Does diet-induced weight change effect anxiety in overweight and obese adults?

Medical Weight-Loss Outcomes in Patients Receiving Concomitant Psychotropic Medication: A Retrospective Cohort Study

OBJECTIVE

This study aimed to elucidate medical weight-loss outcomes in patients unexposed or exposed to psychotropic medication(s).

METHODS

This retrospective cohort study evaluated weight-loss outcomes of completers treated at an academic weight-management center between April 1, 2014, and April 1, 2016. Patients were classified as either unexposed (not prescribed psychotropic medication) or exposed (prescribed psychotropic medication) based on use of antidepressants, mood stabilizers, or antipsychotics during the study.

RESULTS

Of 1,932 patients seen during the study period, 885 were eligible for inclusion, of whom 619 (70.0%) were unexposed and 266 (30.0%) were exposed to psychotropic medications. In the unexposed and exposed groups, the mean age, sex distribution, proportion with type 2 diabetes, initial BMI, and number of weight-loss medications prescribed were similar. At 12 months, the unexposed group lost 1.6% more weight on average than the exposed group (9.1% [SD 7.6%] vs. 7.5% [SD 8.1%], respectively; P = 0.02); 71.0% and 41.2% of the unexposed group achieved ≥ 5% and ≥ 10% weight loss at 12 months, respectively, compared with 63.1% and 31.8% in the exposed group at 12 months (P = 0.04 at 5%; P = 0.02 at 10%).

CONCLUSIONS

Exposure to psychotropic medications was associated with diminished weight loss in patients with medically managed overweight and obesity.

Traditional Brazilian diet and extra virgin olive oil reduce symptoms of anxiety and depression in individuals with severe obesity: Randomized clinical trial

RATIONAL & OBJECTIVE

Although the relationship between obesity, anxiety and depression is known, the clinical benefits of nutrition therapy in individuals with obesity have been scarcely studied. This study assessed the effectiveness of a traditional Brazilian diet (DieTBra) and extra virgin olive oil (EVOO) on the symptoms of anxiety and depression in severe obese participants.

METHOD

This was a parallel randomized clinical trial in adults with severe obesity (Body Mass Index - BMI ≥ 35 kg/m²), DietBra Trial. Participants were randomized into three intervention groups in a ratio of 1: 1: 1 and followed up for 12 weeks. The three intervention groups were: 1) DieTBra, 2) 52 mL/day EVOO, and 3) DieTBra +52 mL/day EVOO. The symptoms of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. The outcome variables were: anxiety, depression and simultaneous anxiety and depression in the same individual.

RESULTS

149 severe obese individuals were randomized. The mean BMI was 46.3 ± 6.5 kg/m² with a mean age of 38.9 ± 8.7 years. After randomization, individuals on medication for depression and anxiety were excluded, totaling 129 at baseline, with 44:43:42 per group. At the end of 12 weeks 113 individuals completed the study. There was a significant reduction of symptoms for the three groups: EVOO, DieTBra and DieTBra + EVOO, respectively: anxiety 38.23% (p = 0.019), 45.83% (p=<0.014), 33.33% (p < 0.013) depression 55.17% (p=<0.001), 50.00% (p=<0.007), 34.61% (p=<0.035), and anxiety/depression 57.69% (p=<0.001), 66.67% (p=<0.014), 27.78% (p=<0.013).

CONCLUSIONS

Both DieTBra and olive oil interventions were effective in reducing symptoms of anxiety and depression in severe obese adults. These interventions can be integrated with clinical protocols for treatment of symptoms of anxiety and depression in severe obese individuals.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02463435.

