Impact of Various Methods of Obesity Treatment on the Quality of Life and Mental Health-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2122. [PMID: 36767489 PMCID: PMC9915720 DOI: 10.3390/ijerph20032122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Obesity, defined as body mass index (BMI) ≥ 30 kg/m2, is one of the most important public health problems. Over one billion people are obese, including 650 million adults, which is 13% of the worldwide population, according to the World Health Organization (WHO). Similar to obesity, mental disorders such as depression and anxiety are huge social problems with serious health implications. There are numerous studies proving a strong link between the prevalence of obesity and depressive disorders, and being overweight is also associated with decreased health-related quality of life (HRQoL). Due to the broad negative impact of obesity on a patient's health, proper treatment is crucial. Currently, the literature describes many methods of treatment such as dietary treatment, pharmacotherapy using glucagon-like peptide-1 (GLP-1) analogs, orlistat, naltrexone/bupropion (NB), or finally bariatric surgery. The most commonly used methods of obesity treatment significantly improve the patient's quality of life and reduce the symptoms of depression and anxiety. The aim of our study was to summarize the knowledge about the impact of known and commonly used methods of obesity treatment (e.g., dietary treatment, bariatric surgery, and pharmacological treatment) on mental health and quality of life. For this purpose, we will try to review the current scientific data, originating from international reports.
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Affiliation(s)
- Marcin Hachuła
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Michał Kosowski
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Kaja Zielańska
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
- Private Health Care Center “ALFA—MED”, Osiedle XXX-lecia 60, 44-386 Wodzisław Śląski, Poland
| | - Marcin Basiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
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Toba-Oluboka T, Vochosková K, Hajek T. Are the antidepressant effects of insulin-sensitizing medications related to improvements in metabolic markers? Transl Psychiatry 2022; 12:469. [PMID: 36347837 PMCID: PMC9643486 DOI: 10.1038/s41398-022-02234-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Insulin-sensitizing medications were originally used in psychiatric practice to treat weight gain and other metabolic side effects that accompany the use of mood stabilizers, antipsychotics, and some antidepressants. However, in recent studies these medications have been shown to cause improvement in depressive symptoms, creating a potential new indication outside of metabolic regulation. However, it is still unclear whether the antidepressant properties of these medications are associated with improvements in metabolic markers. We performed a systematic search of the literature following PRISMA guidelines of studies investigating antidepressant effects of insulin-sensitizing medications. We specifically focused on whether any improvements in depressive symptoms were connected to the improvement of metabolic dysfunction. Majority of the studies included in this review reported significant improvement in depressive symptoms following treatment with insulin-sensitizing medications. Nine out of the fifteen included studies assessed for a correlation between improvement in symptoms and changes in metabolic markers and only two of the nine studies found such association, with effect sizes ranging from R2 = 0.26-0.38. The metabolic variables, which correlated with improvements in depressive symptoms included oral glucose tolerance test, fasting plasma glucose and glycosylated hemoglobin following treatment with pioglitazone or metformin. The use of insulin-sensitizing medications has a clear positive impact on depressive symptoms. However, it seems that the symptom improvement may be unrelated to improvement in metabolic markers or weight. It is unclear which additional mechanisms play a role in the observed clinical improvement. Some alternative options include inflammatory, neuroinflammatory changes, improvements in cognitive functioning or brain structure. Future studies of insulin-sensitizing medications should measure metabolic markers and study the links between changes in metabolic markers and changes in depression. Additionally, it is important to use novel outcomes in these studies, such as changes in cognitive functioning and to investigate not only acute, but also prophylactic treatment effects.
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Affiliation(s)
- Temi Toba-Oluboka
- grid.55602.340000 0004 1936 8200Department of Psychiatry, Dalhousie University, Halifax, NS Canada
| | - Kristýna Vochosková
- grid.447902.cNational Institute of Mental Health, Klecany, Czech Republic ,grid.4491.80000 0004 1937 116XCharles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada. .,National Institute of Mental Health, Klecany, Czech Republic.
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Robustelli BL, Campbell SB, Greene PA, Sayre GG, Sulayman N, Hoerster KD. Table for two: Perceptions of social support from participants in a weight management intervention for veterans with PTSD and overweight or obesity. Psychol Serv 2022; 19:719-729. [PMID: 34516204 PMCID: PMC8918015 DOI: 10.1037/ser0000577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with posttraumatic stress disorder (PTSD) are at an increased risk of being classified as overweight or with obesity in part due to PTSD symptoms (e.g., sleep disturbance and social isolation) interfering with activity and healthy eating. MOVE!+UP is a 16-week behavioral weight management program, tailored to address such barriers for people with PTSD, by combining evidence-based weight loss education and support with cognitive behavior therapy skills to reduce PTSD symptom-based weight management barriers. This qualitative study examined veterans' (n = 37) perceptions of social support relevant to weight management, health behaviors, and mental health while participating in an uncontrolled pilot of MOVE!+UP. Template analysis of transcripts from 1-hr semistructured qualitative interviews identified four main categories of participant responses. Participants described positive aspects, particularly cohesiveness around a shared veteran identity, feeling less alone, accountability, and having others eat healthier and exercise with them. Conversely, relationship-based barriers included other participants' poor MOVE!+UP group session attendance and engagement, and loved ones' encouragement of making unhealthy choices. Many described having limited relationships or trouble accessing available support. Finally, PTSD symptoms were a significant barrier to utilizing social support to facilitate weight loss. Findings suggest future behavioral weight management programs should recruit members with similar backgrounds to capitalize on shared experience, encourage consistent attendance and meaningful participation, deliver education about how to leverage social support from others outside the program, and address mental health symptoms that impede social support and healthy lifestyles. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Sarah B Campbell
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service
| | - Preston A Greene
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development
| | - George G Sayre
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development
| | - Nadiyah Sulayman
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development
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Berman MI, Park J, Kragenbrink ME, Hegel MT. Accept Yourself! A Pilot Randomized Controlled Trial of a Self-Acceptance-Based Treatment for Large-Bodied Women With Depression. Behav Ther 2022; 53:913-926. [PMID: 35987548 DOI: 10.1016/j.beth.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/15/2022]
Abstract
A pilot parallel randomized controlled trial compared a self-acceptance, non-weight-loss intervention, Accept Yourself! (AY), to a weight loss program, Weight Watchers (WW), in order to provide preliminary safety, feasibility, and efficacy data in preparation for a definitive RCT of AY as an intervention to enhance the mental and physical health of larger-bodied women with Major Depressive Disorder (MDD). Adult women with MDD and a Body Mass Index ≥30 were eligible. Nineteen women were randomized by random number table into AY (n = 9) or WW (n = 10). Intake, pretreatment, posttreatment, 3-, 6-, 9-, and 12-month follow-up assessments occurred at a rural academic medical center. Primary outcomes included depression severity and cardiovascular fitness. Chi-square and t-tests assessed attrition and participant preferences for treatment; other analyses used intention-to-treat, linear mixed-effects models for repeated measures, including all participants' available data. Both groups improved in self-reported, F(5, 43.81) = 7.45, p < .001, partial η2 = .38, and blinded-clinician-rated depression, F(6, 62.03) = 10.41, p < .001, partial η2 = .5. AY was superior to WW in self-reported depression, F(5, 43.81) = 2.72, p = .03, partial η2 = .11. Neither group improved in fitness. Eating disorder symptoms and weight gain worsened in WW. AY appeared safe, feasible, and offered initial evidence of efficacy for depression; it should be investigated in a definitive RCT, with modifications to increase potency. WW may not be suitable as a comparator intervention for AY because of risk to participants.
