Abstract
Objective:
Obesity is related to increased risk of several health complications, including depression. Many studies have reported improvements in mood with weight loss, but results have been equivocal. The present meta-analysis examined changes in symptoms of depression that were reported in trials of weight loss interventions. Between-groups comparisons of different weight loss methods (for example, lifestyle modification, diet-alone and pharmacotherapy) were examined, as were within-group changes for each treatment type.
Method:
MEDLINE was searched for articles published between 1950 and January 2009. Several obesity-related terms were intersected with terms related to depression. Results were filtered to return only studies of human subjects, published in English. Of 5971 articles, 394 were randomized controlled trials. Articles were excluded if they did not report mean changes in weight or symptoms of depression, included children or persons with psychiatric disorders (other than depression), or provided insufficient data for analysis. Thirty-one studies (n=7937) were included. Two authors independently extracted a description of each study treatment, sample characteristics, assessment methods and changes in weight and symptoms of depression. Treatments were categorized as lifestyle modification, non-dieting, dietary counseling, diet-alone, exercise-alone, pharmacotherapy, placebo or control interventions.
Results:
Random effects models found that lifestyle modification was superior to control and non-dieting interventions for reducing symptoms of depression, and marginally better than dietary counseling and exercise-alone programs. Exercise-alone programs were superior to controls. No differences were found for comparisons of pharmacologic agents and placebos. Within-group analyses found significant reductions in symptoms of depression for nearly all active interventions. A meta-regression found no relationship between changes in weight and changes in symptoms of depression in lifestyle modification interventions.
Conclusions:
On average, obese individuals in weight loss trials experienced reductions in symptoms of depression. Future studies should examine incidence and resolution of clinically significant depressive disorders with weight loss interventions.
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References
Flegal KM, Carroll MD, Ogden CL, Curtin LR . Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010; 303: 235–241.
National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults--the evidence report. Obes Res 1998; 6 (Suppl 2): 51S–209S.
Flegal KM, Graubard BI, Williamson DF, Gail MH . Impact of smoking and preexisting illness on estimates of the fractions of deaths associated with underweight, overweight, and obesity in the US population. Am J Epidemiol 2007; 166: 975–982.
Simon GE, Von Korff M, Saunders K, Miglioretti DL, Crane PK, van Belle G et al. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 2006; 63: 824–830.
Petry NM, Barry D, Pietrzak RH, Wagner JA . Overweight and obesity are associated with psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosom Med 2008; 70: 288–297.
Mather AA, Cox BJ, Enn MW, Sareen J . Associations of obesity with psychiatric disorders and suicidal behaviors in a nationally representative sample. J Psychosom Res 2009; 66: 277–285.
Goodman E, Whitaker RC . A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics 2002; 110: 497–504.
Pine DS, Cohen P, Brook J, Coplan JD . Psychiatric symptoms in adolescence as predictors of obesity in early adulthood: a longitudinal study. Am J Public Health 1997; 87: 1303–1310.
Pine DS, Goldstein RB, Wolk S, Weissman MM . The association between childhood depression and adulthood body mass index. Pediatrics 2001; 107: 1049–1056.
Anderson SE, Cohen P, Naumova EN, Must A . Association of depression and anxiety disorders with weight change in a prospective community-based study of children followed up into adulthood. Arch Pediatr Adolesc Med 2006; 160: 285–291.
Stice E, Presnell K, Shaw H, Rohde P . Psychological and behavioral risk factors for obesity onset in adolescent girls: a prospective study. J Consult Clin Psychol 2005; 73: 195–202.
Murphy JM, Horton NJ, Burke Jr JD, Monson RR, Laird NM, Lesage A et al. Obesity and weight gain in relation to depression: findings from the Stirling County Study. Int J Obes 2009; 33: 335–341.
Herva A, Laitinen J, Miettunen J, Veijola J, Karvonen JT, Läksy K et al. Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study. Int J Obes 2006; 30: 520–527.
Roberts RE, Deleger S, Strawbridge WJ, Kaplan GA . Prospective association between obesity and depression: evidence from the Alameda County Study. Int J Obes Relat Metab Disord 2003; 27: 514–521.
Carpenter KM, Hasin DS, Allison DB, Faith MS . Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study. Am J Public Health 2000; 90: 251–257.
Heo M, Pietrobelli A, Fontaine KR, Sirey JA, Faith MS . Depressive mood and obesity in US adults: comparison and moderation by sex, age, and race. Int J Obes 2006; 30: 513–519.
Barry D, Pietrzak RH, Petry NM . Gender differences in associations between body mass index and DSM-IV mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Ann Epidemiol 2008; 18: 458–466.
Wadden TA, Butryn ML, Byrne KJ . Efficacy of lifestyle modification for long-term weight control. Obes Res 2004; 12 (Suppl): 151S–162S.