Anxiety-like behaviors and hippocampal nNOS in response to diet-induced obesity combined with exercise

A high-fat diet (HFD) and overweight status can induce hippocampal dysfunction, leading to depression and anxiety. Exercise has beneficial effects on emotional behaviors. We previously reported that exercise training rescues HFD-induced excess hippocampal neuronal nitric oxide synthase (nNOS) expression, which is a key regulator of anxiety. Here, we investigated anxiety-like behaviors and hippocampal nNOS expression in response to HFD combined with exercise. Mice were assigned to standard diet, HFD, or HFD with exercise groups for 12 weeks. We found that exercise during the final 6 weeks of the HFD regime improved 12 weeks of HFD-induced defecation, accompanied by rescue of excess nNOS expression. However, anxiety indicators in the elevated plus maze were unchanged. These effects were not apparent after only 1 week of exercise. In conclusion, 6 weeks of exercise training reduced HFD-related anxiety according to one of our measures (defecation), and reversed changes in the hippocampal nNOS/NO pathway.

Changes in Anxiety and Depression Traits Induced by Energy Restriction: Predictive Value of the Baseline Status

Current evidence proposes diet quality as a modifiable risk factor for mental or emotional impairments. However, additional studies are required to investigate the effect of dietary patterns and weight loss on improving psychological symptoms. The aim of this investigation was to evaluate the effect of energy-restriction, prescribed to overweight and obese participants, on anxiety and depression symptoms, as well as the potential predictive value of some baseline psychological features on weight loss. Overweight and obese participants (n = 305) were randomly assigned for 16 weeks to two hypocaloric diets with different macronutrient distribution: a moderately high-protein (MHP) diet and a low-fat (LF) diet. Anthropometrical, clinical, psychological, and lifestyle characteristics were assessed at baseline and at the end of the intervention. The nutritional intervention evidenced that weight loss has a beneficial effect on trait anxiety score in women (β = 0.24, p = 0.03), depression score in all population (β = 0.15, p = 0.02), particularly in women (β = 0.22, p = 0.03) and in subjects who followed the LF diet (β = 0.22, p = 0.04). Moreover, weight loss could be predicted by anxiety status at baseline, mainly in women and in those who were prescribed a LF diet. This trial suggests that weight loss triggers an improvement in psychological traits, and that anxiety symptoms could predict those volunteers that benefit most from a balanced calorie-restricted intervention, which will contribute to individualized precision nutrition.

Diet-Induced Weight Loss Has No Effect on Psychological Stress in Overweight and Obese Adults: A Meta-Analysis of Randomized Controlled Trials

The effect of weight loss on psychological stress is unknown. The study aimed to investigate the effect of diet-induced weight loss in overweight and obese adults on psychological measures of stress through a meta-analysis of randomized controlled trials (RCTs). Databases including Medline Complete, Embase and PsycINFO were searched up to February 2018 for diet-induced weight loss RCTs, which included self-reported assessment of psychological stress. The mean difference between the intervention and control group of changes in stress (intervention-baseline) was used. Ten RCTs were included with 615 participants (502 women, age range 20⁻80 years). Overall, there was no change in stress (mean difference -0.06, 95% CI: -0.17, 0.06, p = 0.33) and no change in the five studies with a significant reduction in weight in the intervention group compared to a control group that lost no weight (mean difference in weight -3.9 Kg, 95% CI: -5.51, -2.29, p < 0.0001; mean difference in stress 0.04, 95% CI: -0.17, 0.25, p = 0.71). For all analyses, there was low heterogeneity. The benefits of weight loss for those who are overweight and obese do not appear to either increase or reduce psychological stress at the end of the weight loss period.

High-fat diet feeding alters olfactory-, social-, and reward-related behaviors of mice independent of obesity

OBJECTIVE

High-fat diet (HFD) consumption causes obesity, which is associated with well-known increased health risks. Moreover, obesity has been associated with altered sensorimotor and emotional behaviors of humans and mice. This study attempted to dissociate the influence of HFD-induced obesity on behaviors from the influence of HFD consumption itself.

METHODS

C57BL male mice were randomly allocated to a low-fat diet (LFD) group, an HFD-induced obesity (DIO) group, or a pair-fed HFD-feeding nonobese (HFD) group. A comprehensive behavioral test battery was performed on all three groups to assess sensorimotor functions, anxiety- and depression-like behaviors, reward-related behaviors, social behaviors, and learning/memory functions.