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Affiliation(s)
| | - John Park
- Geisel School of Medicine at Dartmouth
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Kannampallil T, Ronneberg CR, Wittels NE, Kumar V, Lv N, Smyth JM, Gerber BS, Kringle EA, Johnson JA, Yu P, Steinman LE, Ajilore OA, Ma J. Design and Formative Evaluation of a Virtual Voice-Based Coach for Problem-solving Treatment: Observational Study. JMIR Form Res 2022; 6:e38092. [PMID: 35969431 PMCID: PMC9419044 DOI: 10.2196/38092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Artificial intelligence has provided new opportunities for human interactions with technology for the practice of medicine. Among the recent artificial intelligence innovations, personal voice assistants have been broadly adopted. This highlights their potential for health care–related applications such as behavioral counseling to promote healthy lifestyle habits and emotional well-being. However, the use of voice-based applications for behavioral therapy has not been previously evaluated.
Objective
This study aimed to conduct a formative user evaluation of Lumen, a virtual voice-based coach developed as an Alexa skill that delivers evidence-based, problem-solving treatment for patients with mild to moderate depression and/or anxiety.
Methods
A total of 26 participants completed 2 therapy sessions—an introductory (session 1) and a problem-solving (session 2)—with Lumen. Following each session with Lumen, participants completed user experience, task-related workload, and work alliance surveys. They also participated in semistructured interviews addressing the benefits, challenges and barriers to Lumen use, and design recommendations. We evaluated the differences in user experience, task load, and work alliance between sessions using 2-tailed paired t tests. Interview transcripts were coded using an inductive thematic analysis to characterize the participants’ perspectives regarding Lumen use.
Results
Participants found Lumen to provide high pragmatic usability and favorable user experience, with marginal task load during interactions for both Lumen sessions. However, participants experienced a higher temporal workload during the problem-solving session, suggesting a feeling of being rushed during their communicative interactions. On the basis of the qualitative analysis, the following themes were identified: Lumen’s on-demand accessibility and the delivery of a complex problem-solving treatment task with a simplistic structure for achieving therapy goals; themes related to Lumen improvements included streamlining and improved personalization of conversations, slower pacing of conversations, and providing additional context during therapy sessions.
Conclusions
On the basis of an in-depth formative evaluation, we found that Lumen supported the ability to conduct cognitively plausible interactions for the delivery of behavioral therapy. Several design suggestions identified from the study including reducing temporal and cognitive load during conversational interactions, developing more natural conversations, and expanding privacy and security features were incorporated in the revised version of Lumen. Although further research is needed, the promising findings from this study highlight the potential for using Lumen to deliver personalized and accessible mental health care, filling a gap in traditional mental health services.
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Affiliation(s)
| | | | - Nancy E Wittels
- University of Illinois at Chicago, Chicago, IL, United States
| | - Vikas Kumar
- University of Illinois at Chicago, Chicago, IL, United States
| | - Nan Lv
- University of Illinois at Chicago, Chicago, IL, United States
| | - Joshua M Smyth
- The Pennsylvania State University, University Park, PA, United States
| | - Ben S Gerber
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Emily A Kringle
- University of Illinois at Chicago, Chicago, IL, United States
| | - Jillian A Johnson
- The Pennsylvania State University, University Park, PA, United States
| | - Philip Yu
- University of Illinois at Chicago, Chicago, IL, United States
| | | | - Olu A Ajilore
- University of Illinois at Chicago, Chicago, IL, United States
| | - Jun Ma
- University of Illinois at Chicago, Chicago, IL, United States
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Dao MC, Yu Z, Maafs‐Rodríguez A, Moser B, Cuevas AG, Economos CD, Roberts SB. Perceived intrinsic, social, and environmental barriers for weight management in older Hispanic/Latino adults with obesity. Obes Sci Pract 2022; 9:145-157. [PMID: 37034568 PMCID: PMC10073816 DOI: 10.1002/osp4.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/07/2022] Open
Abstract
Background The burden of obesity and chronic disease is increasing in the older US Hispanic/Latino adult population. There is limited evidence on successful weight management strategies as perceived by this population. Assessing barriers and opportunities for weight management using mixed methods is a robust approach to collect in-depth information that can be applied to the development of well-tailored weight management interventions for this population. Objective The objective of this study was to assess perceived individual, interpersonal, and environmental factors that influence weight management in older Hispanic/Latino adults. Methods This community-based cross-sectional study included 23 Hispanic/Latino older (>50y) adults with obesity (BMI >30 kg/m2). Perceived barriers and opportunities for weight management were assessed through validated questionnaires and focus groups. Prospectively registered on ClinicalTrials.gov (NCT03978416) on 7 June 2019. Results In this demographically heterogeneous population, language acculturation was generally low, and the frequency of poor dietary behaviors was high. Participants linked financial strain to lower diet quality, as well as anxiety to uncontrolled eating and food cravings. Social support and trust in healthcare professionals were perceived as priorities for healthy eating. Structural and environmental barriers such as affordability and availability of culturally preferred foods were also identified as influences on food choices and eating behavior. Conclusions This study revealed opportunities for culturally tailored weight management interventions in older Hispanic/Latino adults with obesity. Clinical Trial Registry Number NCT03978416 (ClinicalTrials.gov).
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Affiliation(s)
- Maria Carlota Dao
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
- Department of Agriculture University of New Hampshire. Durham Nutritionand Food Systems NH United States Durham
| | - Zihan Yu
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
| | - Ana Maafs‐Rodríguez
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
- Friedman School of Nutrition Science and Policy Tufts University. Boston MA United States Boston
| | - Brandy Moser
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
| | - Adolfo G. Cuevas
- Department of Community Health School of Arts and Sciences Tufts University. Medford MA United States Boston
| | - Christina D. Economos
- Friedman School of Nutrition Science and Policy Tufts University. Boston MA United States Boston
| | - Susan B. Roberts
- Energy Metabolism Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Boston MA United States Durham
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Ronneberg CR, Lv N, Ajilore OA, Gerber BS, Venditti EM, Snowden MB, Steinman LE, Wittels NE, Barve A, Dosala S, Rosas LG, Kringle EA, Ma J. Integrated collaborative care intervention for depression and obesity in primary care: translation from research to practice. HEALTH EDUCATION RESEARCH 2022; 37:227-241. [PMID: 35876850 PMCID: PMC9340965 DOI: 10.1093/her/cyac017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 06/09/2022] [Accepted: 07/06/2022] [Indexed: 05/24/2023]
Abstract
The objective of this study was to present lessons learned about engagement, delivery modality and pandemic impact while delivering a collaborative care intervention with a socioeconomically, racially and ethnically diverse sample. Participants completed a post-intervention survey (n = 41) on experiences and preferred intervention delivery modality, coronavirus 2019 (COVID-19) Impact Survey (n = 50) and provided open-ended feedback about the intervention (n = 27). Intervention process data included attendance, modality, and withdrawals. Data were analyzed using descriptive statistics and inductive content analyses. Of 71 intervention participants, 6 (8%) withdrew before session 1. Completers adhered to intervention timeline better than withdrawals. Participants liked the in-person interaction, efficient coach support, accountability of in-person and Zoom vs. phone sessions and the flexibility and convenience of phone and Zoom vs. in-person sessions. A majority of participants reported experiencing pandemic impacts such as heightened emotional distress, decreased activity engagement, poorer eating behaviors and being unable to meet basic needs. Participants deviating from intervention timelines may be re-engaged by targeted outreach attempts. Videoconference has the potential for providing as-needed coaching. Future interventions may be optimized to account for and address areas impacted by the pandemic. Findings revealed specific strategies that can be implemented in future interventions to improve emotional and physical health among diverse populations.