Goldstein DJ . Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 1992; 16: 397–415.
Look AHEAD Research Group. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care 2007; 30: 1374–1383.
Diabetes Prevention Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403.
Klein S, Burke LE, Bray GA, Blair S, Allison DB, Pi-Sunyer X et al. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2004; 110: 2952–2967.
Cash TF . Self-help for a negative body image: a comparison of components of a cognitive-behavioral program. Behav Ther 2002; 33: 235–251.
Foster GD, Wadden TA, Vogt RA . Body image in obese women before, during, and after weight loss treatment. Health Psychol 1997; 16: 226–229.
Ackermann RT, Edelstein SL, Venkat Narayan KM, Zhang P, Engelgau M, Herman WH et al. Changes in health state utilities with changes in body mass in the Diabetes Prevention Program. Obesity 2009; 17: 2176–2181.
Kaukua J, Pekkarinen T, Sane T, Mustajoki P . Sex hormones and sexual function in obese men losing weight. Obes Res 2003; 11: 689–694.
Kolotkin RL, Crosby RD, Williams GR, Hartley GG, Nicol S . The relationship between health-related quality of life and weight loss. Obes Res 2001; 9: 564–571.
Kolotkin RL, Norquist SM, Crosby RD, Suryawanshi S, Teixeira PJ, Heymsfield SB et al. One-year health-related quality of life outcomes in weight loss trial participants: comparison of three measures. Health Qual Life Outcomes 2009; 7: 53.
Faulconbridge LF, Wadden TA, Rubin RA, Walkup AP, Fabricatore AN, Coday M et al. One-year changes in weight and symptoms of depression in depressed vs non-depressed individuals in the Look AHEAD study. Obesity 2009; 17 (Suppl 2): 576.
Keys A . Biology of Human Starvation. University of Minnesota Press: Minneapolis, MN, 1950.
Stunkard AJ . The dieting depression; incidence and clinical characteristics of untoward responses to weight reduction regimens. Am J Med 1957; 23: 77–86.
US Food and Drug Administration Advisory Committee. FDA Briefing Document: Zimulti (Rimonabant) Tablets, 20 mg. FDA: Rockville, MD, 2007. Available at http://www.fda.gov/OHRMS/DOCKETS/AC/07/briefing/2007-4306b1-00-index.htm (accessed 12 January 2010).
Christensen R, Kristensen KP, Bartels EM, Bliddal H, Astrup A . Efficacy and safety of the weight-loss drug rimonabant: a meta-analysis of randomised trials. Lancet 2007; 370: 1706–1713.
Department of Health and Human Service, Public Health Service, Food and Drug Administration Center for Drug Evaluation and Research Memorandum. November 2006 Overview for December 13 Meeting of Psychopharmacologic Drugs Advisory Committee (PDAC). Appendix 2: Request to Sponsors—Advice for the pharmaceutical industry in exploring their placebo-controlled clinical trials databases for suicidality and preparing data sets for analysis by FDA. Available at http://www.fda.gov/ohrms/dockets/ac/briefing/2006-4272b1-01-FDA.pdf (accessed 24 August 2009).
Andersen RE, Wadden TA, Bartlett SJ, Zemel B, Verde TJ, Franckowiak SC . Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. JAMA 1999; 281: 335–340.
Annesi JJ, Unruh JL . Relations of exercise, self-appraisal, mood changes and weight loss in obese women: testing propositions based on Baker and Brownell's model. Am J Med Sci 2008; 335: 198–204.
Bacon L, Keim NL, Van Loan MD, Derricote M, Gale B, Kazakz A et al. Evaluating a ‘non-diet’ wellness intervention for improvements of metabolic fitness, psychological well-being and eating and activity behaviors. Int J Obes 2002; 26: 854–865.
Cabioglu MT, Ergene N, Tan U . Electroacupuncture treatment of obesity with psychological symptoms. Int J Neurosci 2007; 117: 579–590.
Carels RA, Darby LA, Caccapaglia HM, Douglass OM . Reducing cardiovascular risk factors in postmenopausal women through a lifestyle change intervention. J Women's Health 2004; 13: 412–426.
Dennis KE, Pane KW, Adams BK, Qi BB . The impact of a shipboard weight control program. Obes Res 1999; 7: 60–67.
Evangelista LS, Doering LV, Lennie T, Moser DK, Hamilton MA, Fonarow GC . Usefulness of a home-based exercise program for overweight and obese patients with advanced heart failure. Am J Cardiol 2006; 97: 886–890.
Faulconbridge LF, Wadden TF, Berkowitz RI, Sarwer DB, Womble LG, Hesson LA et al. Changes in symptoms of depression with weight loss: results of a randomized trial. Obesity 2009; 17: 1009–1016.