RESULTS

Both the DIO and HFD groups exhibited disturbed olfaction, blunted ethanol preference, and enhanced social interactions. The DIO group exhibited blunted sucrose preference, shorter latency before falling off during the rotarod test, and a lower response to mechanical stimuli.

CONCLUSIONS

The HFD-fed nonobese mice showed altered behaviors related to olfaction, social interactions, and rewards that were similar to those of the DIO mice. This finding suggests that HFD consumption alters a variety of behaviors independent of obesity.

Food addiction symptomology, impulsivity, mood, and body mass index in people with type two diabetes

This research explored how food addiction (FA) and impulsivity (non-planning, motor, and attentional) relate to body mass index (BMI) in a sample of people with type 2 diabetes (t2d). Participants with t2d (N = 334, Mage = 41.0, SDage = 9.5, 66% female, MBMI = 37.6 kg/m(2), SDBMI = 8.0 kg/m(2)) completed an online survey including the Depression Anxiety Stress Scale (DASS-21), the Barratt Impulsiveness Scale (BIS-II), and the Yale Food Addiction Scale (YFAS). Results demonstrated that over 70% of the sample with t2d met the YFAS criteria for FA. Results also demonstrated that participants classified as FA had significantly higher BMI, t (332) = 12.11, p < .001. The food addict classification group also had a significantly higher percentage of obese participants, χ(2) (2) = 87.1, p < .001, phi = .511. Utilising a cross-sectional design to predict BMI, significant forward stepwise multiple regression demonstrated that FA (β = .386) and impulsivity (non-planning) (β = .286) were significant predictors. In combination FA and impulsivity (non-planning) significantly explained 38% of BMI variance; however depression, anxiety, and stress did not significantly improve the model. These results suggest FA and impulsivity (non-planning) are more salient cross-sectional predictors of BMI, in people with t2d, than indices of depression, anxiety, stress and impulsivity (motor and attentional). These results, implicating FA in the development of obesity, have important ramifications for potential future treatment methods of t2d where FA symptomology could be routinely screened, and if present, treated via addiction models rather than purely attempting to treat the potential consequences of FA.

An Increase in Plasma Homovanillic Acid with Cocoa Extract Consumption Is Associated with the Alleviation of Depressive Symptoms in Overweight or Obese Adults on an Energy Restricted Diet in a Randomized Controlled Trial

BACKGROUND

Obesity has been associated with various health disorders, including psychological alterations. Cocoa consumption and weight management may produce a beneficial effect on these problems.

OBJECTIVE

The purpose of this study was to investigate the effect of cocoa extract supplementation as part of an energy-restricted diet on psychological status and peripheral dopaminergic activity in overweight or obese middle-aged subjects.

METHODS

In a 4-wk, double-blind, randomized, placebo-controlled parallel nutritional intervention, 22 men and 25 women [mean ± SD age: 57 ± 5 y; body mass index (kg/m2): 30.6 ± 2.3] were studied. After a 1-wk run-in period, volunteers consumed 15% energy-restricted diets; one-half of the volunteers were randomly assigned to receive ready-to-eat meals supplemented with 1.4 g cocoa extract/d (645 mg total polyphenols/d), whereas the rest of the volunteers received the same meals without cocoa supplementation. Plasma monoamines [dopamine, dopac, and homovanillic acid (HVA)], monoamine oxidase (MAO), and psychological status (anxiety and depressive symptoms) were analyzed in fasting participants at baseline and endpoint. Data were analyzed over time, and regression and correlation analyses were conducted to determine the relation between variables.

RESULTS

Depressive symptoms decreased in both groups after the intervention (control: -9.4%, P < 0.001; cocoa: -6.3%, P = 0.008), but anxiety symptoms did not. The increase in plasma HVA was 11.5% greater in the cocoa group than in the control group (P = 0.016), but plasma dopamine, dopac, and MAO changes did not differ between groups. A negative relation between changes in depressive symptoms and changes in plasma HVA was observed in the cocoa group (β = -0.39, P = 0.029). Moreover, the change in plasma dopamine was positively associated with the change in methyl-catechin-O-glucoronide in the cocoa-supplemented group (r = 0.69, P = 0.019).