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Affiliation(s)
- Corina R Ronneberg
- Department of Medicine, University of Illinois Chicago, Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, USA
| | - Nan Lv
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, USA
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois Chicago, 1601 W Taylor St, Chicago, IL 60612, USA
| | - Ben S Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA 01605, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, USA
| | - Lesley E Steinman
- Health Promotion Research Center, University of Washington, 3980 15th Ave NE, 4th Floor, UW Mailbox 351621, Seattle, WA 98195, USA
| | - Nancy E Wittels
- Department of Medicine, University of Illinois Chicago, Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, USA
| | - Amruta Barve
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, USA
| | - Sushanth Dosala
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, 1701 Page Mill Rd # 2, Palo Alto, California 94304, Stanford, CA, USA
| | - Emily A Kringle
- Department of Medicine, University of Illinois Chicago, Chicago, 1747 W. Roosevelt Rd, Chicago, IL 60608, USA
| | - Jun Ma
- Vitoux Program on Aging and Prevention, Department of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608, USA
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Kannampallil T, Dai R, Lv N, Xiao L, Lu C, Ajilore OA, Snowden MB, Venditti EM, Williams LM, Kringle EA, Ma J. Cross-trial prediction of depression remission using problem-solving therapy: A machine learning approach. J Affect Disord 2022; 308:89-97. [PMID: 35398399 DOI: 10.1016/j.jad.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Psychotherapy is a standard depression treatment; however, determining a patient's prognosis with therapy relies on clinical judgment that is subject to trial-and-error and provider variability. PURPOSE To develop machine learning (ML) algorithms to predict depression remission for patients undergoing 6 months of problem-solving therapy (PST). METHOD Using data from the treatment arm of 2 randomized trials, ML models were trained and validated on ENGAGE-2 (ClinicalTrials.gov, #NCT03841682) and tested on RAINBOW (ClinicalTrials.gov, #NCT02246413) for predictions at baseline and at 2-months. Primary outcome was depression remission using the Depression Symptom Checklist (SCL-20) score < 0.5 at 6 months. Predictor variables included baseline characteristics (sociodemographic, behavioral, clinical, psychosocial) and intervention engagement through 2-months. RESULTS Of the 26 candidate variables, 8 for baseline and 11 for 2-months were predictive of depression remission, and used to train the models. The best-performing model predicted remission with an accuracy significantly greater than chance in internal validation using the ENGAGE-2 cohort, at baseline [72.6% (SD = 3.6%), p < 0.0001] and at 2-months [72.3% (5.1%), p < 0.0001], and in external validation with the RAINBOW cohort at baseline [58.3% (0%), p < 0.0001] and at 2-months [62.3% (0%), p < 0.0001]. Model-agnostic explanations highlighted key predictors of depression remission at the cohort and patient levels, including female sex, lower self-reported sleep disturbance, lower sleep-related impairment, and lower negative problem orientation. CONCLUSIONS ML models using clinical and patient-reported data can predict depression remission for patients undergoing PST, affording opportunities for prospective identification of likely responders, and for developing personalized early treatment optimization along the patient care trajectory.
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Affiliation(s)
- Thomas Kannampallil
- Department of Anesthesiology, Washington University in Saint Louis, United States of America; Institute for Informatics, School of Medicine, Washington University in Saint Louis, United States of America; Deparment of Computer Science and Engineering, McKelvey School of Engineering, Washington University in Saint Louis, United States of America
| | - Ruixuan Dai
- Deparment of Computer Science and Engineering, McKelvey School of Engineering, Washington University in Saint Louis, United States of America
| | - Nan Lv
- Department of Medicine, University of Illinois at Chicago, United States of America
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, United States of America
| | - Chenyang Lu
- Deparment of Computer Science and Engineering, McKelvey School of Engineering, Washington University in Saint Louis, United States of America
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois at Chicago, United States of America
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| | | | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States of America
| | - Emily A Kringle
- Department of Medicine, University of Illinois at Chicago, United States of America
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago, United States of America.
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Freshwater M, Christensen S, Oshman L, Bays HE. Behavior, motivational interviewing, eating disorders, and obesity management technologies: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 2:100014. [PMID: 37990715 PMCID: PMC10661888 DOI: 10.1016/j.obpill.2022.100014] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 03/19/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of "Behavior, Motivational Interviewing, Eating Disorders, and Obesity Management Technologies." Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS outlines important components of behavior, motivational interviewing, eating disorders, and obesity management technologies as they relate to pre-obesity and obesity. Topics include eating behavior disorder evaluation, the motivations behind eating and physical activity behaviors (including underlying neurophysiology, eating disorders, environmental factors, and personal prioritization), motivational interviewing techniques, and technologies that may assist with pre-obesity/obesity management. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on "Behavior, Motivational Interviewing, Eating Disorders, and Obesity Management Technologies" is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of pre-obesity/obesity. Implementation of appropriate clinical practices in these areas may improve the health of patients, especially those with adverse fat mass and adiposopathic metabolic consequences.
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Affiliation(s)
- Michelle Freshwater
- Diplomate of American Board of Obesity Medicine, Idaho Weight Loss, 801 N Stilson Road, Boise, ID, 83703, USA
| | - Sandra Christensen
- Certificate of Advanced Education in Obesity Medicine, Integrative Medical Weight Management, 2611 NE 125th St, Suite 100B, Seattle, WA, 98125, USA
| | - Lauren Oshman
- Diplomate of American Board of Obesity Medicine, University of Michigan Medical School, 14700 E Old US Hwy 12, Chelsea, MI, 48118, USA
| | - Harold Edward Bays
- Diplomate of American Board of Obesity Medicine, Medical Director/President Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor/University of Louisville Medical School, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Nitschke E, Gottesman K, Hamlett P, Mattar L, Robinson J, Tovar A, Rozga M. Impact of Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the Adult General Population: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14091729. [PMID: 35565696 PMCID: PMC9103154 DOI: 10.3390/nu14091729] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/18/2022] Open
Abstract
Healthy dietary intake and physical activity reduce the risk of non-communicable diseases. This systematic review and meta-analysis aimed to examine the effect of interventions including both nutrition and physical activity provided by nutrition and exercise practitioners for adults in the general population (those without diagnosed disease). The MEDLINE, CINAHL, Cochrane Central, Cochrane Database of Systematic Reviews and SportDiscus databases were searched for randomized controlled trials (RCTs) published from 2010 until April 2021. Outcomes included physical activity, fruit and vegetable intake, waist circumference, percent weight loss, quality of life (QoL) and adverse events. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods were used to synthesize and grade evidence. Meta-analyses were stratified according to participant health status. The database search identified 11,205 articles, and 31 RCTs were included. Interventions increased physical activity amount [standardized mean difference (SMD) (95% CI): 0.25 (0.08, 0.43)] (low certainty evidence); increased vegetable intake [SMD (95% CI): 0.14 (0.05, 0.23)] (moderate certainty evidence); reduced waist circumference [MD (95% CI): −2.16 cm (−2.96, −1.36)] (high certainty evidence); and increased likelihood of achieving 5% weight loss for adults with overweight and obesity [relative risk (95% CI): 2.37 (1.76, 3.19)] (high certainty evidence). Very low and low certainty evidence described little-to-no effect on QoL or adverse events. Nutrition and exercise practitioners play key roles in facilitating positive lifestyle behaviors to reduce cardiometabolic disease risk in adults.
