Author Interviews, Depression, OBGYNE, Weight Research / 05.03.2019
Obesity and Depression Can Be Treated With Collaborative Care
MedicalResearch.com Interview with:
Jun Ma, MD, PhD, FAHA, FABMR
Professor and Associate Head of Research
Department of Medicine
Director, Center for Health Behavior Research
The University of Illinois at Chicago
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obesity and depression are major public health problems. Obesity affects 40% of United States (US) adults. About 20% in US women and 13% in men experience major depressive disorder at some point in their lifetime and, additionally, many adults have elevated depressive symptoms that do not meet clinical diagnostic criteria but can nevertheless negatively affect their health and quality of life. Obesity and depression share common risk factors, such as poor diet and lack of exercise, and cause other health problems, such as diabetes and cardiovascular disease. People with obesity are at increased risk of being depressed and, likewise, people with depression are at increased risk of being obese. Consequently, obesity and depression often co-occur. To date, there has been no integrated therapy to effectively treat patients affected by both conditions at the same time.
The RAINBOW randomized clinical trial addressed this gap.
The main finding from the trial is that, among adult patients with obesity and depression, a collaborative care intervention integrating behavioral weight loss treatment, problem-solving therapy, and as-needed antidepressant medications significantly improve weight loss and depressive symptoms over one year compared with usual care, which patients received through their primary care physicians.
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Dr Paul Gentil
Faculty of Physical Education and Dance
Federal University of Goias
Goiania, Brazil
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although being overweight and/or obese are associated with numerous health risks, the prevalence of both are continuing to increase worldwide. The treatment would include anything that results in an increase in energy expenditure (exercise) or a decrease in energy intake (diet). However, our metabolism seems to adapt to variations in physical activity to maintain total energy expenditure. Although lower-than-expected weight loss is often attributed to incomplete adherence to prescribed interventions, there are other factors that might influence the results, such as, metabolic downregulation.
So, instead of making people spend more calories, maybe we have to think on how to promote metabolic changes in order to overcome these physiological adaptations above-mentioned. In this regard, high intensity training might be particularly interesting as a strategy to promote fat loss. Irrespective the amount of calories spent during training, higher intensity exercise seems to promote many physiological changes that might favor long-term weight loss. For example, previous studies have shown that interval training is able to promote upregulation of important enzymes associated with glycolysis and beta oxidation pathways, which occurs in a greater extent than with moderate intensity continuous exercise.
Our findings suggest that interval training might be an important tool to promote weigh loss. However, I t might be performed adequately and under direct supervision in order to get better results.
Dr. Janey Pratt, MD
Clinical Associate Professor, Surgery
Stanford University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In 2013 obesity became recognized as a disease. The rate of pediatric obesity continues to rise. Severe pediatric obesity is rising at a even faster rate than obesity in pediatrics. Despite this Metabolic and Bariatric Surgery (MBS) remains underutilized in the treatment of severe pediatric obesity. There is a significant amount of adult data and now pediatric data about effective treatments for severe obesity. These support the use of MBS as a primary treatment for severe obesity in children. (BMI > 120% of 95th percentile with a comorbidity or BMI > 140% of 95th percentile).