Interventions for Obese, Depressed Patients

By March 12, 2019 Commentary

Two studies carried in the Journal of the American Medical Association focus on whether intensive interventions can create better outcomes in patients who are overweight and depressed.   (JAMA Study)  (JAMA Study)   It obviously is the case that people who struggle with their weight are likely to have some depressive symptoms, so this has been an area of focus for interventions.  In the first study, the researchers sought to assess whether use of nutritional supplements and/or behavioral therapy could help prevent major depressive episodes among a group of overweight patients with depressive tendencies.  The study period lasted one year and about 780 patients, so not a huge number, completed the entire course of treatment. To be brief, no strategy–supplements alone, therapy alone or the combination of therapy and supplements made any difference in development of major depressive episodes compared to nothing.  The second trial was even smaller, 344 overweight patients with depression diagnoses who completed the full study period.  The intervention here was a diabetes prevention program-based behavioral weight loss program with problem-solving therapy for depression and medications, if indicated.  Body Mass Index and depression scores were the primary outcomes and one-year was also the study period.  There was a slight change in BMI in the intervention group compared to the control group and there was a modest improvement in depression scale scores. As the authors note, the clinical importance of these changes is unclear.

These studies have implications too for health plans, government payers and self-funded employers.  These payers have been besieged by vendors claiming to have interventions, often “digital” that will help people lose weight and/or not be depressed.  Based on all the research I have seen, odds are most of these do nothing but add expense without creating meaningful improvement in clinical outcomes.  So it helps all those payers think about whether the extra spending is worth it.  Certainly these patients need and deserve interventions that help them deal with both their weight issue and depressive symptoms.

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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