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Affiliation(s)
- Erin Nitschke
- Department of Exercise Science, Laramie County Community College, 1400 E College Drive, Cheyenne, WY 82007, USA;
| | - Kimberly Gottesman
- Department of Kinesiology, Nutrition and Food Science, California State University Los Angeles, 5151 South University Drive, Los Angeles, CA 90032, USA;
| | - Peggy Hamlett
- Department of Movement Sciences, University of Idaho, 875 Perimeter Drive, Moscow, ID 83844, USA;
| | - Lama Mattar
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut 10150, Lebanon;
| | - Justin Robinson
- Kinesiology Department, Point Loma Nazarene University, 3900 Lomaland Dr, San Diego, CA 92106, USA;
| | - Ashley Tovar
- Gilead Sciences, 333 Lakeside Dr, Foster City, CA 94404, USA;
| | - Mary Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, 120 S Riverside Plaza, Suite 2190, Chicago, IL 60606, USA
- Correspondence: ; Tel.: +1-(312)-899-1758
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Lv N, Kringle EA, Ma J. Integrated Behavioral Interventions for Adults with Comorbid Obesity and Depression: a Systematic Review. Curr Diab Rep 2022; 22:157-168. [PMID: 35304703 PMCID: PMC8930483 DOI: 10.1007/s11892-022-01458-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To synthesize evidence from randomized controlled trials on the effects of integrated behavioral interventions for comorbid obesity and depression in adults. RECENT FINDINGS Seven trials (n = 33 to 409) were included. The quality of evidence was mixed. In 2 trials, integrated interventions led to greater improvements in both obesity and depression over 12 months, compared with usual care. Of 4 trials comparing integrated interventions with a standalone obesity intervention, 2 showed incremental effects on depression only, and 2 did not detect a significant effect for either outcome. One 3-arm trial compared an integrated intervention with standalone obesity and depression interventions and only detected incremental effects on obesity when compared with a standalone depression intervention. The effects of integrated interventions for comorbid obesity and depression are varied but promising. Implications for future research to guide intervention optimization and implement integrated interventions in clinical practice are provided.
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Affiliation(s)
- Nan Lv
- Department of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608 USA
| | - Emily A. Kringle
- Department of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608 USA
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608 USA
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Kaloiya GS, Kaur T, Ranjan P, Chopra S, Sarkar S, Kumari A, Bhatia H. Counselling and Behaviour Modification Techniques for the Management of Obesity in Postpartum and Midlife Women: A Practical Guide for Clinicians. J Obstet Gynaecol India 2022; 72:134-140. [PMID: 35492859 PMCID: PMC9008080 DOI: 10.1007/s13224-022-01652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022] Open
Abstract
Behaviour change is the basic foundation in the management of obesity. Such behaviour change is difficult to achieve due to several psychosocial and behavioural barriers that often remain unidentified and unaddressed in a weight management programme. This is even more challenging in postpartum and midlife women because of several biopsychosocial factors. The non-availability of psychologists or trained healthcare counsellors further complicates the attainment of behavioural changes. Therefore, clinicians, who are often the first point of contact for treating these population groups, are hamstrung by the lack of a multidisciplinary approach for weight reduction. Some of the common psychological, social and behavioural barriers have been identified in this article, and evidence-based techniques such as goal setting, stimulus control and cognitive restructuring are presented in a step-wise approach, to help clinicians cater to these population groups in a holistic manner.
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Developing weight navigation program to support personalized and effective obesity management in primary care settings: protocol for a quality improvement program with an embedded single-arm pilot study. Prim Health Care Res Dev 2022; 23:e14. [PMID: 35234116 PMCID: PMC8919179 DOI: 10.1017/s1463423621000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary care providers (PCPs) are expected to help patients with obesity to lose weight through behavior change counseling and patient-centered use of available weight management resources. Yet, many PCPs face knowledge gaps and clinical time constraints that hinder their ability to successfully support patients' weight loss. Fortunately, a small and growing number of physicians are now certified in obesity medicine through the American Board of Obesity Medicine (ABOM) and can provide personalized and effective obesity treatment to individual patients. Little is known, however, about how to extend the expertise of ABOM-certified physicians to support PCPs and their many patients with obesity. AIM To develop and pilot test an innovative care model - the Weight Navigation Program (WNP) - to integrate ABOM-certified physicians into primary care settings and to enhance the delivery of personalized, effective obesity care. METHODS Quality improvement program with an embedded, 12-month, single-arm pilot study. Patients with obesity and ≥1 weight-related co-morbidity may be referred to the WNP by PCPs. All patients seen within the WNP during the first 12 months of clinical operations will be compared to a matched cohort of patients from another primary care site. We will recruit a subset of WNP patients (n = 30) to participate in a remote weight monitoring pilot program, which will include surveys at 0, 6, and 12 months, qualitative interviews at 0 and 6 months, and use of an electronic health record (EHR)-based text messaging program for remote weight monitoring. DISCUSSION Obesity is a complex chronic condition that requires evidence-based, personalized, and longitudinal care. To deliver such care in general practice, the WNP leverages the expertise of ABOM-certified physicians, health system and community weight management resources, and EHR-based population health management tools. The WNP is an innovative model with the potential to be implemented, scaled, and sustained in diverse primary care settings.
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Drew RJ, Morgan PJ, Young MD. Mechanisms of an eHealth program targeting depression in men with overweight or obesity: A randomised trial. J Affect Disord 2022; 299:309-317. [PMID: 34871640 DOI: 10.1016/j.jad.2021.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The SHED-IT: Recharge study demonstrated that a gender-tailored eHealth program could improve the depressive symptoms of men with overweight or obesity and low mood. This study examined whether changes in key behaviours and cognitions acted as significant mediators of this treatment effect. METHODS The study was a randomised controlled trial (RCT) including 125 men with overweight or obesity (mean (SD) weight 103.8 (15.8) kg), and current depressive symptoms (Patient Health Questionnaire (PHQ-9) ≥ 5; mean (SD) 9.2 (4.1) units). Assessments were held at baseline, 3 months (post-intervention), and 6 months (follow-up). Depressive symptoms were assessed using the validated PHQ-9 and Masculine Depressive Risk Scale (MDRS-22). Behavioural and cognitive mediators were assessed with validated measures. Intention-to-treat mediation analyses were conducted using the PROCESS macro in SPSS. RESULTS Single mediation analyses demonstrated that the intervention effect on both PHQ-9 and MDRS-22 scores was significantly mediated by changes in MVPA, energy-dense nutrient-poor foods, cognitive flexibility, and behavioural activation. In addition, changes in sleep quality mediated improvements in MDRS-22 scores. No mediation effects were observed for light physical activity, sedentary behaviour, fruit and vegetable intake, risky alcohol consumption or mindfulness. LIMITATIONS The study was a secondary analysis with power to detect moderate-to-large mediation effects only. CONCLUSION To prevent or treat depression in men with overweight or obesity, early evidence suggests MVPA, sleep quality, energy-dense nutrient-poor food intake, cognitive flexibility, and behavioural activation are important intervention targets.
