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Depressed Women Can Lose Weight as Successfully as Others Do
ScienceDaily (Jan. 5, 2010) — Women with major depression were no less likely than were women without it to have successful results with a weight loss program, according to an article in the Winter 2009 Behavioral Medicine. Group Health Research Institute Senior Research Associate Evette J. Ludman, PhD, the study leader, concluded that weight loss programs should not exclude depressed people.

Dr. Ludman's study included 190 female Group Health patients age 40 to 65 with a body mass index (BMI) of 30 or more: 65 with major depressive disorder and 125 without it. The women had not been seeking treatment, but they enrolled in a one-year behavioral weight loss intervention involving 26 group sessions. The intervention, developed at the University of Minnesota over the past 20 years, has proven at least as good as any other currently available non-medical treatment.

Some previous research had hinted that depression might worsen outcomes in behavioral weight loss programs. That's why trials of weight loss interventions typically exclude people with major depression.

"We expected women with major depression to lose less weight, attend fewer sessions, eat more calories, and get less exercise than those without depression," Dr. Ludman said. "We were surprised to find no significant differences between the women who had depression and those who did not have it." Women had lost around the same amount of weight at 6 months (8 or 9 pounds) and 12 months (7 or 8 pounds), with no significant differences between the groups with and without depression.

"Instead, what made a difference was just showing up," she said. Women who attended at least 12 sessions lost more weight (14 pounds at 6 months, and 11 pounds at 12 months) than did those who attended fewer sessions (4 pounds at both 6 and 12 months), regardless of whether they had depression. Being depressed didn't lead them to attend fewer sessions or lose less weight.

"Because of our findings and the well-documented health risks of obesity, we think rigorous efforts should be taken to engage and retain all women in need of such services in intensive weight loss programs," Dr. Ludman said.

For years, Dr. Ludman and her colleagues have been researching the link between depression and obesity. She is also the coauthor of a self-help workbook called Overcoming Bipolar Disorder: A Comprehensive Workbook for Managing Your Symptoms and Achieving Your Life Goals. Her Harvard coauthors include Mark Bauer, MD. Published in 2008, the book outlines the research-based Life Goals Program to help people live with bipolar disorder.

Dr. Ludman's co-authors on this study are Group Health psychiatrist Gregory E. Simon, MD, MPH, who is also a senior investigator at Group Health Research Institute; Biostatistician Laura Ichikawa, MS, Project Manager Belinda H. Operskalski, MPH, and Assistant Investigator David Arterburn, MD, MPH of Group Health Research Institute; Jennifer A. Linde, PhD, and Robert W. Jeffery, PhD, of the University of Minnesota School of Public Health in Minneapolis; Paul Rohde, PhD, of the Oregon Research Institute in Eugene; and Emily A. Finch, MA, of Indiana University School of Medicine in Indianapolis.

The National Institute of Mental Health and the Office of Behavioral Social Sciences Research funded this study.


Obesity, Depression Often Coexist In Middle-Aged Women

ScienceDaily (Jan. 12, 2008) — Middle-aged women are much more likely to be depressed if they are obese, and vice versa, a new study finds. Rising excess weight goes along with less physical activity, higher calorie intake — and depression — according to the research.

What is the reason? Depression and obesity likely fuel one another, said lead author Gregory Simon, M.D. “When people gain weight, they’re more likely to become depressed, and when they get depressed, they have more trouble losing weight,” said Simon, a psychiatrist and researcher at Group Health Cooperative in Seattle.

In the study, published in the January/February issue of General Hospital Psychiatry, researchers interviewed 4,641 female health-plan enrollees, ages 40 to 65, by phone. The women responded to items on height, weight, exercise levels, dietary habits and body image. They also completed the Patient Health Questionnaire, a measure of depression symptoms.

Women with clinical depression were more than twice as likely to be obese, defined as having a body-mass index (BMI) of 30 or more; likewise, obese women were more than twice as likely to be depressed.

Moreover, women with BMIs at or above 30 exercised the least, had the poorest body image and ingested 20 percent more calories than those with lower BMIs. The depression-obesity association held even when the researchers controlled for marital status, education, tobacco use and antidepressant use.

The association was stronger in this study than in previous, comparable ones — possibly because the sample was predominantly white and middle-class, Simon said: “There is some evidence that being overweight is less stigmatized for men, for lower-income people and for women in nonwhite ethnic groups.”

The stigma of being overweight could hurt self-esteem, and thus, efforts to lose weight, Simon said. “It’s not that these women are clueless,” he said. “It’s that they’re hopeless.”

The takeaway for obese women is to focus on rebuilding their spirit, which can help with losing pounds, he said.

Health care providers should glean a similar message from the study results, said Richard Rubin, Ph.D., a Johns Hopkins University psychologist. “Providers need to monitor for depression and treat it in overweight individuals, especially given the dramatically increased risk of diabetes among those who are overweight,” said Rubin, former president for health care and education of the American Diabetes Association.

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.

Simon GE, et al. Association between obesity and depression in middle-aged women. Gen Hosp Psychiatry 30(1), 2008.