Epidemiology and Care of Comorbid Obesity and Depression
Epidemiology and Care of Comorbid Obesity and Depression
We propose to:

 -  Conduct cross-sectional assessments of depression, disability, health-related quality of
 life, eating patterns, and eating attitudes in a population-based sample approximately
 6000 women aged 40-60 with over-sampling of women with BMI greater than 30 kg/m2.

 -  Among obese women free of depression, enroll approximately 100 in a 6-month standard
 behavior therapy weight management program.

 -  Among obese women with significant depression, randomly assign 200 to either a 6-month
 standard behavior therapy weight management program or a combined cognitive-behavior
 therapy program focused on both depression and weight management.

 -  Complete follow up assessments of weight, depressive symptoms, and functional status in
 all three treatment groups for 12 months following enrollment

 Screening and follow-up data will be used to address the following questions:

 -  Association between depression and obesity among middle-aged women

 -  Specific effects of depression and obesity on functional status, disability, and health
 services utilization

 -  Impact of depression on participation in and outcomes of a standardized weight
 management program

 -  Benefit of combined treatment (focused on depression and weight management) above that
 of standardized behavioral therapy for obese women with significant depressive symptoms.
Obesity is a significant and growing public health concern, accounting for approximately
 300,000 excess deaths per year and approximately 9% of US health care expenditures.
 Prevalence of obesity has steadily increased, with an estimated rate among middle-aged women
 exceeding 30%. Obesity has a substantial impact on medical morbidity and health-related
 quality of life.

 Public health approaches to the prevention and treatment of obesity must consider the
 substantial overlap with depression. Some data suggest a 50% increase in risk of depression
 among obese women. Women with a history of depression or depression treatment are
 over-represented among those seeking obesity treatment. Current or past depression is also
 associated with less success in losing weight or maintaining weight loss. Because women with
 depressive disorders are typically excluded from clinical trials of weight loss treatments,
 data on the management of comorbid depression and obesity are limited.

 We propose two related studies: A population-based epidemiologic study of the association
 between obesity and depression among women and a longitudinal study of obesity treatment
 among two cohorts (one with comorbid obesity and depression, one with obesity only)
 identified by the epidemiologic study.

 Study 1 - Epidemiologic Study: A population-based sample of approximately 6000 women aged
 40-65 will complete structured telephone assessment of weight, nutrient intake, physical
 activity, depression, functional impairment, and disability. Women with Body Mass Index (BMI)
 >30 will be oversampled. Insurance claims data will be used to measure health care costs.
 Aims of the epidemiologic study include:

 1. Examine the association between obesity and depression among middle-aged women.
 Secondary analyses will examine possible mechanisms for any association.

 2. Examine the specific contributions of obesity and depression to disability, functional
 impairment, and health care utilization and cost.

 Study 2 - Treatment study: A cohort of approximately 100 women with obesity (BMI > 30) and no
 current depressive disorder will be enrolled in a 6-month state-of-the-art group weight loss
 treatment. Approximately 200 women with comorbid obesity and depression will be randomly
 assigned to either the identical weight loss treatment or to a combined cognitive-behavior
 group therapy program focused on both depression and weight loss. Aims of the treatment study
 will include:

 1. Examine the effect of depression on success in weight loss treatment by comparing weight
 loss, nutrient intake, and physical activity in depressed and non-depressed women
 enrolled in the identical weight loss program. Secondary analyses will examine
 mechanisms for any observed difference.

 2. Examine the benefits of a combined weight loss/depression intervention above those of
 weight loss treatment alone by comparing weight loss, nutrient intake, physical
 activity, depressive symptoms, functional impairment, and disability in the two groups
 of women with comorbid obesity and depression randomly assigned to the two different
 intervention programs.
Inclusion Criteria:

 -  Age 40 to 65

 -  Body Mass Index >= 30

 -  Clinically significant depression

 -  PHQ score of 10 or more

 -  Current or past major depressive episode

 -  Current symptoms include depressed mood or loss of interest

 -  Enrolled in Group Health Cooperative health plan

 Exclusion Criteria:

 -  History of treatment for bipolar disorder or schizophrenia

 -  Not willing to participate in group intervention

 -  Medical contra-indications to graded exercise program

 -  Unable to walk for 10 minutes