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Affiliation(s)
- Ryan J Drew
- Priority Research Centre for Physical Activity and Nutrition, School of Education, College of Human and Social Futures, University of Newcastle, Australia
| | - Philip J Morgan
- Priority Research Centre for Physical Activity and Nutrition, School of Education, College of Human and Social Futures, University of Newcastle, Australia
| | - Myles D Young
- Priority Research Centre for Physical Activity and Nutrition, School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, NSW, Australia.
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Wang X, Hu Y, Qin LQ, Dong JY. Combined association of central obesity and depressive symptoms with risk of heart disease: A prospective cohort study. J Affect Disord 2022; 297:360-365. [PMID: 34715187 DOI: 10.1016/j.jad.2021.10.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/14/2021] [Accepted: 10/23/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the combined association of central obesity and depressive symptoms with risk of heart disease in a national prospective cohort study of the Chinese population. METHODS Data came from 10,722 community-dwelling adults aged over 45 years, from the China Health and Retirement Longitudinal Study during 2011-2018. Central obesity was assessed with waist circumference (WC) in physical examinations (men with a WC of ≥ 90 cm and women with a WC of ≥ 80 cm). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (score ≥ 10). Participants were assigned to four groups according to central obesity (yes/no) and depressive symptoms (yes/no). Cox proportional hazard regression was used after adjusting for covariates. RESULTS During 7 years of follow-up, we identified 1080 heart disease cases. Compared with people without central obesity and depressive symptoms, the multivariable-adjusted hazard ratios (95% confidence intervals) were 1.39 (1.18, 1.64) for those who had central obesity alone, 1.44 (1.18, 1.77) for those who had depressive symptoms alone, and 1.88 (1.55, 2.30) for those who had both central obesity and depressive symptoms. The combined association in men was more evident than that in women. CONCLUSIONS Our study provided evidence that the coexistence of central obesity and depressive symptoms were associated with a substantially increased risk of heart disease compared to those without these two conditions.
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Affiliation(s)
- Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 5650871, Japan
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; Medical Informatics Center, Peking University Health Science Center, Beijing 100191, China
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou 215000, China
| | - Jia-Yi Dong
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 5650871, Japan.
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Fulton S, Décarie-Spain L, Fioramonti X, Guiard B, Nakajima S. The menace of obesity to depression and anxiety prevalence. Trends Endocrinol Metab 2022; 33:18-35. [PMID: 34750064 DOI: 10.1016/j.tem.2021.10.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 02/07/2023]
Abstract
The incidence of depression and anxiety is amplified by obesity. Mounting evidence reveals that the psychiatric consequences of obesity stem from poor diet, inactivity, and visceral adipose accumulation. Resulting metabolic and vascular dysfunction, including inflammation, insulin and leptin resistance, and hypertension, have emerged as key risks to depression and anxiety development. Recent research advancements are exposing the important contribution of these different corollaries of obesity and their impact on neuroimmune status and the neural circuits controlling mood and emotional states. Along these lines, this review connects the clinical manifestations of depression and anxiety in obesity to our current understanding of the origins and biology of immunometabolic threats to central nervous system function and behavior.
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Affiliation(s)
- Stephanie Fulton
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Department of Nutrition, Université de Montréal, Montréal, QC H3T1J4, Canada.
| | - Léa Décarie-Spain
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Department of Neuroscience, Université de Montréal, Montréal, QC H3T1J4, Canada
| | - Xavier Fioramonti
- NutriNeuro, UMR 1286 INRAE, Bordeaux INP, Bordeaux University, Bordeaux, France
| | - Bruno Guiard
- Centre de Recherches sur la Cognition Animale (CRCA), Centre de Biologie Intégrative (CBI), CNRS UMR5169, UPS, Université de Toulouse, Toulouse, France
| | - Shingo Nakajima
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Department of Nutrition, Université de Montréal, Montréal, QC H3T1J4, Canada
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Tavernier RLE, Mason SM, Levy RL, Seburg EM, Sherwood NE. Association of childhood abuse with behavioral weight-loss outcomes: Examining the mediating effect of binge eating severity. Obesity (Silver Spring) 2022; 30:96-105. [PMID: 34932887 PMCID: PMC8970345 DOI: 10.1002/oby.23320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The study aims were to (1) document the relationship between a history of childhood abuse and weight change during behavioral obesity treatment and (2) estimate the indirect effect of childhood abuse on weight change through binge eating severity. METHODS Participants (n = 431) were enrolled in a behavioral weight-loss intervention. Childhood physical and emotional abuse history and current binge eating severity were self-reported. Percent weight loss at 6 months was calculated using measured weight. Adjusted mediation models examined whether there was an indirect effect of childhood physical and emotional abuse on 6-month percent weight loss that operated through binge eating severity. RESULTS After covariate adjustment, childhood physical abuse, but not emotional abuse, predicted a lower percent weight loss (B = -1.78%; 95% CI: -3.10% to -0.47%). Although childhood physical and emotional abuse were positively related to baseline binge eating severity, binge eating severity did not mediate the associations between either childhood abuse type and percent weight loss. CONCLUSIONS Individuals with a childhood physical abuse history had a lower percent weight loss than those without such histories during behavioral obesity treatment. This effect was not explained by binge eating severity. Individuals with a history of childhood abuse may benefit from trauma-informed obesity care.
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Affiliation(s)
- Rebecca L. Emery Tavernier
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth campus, Duluth, MN, USA
| | - Susan M. Mason
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rona L. Levy
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Nancy E. Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Castro A, Roca M, Ricci-Cabello I, García-Toro M, Riera-Serra P, Coronado-Simsic V, Pérez-Ara MÁ, Gili M. Adherence to Lifestyle Interventions for Treatment of Adults with Depression: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413268. [PMID: 34948874 PMCID: PMC8702100 DOI: 10.3390/ijerph182413268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/18/2022]
Abstract
The aim of this systematic review was to determine the adherence to lifestyle interventions for adults with depression and to estimate the dropout rates in trials examining the impact of these interventions. A bibliographic search was conducted in PubMed, Embase, PsycINFO, the Cochrane library, and several sources of grey literature. We included randomised controlled trials examining the impact of multiple lifestyle interventions on depressive symptomatology in adults when compared to control or other active treatments. Two reviewers independently screened citations, extracted the relevant data, and assessed the risk of bias using Cochrane tools. A random effects meta-analysis of proportions was used to summarise the proportion of participants who completed the intervention and to determine the proportion of dropouts at post-treatment assessment. Multiple subgroup analyses were also carried out. We identified six trials. The meta-analysis of proportions showed that 53% (95%CI 49% to 58%) of the participants assigned to the intervention group fully adhered to the intervention program. The weighted mean proportion of completed intervention sessions was 66%. The pooled trial dropout rate was 22% (95%CI 20% to 24%). Around half of adults with depression adhere to lifestyle interventions. Future research is needed to develop interventions to support adherence to lifestyle interventions in depressive patients.