Fontaine KR, Barofsky I, Anderson RE, Bartlett SJ, Wiersema L, Cheskin LJ et al. Impact of weight loss on health-related quality of life. Qual Life Res 1999; 8: 275–277.
Galletly C, Moran L, Noakes M, Clifton P, Tomlinson L, Norman R . Psychological benefits of a high-protein, low-carbohydrate diet in obese women with polycystic ovary syndrome—a pilot study. Appetite 2007; 49: 590–593.
Hainer V, Kunesova M, Bellisle F, Hill M, Braunerova R, Wagenknecht M . Psychobehavioral and nutritional predictors of weight loss in obese women treated with sibutramine. Int J Obes 2005; 29: 208–216.
Halyburton AK, Brinkworth GD, Wilson CJ, Noakes M, Buckley JD, Keogh JB et al. Low- and high-carbohydrate weight loss diets have similar effects on mood but not cognitive performance. Am J Clin Nutr 2007; 86: 580–587.
Kerr J, Patrick K, Norman G, Stein MB, Calfas K, Zabinski M et al. Randomized controlled trial of a behavioral intervention for overweight women: impact on depressive symptoms. Depress Anxiety 2008; 25: 555–558.
Kiortsis DN, Tsouli S, Filippatos TD, Konitsiotis S, Elisaf MS . Effects of sibutramine and orlistat on mood in obese and overweight subjects: a randomised study. Nutr Metab Cardiovasc Dis 2008; 18: 207–210.
Klem ML, Wing RR, Simkin-Silverman L, Kuller LH . The psychological consequences of weight gain prevention in healthy, premenopausal women. Int J Eat Disord 1997; 21: 167–174.
Melanson KJ, Dell’Olio J, Carpenter MR, Angelopoulous TJ . Changes in multiple health outcomes at 12 and 34 weeks resulting from 12 weeks of exercise counseling with or without dietary counseling in obese adults. Nutrition 2004; 20: 849–856.
Nieman DC, Custer WF, Butterworth DE, Utter AC, Henson DA . Psychological response to exercise training and/or energy restriction in obese women. J Psychosom Res 2000; 48: 23–29.
Pi-Sunyer XF, Aronne LJ, Heshmati HM, Devin J, Rosenstock J . Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients RIO-North America: a randomized controlled Trial. JAMA 2006; 295: 761–775.
Rapoport L, Clark M, Wardle J . Evaluation of a modified cognitive-behavioural programme for weight management. Int J Obes Relat Metab Disord 2000; 24: 1726–1737.
Sarsan A, Ardic F, Ozgen M, Topuz O, Sermez Y . The effects of aerobic and resistance exercises in obese women. Clin Rehabil 2006; 20: 773–782.
Sbrocco T, Nedegaard RC, Stone JM, Lewis EL . Behavioral choice treatment promotes continuing weight loss: preliminary results of a cognitive-behavioral decision-based treatment for obesity. J Consul Clin Psychol 1999; 67: 260–266.
Scheen AJ, Finer N, Hollander P, Jensen MD, Van Gaal LF . Efficacy and tolerability of rimonabant in overweight or obese patients with type 2 diabetes: a randomised controlled study. Lancet 2006; 368: 1660–1672.
Smith PJ, Blumenthal JA, Babyak MA, Georgiades A, Hinderliter A, Sherwood A . Effects of weight loss on depressive symptoms among men and women with hypertension. J Psychosom Res 2007; 63: 463–469.
Surwit RS, Feinglos MN, McCaskill CC, Clay SL, Babyak MA, Brownlow BS et al. Metabolic and behavioral effects of a high-sucrose diet during weight loss. Am J Clin Nutr 1997; 65: 908–915.
Tanco S, Linden W, Earle T . Well-being and morbid obesity in women: a controlled therapy evaluation. Int J Eat Disord 1998; 23: 325–329.
Van Gaal LF, Scheen AJ, Rissanen AM, Rossner S, Hanotin C, Ziegler O et al. Long-term effect of CB1 blockade with rimonabant on cardiometabloic risk factors: two year results from the RIO-Europe Study. Eur Heart J 2008; 29: 1761–1771.
Vander Wal JS, McBurney MI, Cho S, Dhurandhar NV . Ready-to-eat cereal products as meal replacements for weight loss. Int J Food Sci Nutr 2007; 58: 331–340.
Wadden TA, Mason G, Foster GD, Stunkard AJ, Prange AJ . Effects of a very low calorie diet on weight, thyroid hormones and mood. Int J Obes 1990; 14: 249–258.
Wadden TA, Foster GD, Sarwer DB, Anderson DA, Gladis M, Sanderson RS et al. Dieting and the development of eating disorders in obese women: results of a randomized controlled trial. Am J Clin Nutr 2004; 80: 560–568.