CONCLUSION

The intake of cocoa extract by participants consuming a 15% energy-restricted diet contributed to an increase in plasma HVA concentrations. This change was associated with a reduction in depressive symptoms, suggesting a potential effect of cocoa extract intake on this relation. The present results are secondary analyses of a clinical trial that was registered at www.clinicaltrials.gov as NCT01596309.

Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets

OBJECTIVE

The aim of this study was to determine the effect of plant-based diets on weight loss.

METHODS

Participants were enrolled in a 6-mo, five-arm, randomized controlled trial in 2013 in South Carolina. Participants attended weekly group meetings, with the exception of the omnivorous group, which served as the control and attended monthly meetings augmented with weekly e-mail lessons. All groups attended monthly meetings for the last 4 mo of the study. Diets did not emphasize caloric restriction.

RESULTS

Overweight adults (body mass index 25-49.9 kg/m(2); age 18-65 y, 19% non-white, and 27% men) were randomized to a low-fat, low-glycemic index diet: vegan (n = 12), vegetarian (n = 13), pesco-vegetarian (n = 13), semi-vegetarian (n = 13), or omnivorous (n = 12). Fifty (79%) participants completed the study. In intention-to-treat analysis, the linear trend for weight loss across the five groups was significant at both 2 (P < 0.01) and 6 mo (P < 0.01). At 6 mo, the weight loss in the vegan group (-7.5% ± 4.5%) was significantly different from the omnivorous (-3.1% ± 3.6%; P = 0.03), semi-vegetarian (-3.2% ± 3.8%; P = 0.03), and pesco-vegetarian (-3.2% ± 3.4%; P = 0.03) groups. Vegan participants decreased their fat and saturated fat more than the pesco-vegetarian, semi-vegetarian, and omnivorous groups at both 2 and 6 mo (P < 0.05).

CONCLUSIONS

Vegan diets may result in greater weight loss than more modest recommendations.

Effect of dietary restriction on peripheral monoamines and anxiety symptoms in obese subjects with metabolic syndrome

Reduced circulating monoamines may have a role in the development of the metabolic syndrome (MetS), which is becoming a major health problem worldwide. Moreover, an association between anxiety disorder and MetS has been reported; however, it is not clear whether weight loss can diminish anxiety. This investigation is aimed to examine the effects of a weight loss intervention on peripheral monoamines levels and anxiety symptoms in subjects with metabolic syndrome (MetS). The study population encompassed subjects with MetS (age: 50±10 y.o. and BMI: 35.8±4.3 kg/m2) selected from the RESMENA study after they had completed the 6-month weight loss intervention (-30% energy). Anthropometric measurements, dietary records, anxiety symptoms, and blood monoamines levels were analysed before and after the intervention. Dopamine (DA) (+18.2%; 95% confidence interval (CI): -51.2 to -0.5) and serotonin (5-HT) (+16.1%; 95% CI: -26.3 to -2.2) blood levels were significantly increased after the intervention. Higher DA blood concentrations at the end of the study were inversely related with the carbohydrate intake during the study (B=-3.3; 95% CI: -8.4 to -0.4) and basal DA levels predicted a greater decrease in body weight and anthropometric parameters. Subjects with higher 5-HT concentrations after the weight loss intervention also showed a lower energy intake during the intervention (B=-0.04; 95% CI: -0.07 to -0.01). Additionally, anxiety symptoms decreased after the weight loss treatment (-28.3%; 95% CI: 6.2-20.4), which was parallel to a greater decrease in body weight and anthropometric markers, being related to lower 5-HT basal levels. Dietary restriction in patients with MetS may help in reducing anxiety symptoms, and also in increasing 5-HT and DA blood levels. These results provide further insights regarding emotional and neurological factors behind weight loss.