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Affiliation(s)
- Adoración Castro
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
- Correspondence: ; Tel.: +34-971259888
| | - Miquel Roca
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 28029 Madrid, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, 07002 Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Mauro García-Toro
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
| | - Pau Riera-Serra
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
| | - Victoria Coronado-Simsic
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
| | - María Ángeles Pérez-Ara
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
| | - Margalida Gili
- Health Research Institute of the Balearic Islands (IdiSBa), Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain; (M.R.); (I.R.-C.); (M.G.-T.); (P.R.-S.); (M.Á.P.-A.); (M.G.)
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain;
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 28029 Madrid, Spain
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Drew RJ, Morgan PJ, Kay-Lambkin F, Collins CE, Callister R, Kelly BJ, Hansen V, Young MD. Men's Perceptions of a Gender-Tailored eHealth Program Targeting Physical and Mental Health: Qualitative Findings from the SHED-IT Recharge Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12878. [PMID: 34948488 PMCID: PMC8702011 DOI: 10.3390/ijerph182412878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
Despite increasing rates of co-morbid depression and obesity, few interventions target both conditions simultaneously, particularly in men. The SHED-IT: Recharge trial, conducted in 125 men with depressive symptoms and overweight or obesity, tested the efficacy of a gender-tailored eHealth program with integrated mental health support. The aims of this study were to examine the perceptions of men who received the SHED-IT: Recharge intervention in relation to recruitment, satisfaction with the program, and suggestions to improve the program. Individual semi-structured interviews were conducted in a random sub-sample, stratified by baseline depression and weight status (n = 19, mean (SD) age 49.6 years (11.6), PHQ-9 score 9.0 (3.7), BMI 32.5 kg/m2 (4.6)). Transcripts were analyzed using an inductive process by an independent qualitative researcher. Four themes emerged, namely, (i) specific circumstances determined men's motivation to enroll, (ii) unique opportunity to implement sustained physical and mental health changes compared to previous experiences, (iii) salience of the program elements, and (iv) further opportunities that build accountability could help maintain focus. Gender-tailored, self-directed lifestyle interventions incorporating mental health support are acceptable and satisfying for men experiencing depressive symptoms. These findings provide important insights for future self-guided lifestyle interventions for men with poor physical and mental health.
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Affiliation(s)
- Ryan J. Drew
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia; (R.J.D.); (P.J.M.)
| | - Philip J. Morgan
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia; (R.J.D.); (P.J.M.)
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (F.K.-L.); (B.J.K.)
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Brian J. Kelly
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (F.K.-L.); (B.J.K.)
| | - Vibeke Hansen
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, NSW 2450, Australia;
| | - Myles D. Young
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW 2308, Australia
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Depression and obesity among females, are sex specificities considered? Arch Womens Ment Health 2021; 24:851-866. [PMID: 33880649 DOI: 10.1007/s00737-021-01123-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Abstract
This study aimed to systematically review the relationship of obesity-depression in the female sex. We carried out a systematic search (PubMed, MEDLINE, Embase) to quantify the articles (controlled trials and randomized controlled trials) regarding obesity and depression on a female population or a mixed sample. Successively, we established whether the sex specificities were studied by the authors and if they reported on collecting data regarding factors that may contribute to the evolution of obesity and depression and that could be responsible for the greater susceptibility of females to those conditions. After applying the inclusion and exclusion criteria, we found a total of 20 articles with a female sample and 54 articles with a mixed sample. More than half of all articles (51.35%, n = 38) evaluated the relationship between depression and obesity, but only 20 (27.03%) evaluated this relationship among females; still, 80% of those (n = 16) presented supporting results. However, few articles considered confounding factors related to female hormones (12.16%, n = 9) and none of the articles focused on factors responsible for the binomial obesity-depression in the female sex. The resulting articles also supported that depression (and related impairments) influencing obesity (and related impairments) is a two-way road. This systematic review supports the concurrency of obesity-depression in females but also shows how sex specificities are ultimately under-investigated. Female sex specificity is not being actively considered when studying the binomial obesity-depression, even within a female sample. Future studies should focus on trying to understand how the female sex and normal hormonal variations influence these conditions.
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Jones RA, Mueller J, Sharp SJ, Vincent A, Duschinsky R, Griffin SJ, Ahern AL. The impact of participant mental health on attendance and engagement in a trial of behavioural weight management programmes: secondary analysis of the WRAP randomised controlled trial. Int J Behav Nutr Phys Act 2021; 18:146. [PMID: 34743721 PMCID: PMC8574009 DOI: 10.1186/s12966-021-01216-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/20/2021] [Indexed: 01/07/2023] Open
Abstract
Background Low attendance and engagement in behavioural weight management trials are common. Mental health may play an important role, however previous research exploring this association is limited with inconsistent findings. We aimed to investigate whether mental health was associated with attendance and engagement in a trial of behavioural weight management programmes. Methods This is a secondary data analysis of the Weight loss referrals for adults in primary care (WRAP) trial, which randomised 1267 adults with overweight or obesity to brief intervention, WW (formerly Weight Watchers) for 12-weeks, or WW for 52-weeks. We used regression analyses to assess the association of baseline mental health (depression and anxiety (by Hospital Anxiety and Depression Scale), quality of life (by EQ5D), satisfaction with life (by Satisfaction with Life Questionnaire)) with programme attendance and engagement in WW groups, and trial attendance in all randomised groups. Results Every one unit of baseline depression score was associated with a 1% relative reduction in rate of WW session attendance in the first 12 weeks (Incidence rate ratio [IRR] 0.99; 95% CI 0.98, 0.999). Higher baseline anxiety was associated with 4% lower odds to report high engagement with WW digital tools (Odds ratio [OR] 0.96; 95% CI 0.94, 0.99). Every one unit of global quality of life was associated with 69% lower odds of reporting high engagement with the WW mobile app (OR 0.31; 95% CI 0.15, 0.64). Greater symptoms of depression and anxiety and lower satisfaction with life at baseline were consistently associated with lower odds of attending study visits at 3-, 12-, 24-, and 60-months. Conclusions Participants were less likely to attend programme sessions, engage with resources, and attend study assessments when reporting poorer baseline mental health. Differences in attendance and engagement were small, however changes may still have a meaningful effect on programme effectiveness and trial completion. Future research should investigate strategies to maximise attendance and engagement in those reporting poorer mental health. Trial registration The original trial (ISRCTN82857232) and five year follow up (ISRCTN64986150) were prospectively registered with Current Controlled Trials on 15/10/2012 and 01/02/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01216-6.
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Affiliation(s)
- Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ann Vincent
- Department of Medicine, University College London, London, UK
| | - Robbie Duschinsky
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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de Lannoy L, Cowan T, Fernandez A, Ross R. Physical activity, diet, and weight loss in patients recruited from primary care settings: An update on obesity management interventions. Obes Sci Pract 2021; 7:619-628. [PMID: 34631139 PMCID: PMC8488444 DOI: 10.1002/osp4.514] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Obesity and related comorbidities are the most common chronic conditions in North America where behavior modification including the adoption of physical activity (PA) and a healthful diet are primary treatment strategies. Patients are more likely to engage in behavior modification if encouraged by their physician; however, behavioral counseling in primary care rarely occurs due to lack of training and resources. A more effective method may be to refer patients from clinical settings to other health professionals. OBJECTIVE This systematic review examines the effectiveness of behavior-based counseling for obesity management among participants referred from clinical settings. METHODS PubMed, CINAHL, and EMBASE were used to identify randomized clinical trials (2014-2020) for weight loss with the following inclusion criteria: trial duration ≥12 months, included a control or usual care group, recruited adults with overweight or obesity from primary care and/or treated in the primary care setting, and the intervention included counseling on PA and diet. RESULTS Seventeen studies, encompassing 21 different intervention groups with 6185 unique participants (56% female) met the inclusion criteria. All participants had overweight or obesity, with a body mass index between 28.2 and 41.0 kg/m2. In 11 (52%) of the intervention groups, significant weight loss in the intervention group was observed compared to usual care (mean weight loss: 4.9[2.1] kg vs. 1.0[0.9] kg). In 13 out of 18 interventions (72%) reporting weight loss at two time points, weight regain was observed by 12 months. Statistically significant weight loss was observed in one intervention (of two total) that was longer than 12 months. CONCLUSIONS Sustained weight loss regardless of the behavior-based, intervention strategy remains a challenge for most adults. Given the established benefits of routine PA and a healthful diet, prioritizing the adoption of healthy behaviors regardless of weight loss may be a more effective strategy for ensuring long-term health benefit.