Williamson DA, Martin CK, Anton SD, York-Crowe E, Han H, Redman L et al. Is caloric restriction associated with development of eating-disorder symptoms? Results from the CALERIE trial. Health Psychol 2008; 27 (Suppl 1): S32–S42.
Wing RR, Marcus MD, Blair EH, Burton LR . Psychological responses of obese type II diabetic subjects to very-low-calorie diet. Diabetes Care 1991; 14: 596–599.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J . An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561–571.
Beck AT, Steer RA, Brown GK . Manual for the Beck Depression Inventory-II. Psychological Corporation: San Antonio, TX, 1996.
Radloff LS . The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385–401.
Fazio AF . A Concurrent Validation Study of the NCHS’ General Well-Being Schedule. Vital and Health Statistics, Series 2, No. 73. US Department of Health, Education, and Welfare: Hyattsville, MD, 1977.
Zigmond AS, Snaith RP . The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–370.
Hamilton M . Rating depressive patients. J Clin Psychiatry 1980; 41: 21–24.
Zuckerman M, Lubin B . Manual for the Revised Multiple Affect Adjective Check List. Educational and Industrial Testing Service: San Diego, CA, 1985.
McNair DM, Lorr M, Droppleman LF . Educational and Trial Testing Service Manual: Profile of Mood States. Educational and Industrial Testing Service: San Diego, CA, 1970.
Derogatis LR . The Symptom Checklist-90-Revised. NCS Assessments: Minneapolis, MN, 1992.
Brownell KD . The LEARN Program for Weight Management, 10th edn. American Health Publishing Company: Dallas, TX, 2004.
The Diabetes Prevention Program Research Group. The Diabetes Prevention Program (DPP): Description of Lifestyle Intervention. Diabetes Care 2002; 25: 2165–2171.
Borenstein M, Hedges L, Higgins J, Rothstein H . Comprehensive Meta-Analysis (Version 2.2.023) [Computer software], Biostat: Englewood Cliffs, NJ, 2005.
Cohen J . Statistical Power for the Behavioral Sciences. Lawrence Erlbaum Associates Inc.: Hillsdale, NJ, 1988.
Greer TF, Trivedi MH . Exercise in the treatment of depression. Curr Psychiatry Rep 2009; 11: 466–472.
Blake H, Mo P, Malik S, Thomas S . How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review. Clin Rehabil 2009; 23: 873–887.
Maciejewski ML, Patrick DL, Williamson DF . A structured review of randomized controlled trials of weight loss showed little improvement in health-related quality of life. J Clin Epidemiol 2005; 58: 568–578.
Wardle J, Rogers P, Judd P, Taylor MA, Rapoport L, Green M et al. Randomized trial of the effects of cholesterol-lowering dietary treatment of psychological function. Am J Med 2000; 108: 547–553.
Mazzoni T, Mannucci E, Rizzello SM, Ricca V, Rotella CM . Failure of acupuncture in the treatment of obesity: a pilot study. Eat Weight Disord 1999; 4: 198–202.
Renjilian DA, Perri MG, Nezu AM, McKelvey WF, Shermer RI, Anton SD . Individual versus group therapy for obesity: effects of matching participants to their treatment preferences. J Consult Clin Psychol 2001; 69: 717–721.
Painot D, Jotternad S, Kammer A, Fossatin M, Goaly A . Simultaneous nutritional cognitive-behavioural therapy in obese patients. Patient Educ Couns 2001; 42: 47–52.
Kiernan M, King AC, Stefanick ML, Killen JD . Men gain additional psychological benefits by adding exercise to a weight-loss program. Obes Res 2001; 9: 770–777.
Acknowledgements
This work was supported, in part, by a grant from Merck to Fabricatore and by National Institutes of Health (NIH) grants K23 DK070777 and K24 DK065018 to Fabricatore and Wadden, respectively.
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Fabricatore has served as a consultant for Pfizer, Merck and Ethicon-Endosurgery, and has received research support (including funding for this study) from Merck. Although he is now employed by Nutrisystem, Inc., Fabricatore was employed full-time at the University of Pennsylvania (where he retains an adjunct appointment) at the time the study was completed. Wadden serves on the Advisory Boards of Novo Nordisk and Orexigen and has received research support from Orexigen and Pfizer. Nguyen is employed by Merck and Heymsfield was employed by Merck at the time the work was completed. Faith has served as a consultant to, and has received research support from, Merck. The other authors declare no conflict of interest.
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Fabricatore, A., Wadden, T., Higginbotham, A. et al. Intentional weight loss and changes in symptoms of depression: a systematic review and meta-analysis. Int J Obes 35, 1363–1376 (2011). https://doi.org/10.1038/ijo.2011.2
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DOI: https://doi.org/10.1038/ijo.2011.2
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