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Affiliation(s)
- Louise de Lannoy
- School of Kinesiology and Health StudiesQueen's UniversityKingstonOntarioCanada
| | - Theresa Cowan
- School of Kinesiology and Health StudiesQueen's UniversityKingstonOntarioCanada
| | - Angela Fernandez
- School of Kinesiology and Health StudiesQueen's UniversityKingstonOntarioCanada
| | - Robert Ross
- School of Kinesiology and Health StudiesQueen's UniversityKingstonOntarioCanada
- School of MedicineFaculty of Health SciencesQueen's UniversityKingstonOntarioCanada
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46
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Lv N, Lefferts WK, Xiao L, Goldstein-Piekarski AN, Wielgosz J, Lavori PW, Simmons JM, Smyth JM, Stetz P, Venditti EM, Lewis MA, Rosas LG, Snowden MB, Ajilore OA, Suppes T, Williams LM, Ma J. Problem-solving therapy-induced amygdala engagement mediates lifestyle behavior change in obesity with comorbid depression: a randomized proof-of-mechanism trial. Am J Clin Nutr 2021; 114:2060-2073. [PMID: 34476464 PMCID: PMC8634561 DOI: 10.1093/ajcn/nqab280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/04/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Depression hinders obesity treatment; elucidating mechanisms may enable treatment enhancements. OBJECTIVES The aim was to investigate whether changes in neural targets in the negative affect circuit following psychotherapy mediate subsequent changes in weight and behaviors. METHODS Adults (n = 108) with obesity and depression were randomly assigned to usual care or an intervention that delivered problem-solving therapy (PST) for depression over 2 mo. fMRI for brain imaging was performed at baseline and 2 mo. BMI, physical activity, and diet were measured at baseline and 12 mo. Mediation analysis assessed between-group differences in neural target changes using t test and correlations between neural target changes and outcome changes (simple and interaction effect) using ordinary least-squares regression. RESULTS Compared with usual care, PST led to reductions in left amygdala activation (-0.75; 95% CI: -1.49, -0.01) and global scores of the negative affect circuit (-0.43; -0.81, -0.06), engaged by threat stimuli. Increases in amygdala activation and global circuit scores at 2 mo correlated with decreases in physical activity outcomes at 12 mo in the usual-care group; these relations were altered by PST. In relation to change in leisure-time physical activity, standardized β-coefficients were -0.67 in usual care and -0.01 in the intervention (between-group difference: 0.66; 0.02, 1.30) for change in left amygdala activation and -2.02 in usual care and -0.11 in the intervention (difference: 1.92; 0.64, 3.20) for change in global circuit scores. In relation to change in total energy expenditure, standardized β-coefficients were -0.65 in usual care and 0.08 in the intervention (difference: 0.73; 0.29, 1.16) for change in left amygdala activation and -1.65 in usual care and 0.08 in the intervention (difference: 1.74; 0.85, 2.63) for change in global circuit scores. Results were null for BMI and diet. CONCLUSIONS Short-term changes in the negative affect circuit engaged by threat stimuli following PST for depression mediated longer-term changes in physical activity. This trial was registered at www.clinicaltrials.gov as NCT02246413 (https://clinicaltrials.gov/ct2/show/NCT02246413).
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Affiliation(s)
- Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Wesley K Lefferts
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
| | - Andrea N Goldstein-Piekarski
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Joseph Wielgosz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Philip W Lavori
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Janine M Simmons
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Joshua M Smyth
- Departments of Biobehavioral Health and Medicine, The Pennsylvania State University, University Park, PA, USA
| | - Patrick Stetz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megan A Lewis
- Center for Communication Science, RTI International, Seattle, WA, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA,Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA, USA
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA,Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jun Ma
- Address correspondence to JM (e-mail: )
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Venditti EM, Marcus MD, Miller RG, Arena VC, Greenspan SL, Rockette-Wagner B. Group Lifestyle Phone Maintenance for Weight, Health, and Physical Function in Adults Aged 65-80 Years: A Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci 2021; 76:352-360. [PMID: 32918078 DOI: 10.1093/gerona/glaa229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Group lifestyle sessions with phone maintenance could improve weight, health, and function in vulnerable older adults. METHODS Community-dwelling adults (N = 322) with body mass index (BMI, kg/m2) ≥27 and additional risk factors received 12 one-hour in-person behavioral weight management group sessions then were randomized to 8 half-hour telephone sessions (n = 162) or newsletter control (n = 160) from 4 to 12 months with no treatment contact thereafter. Primary outcome was 0- to 12-month weight change. Cardiometabolic, short physical performance battery (SPPB), and self-reported activity changes were assessed at 12 and 24 months. RESULTS At baseline, the mean (SD) age was 71.2 (4.3) and BMI was 33.8 (5.1). Participants were 77% women, 13% Black, 85% retired, averaging 4 medical conditions, and taking blood pressure (67.4%) and lipid-lowering (51.6%) medications. At 12 months, a greater proportion of the phone group (66.0%) achieved ≥5% weight loss compared with newsletter control (53.2%; p = .02). Mean (95% CI) weight loss was greater for phone (-6.6 kg [-7.5, -5.8]) than newsletter (-5.1 kg [-7.2, -3.0]); p = .01. Modest lipid, glucose, and blood pressure improvements were found, but did not differ significantly between groups. Small SPPB and activity improvements were maintained at 12 and 24 months in both groups. CONCLUSIONS Brief phone contacts compared to newsletters enhanced weight loss maintenance among older high-risk adults at 1 year, but not cardiometabolic outcomes. Modest functional improvements were observed in both. Lower-intensity maintenance contacts (phone or newsletter) for weight, health, and physical function in older adults warrant further study. CLINICAL TRIALS REGISTRATION NUMBER NCT03192475.
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Affiliation(s)
- Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
| | - Rachel G Miller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Vincent C Arena
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Susan L Greenspan
- Department of Endocrinology, University of Pittsburgh School of Medicine, Pennsylvania.,Department of Geriatrics, University of Pittsburgh School of Medicine, Pennsylvania
| | - Bonny Rockette-Wagner
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
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Venditti EM, Steinman LE, Lewis MA, Weiner BJ, Ma J. Seeking a pot of gold with integrated behavior therapy and research to improve health equity: insights from the RAINBOW trial for obesity and depression. Transl Behav Med 2021; 11:1691-1698. [PMID: 34244787 PMCID: PMC8344914 DOI: 10.1093/tbm/ibab069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
More than one third of adults in the United States (U.S.) live with multiple chronic conditions that affect their physical and mental health, functional outcomes, independence, and mortality. The COVID-19 pandemic has exposed not only an increased risk for infection, morbidity, and mortality among those with chronic conditions but long-standing health inequities by age, race, sex, and other social determinants. Obesity plus depression represent one such prevalent comorbidity for which few effective integrated interventions exist, prompting concern about the potential for secondary physical and mental health pandemics post COVID-19. Translational behavioral medicine research can play an important role in studying integrated collaborative healthcare approaches and advancing scientific understanding on how to engage and more effectively treat diverse populations with physical and mental health comorbidities. The RAINBOW (Research Aimed at Improving Both Mood and Weight) clinical trial experience offers a wealth of insights into the potential of collaborative care interventions to advance behavior therapy research and practice. Primary care patients with co-occurring obesity and depression were assigned to either Integrated Coaching for Mood and Weight (I-CARE), which blended Group Lifestyle Balance (GLB) for weight management and the Program to Encourage Active Rewarding Lives (PEARLS) for depression, or usual care, to examine clinical, cost-effectiveness, and implementation outcomes. This commentary highlights the empirical findings of eight RAINBOW research papers and discusses implications for future studies, including their relevance in the U.S. COVID-19 context. Organized by key principles of translational behavioral medicine research, the commentary aims to examine and embrace the heterogeneity of baseline and intervention response differences among those living with multiple chronic conditions. We conclude that to prevent health and healthcare disparities from widening further, tailored engagement, dissemination, and implementation strategies and flexible delivery formats are essential to improve treatment access and outcomes among underrepresented populations.
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Affiliation(s)
- Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lesley E Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | | | - Bryan J Weiner
- Departments of Global Health and Health Services, University of Washington, Seattle, WA, USA
| | - Jun Ma
- Department of Medicine and Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
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Hoerster KD, Tanksley L, Sulayman N, Bondzie J, Brier M, Damschroder L, Coggeshall S, Houseknecht D, Hunter-Merrill R, Monty G, Saelens BE, Sayre G, Simpson T, Wong E, Nelson K. Testing a tailored weight management program for veterans with PTSD: The MOVE! + UP randomized controlled trial. Contemp Clin Trials 2021; 107:106487. [PMID: 34144246 DOI: 10.1016/j.cct.2021.106487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
Post-traumatic stress disorder (PTSD), prevalent among Veterans, increases risk for having a high Body Mass Index. Although the Veterans Health Administration (VHA) offers an evidence-based behavioral weight management program called MOVE!, participants with PTSD lose less weight than those without mental health conditions, despite comparable participation. PTSD symptoms can interfere with one's ability to be physically active and maintain a healthy diet, the key targets in weight management programs. We developed and piloted a behavioral weight management program called MOVE! + UP that targets PTSD-related weight loss barriers. MOVE! + UP includes 16 group sessions with training in evidence-based weight management strategies, coupled with Cognitive Behavior Therapy (CBT) skills to address PTSD-specific barriers. The 16 sessions also include 30-min community walks to address PTSD-related barriers that may impede exercise. Two individual dietician sessions are provided. This hybrid type 1 randomized controlled trial (RCT) will compare MOVE! + UP to standard care-MOVE!-among 164 Veterans with BMI ≥ 25 who are receiving care for PTSD. We will randomize participants to MOVE! + UP or standard care and will compare absolute post-baseline change in weight at 6 (primary outcome) and 12 (secondary outcome) months, and PTSD symptom severity at 6 and 12 months (secondary outcome). Exploratory analyses will compare the treatment conditions on treatment targets measured at 6 months (e.g., physical activity, eating behavior, social support). Finally, we will estimate intervention costs, and identify MOVE! + UP implementation barriers and facilitators. If effective, MOVE! + UP could be an efficient way to simultaneously address physical and mental health for Veterans with PTSD.
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Affiliation(s)
- Katherine D Hoerster
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service; 1660 South Columbian Way (S-116), Seattle, WA 98108, United States; VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, 100 NE 45(th) Street, Suite 300, Seattle, WA 98105; United States.
| | - Lamont Tanksley
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service; 1660 South Columbian Way (S-116), Seattle, WA 98108, United States.
| | - Nadiyah Sulayman
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Juliana Bondzie
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Moriah Brier
- VA Puget Sound Healthcare System, Anesthesiology Service, 1660 South Columbian Way, Seattle, WA 98108, United States.
| | - Laura Damschroder
- VA Ann Arbor Center for Clinical Management Research, 2800 Plymouth Rd. NCRC Bldg 16 (152), Ann Arbor, MI 48105, USA.
| | - Scott Coggeshall
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Dakota Houseknecht
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Rachel Hunter-Merrill
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Gillian Monty
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Brian E Saelens
- Seattle Children's Research Institute, 1920 Terry Avenue, Seattle, WA 98101, United States of America; University of Washington, Department of Pediatrics, 1959 NE Pacific Street, Seattle, WA 98195, United States of America.
| | - George Sayre
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; VA Puget Sound Health Care System, Center of Excellence in Substance Addiction Treatment and Education (CESATE), 1660 South Columbian Way, Seattle, WA 98108, United States; University of Washington, School of Public Health, Department of Health Services, United States.
| | - Tracy Simpson
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service; 1660 South Columbian Way (S-116), Seattle, WA 98108, United States; VA Puget Sound Health Care System, Center of Excellence in Substance Addiction Treatment and Education (CESATE), 1660 South Columbian Way, Seattle, WA 98108, United States; University of Washington, School of Public Health, Department of Health Services, United States.
| | - Edwin Wong
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States.
| | - Karin Nelson
- VA Puget Sound Healthcare System, Seattle Division, Health Services Research and Development, 1660 South Columbian Way (S-152), Seattle, WA 98108, United States; VA Puget Sound Health Care System, Center of Excellence in Substance Addiction Treatment and Education (CESATE), 1660 South Columbian Way, Seattle, WA 98108, United States; University of Washington, School of Public Health, Department of Health Services, United States; University of Washington, Department of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States.
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50
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Primary care-based interventions for treatment of obesity: a systematic review. Public Health 2021; 195:61-69. [PMID: 34058627 DOI: 10.1016/j.puhe.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 02/19/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to synthesise evidence from primary care-based interventions for the treatment of obesity in adults and the elderly. STUDY DESIGN Systematic review. METHODS Eight electronic databases (MEDLINE, Lilacs, Embase, Psycinfo, Cochrane, WHOLIS, Open Gray and Scholar Google) were searched. There was no limitation on publication period; articles published in English, Portuguese or Spanish were included. The selection, data extraction and quality analyses were performed by three reviewers. RESULTS A literature search retrieved 6464 publications, of which 5120 publications were excluded after reading the title/abstract and 293 after reading the full text. In total, 56 publications, representing 72 interventions were included. All studies were published between 2000 and 2020. Most studies were conducted in high-income countries. The mean duration of interventions was 11.5 months (SD: 7.5), ranging from 3 to 44 months. Most interventions were effective for body mass index reduction, weight loss and waist circumference change. CONCLUSION Our study showed that most interventions were effective for outcomes analysed in adults and the elderly. We also found some literature gaps, such as the need to implement and evaluate obesity after intervention and the requirement to carry out more studies in low- and middle-income countries.
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