Effect of Integrated Behavioral Weight Loss Treatment and Problem-Solving Therapy on Body Mass Index and Depressive Symptoms Among Patients With Obesity and Depression The RAINBOW Randomized Clinical Trial
Effect of Integrated Behavioral Weight Loss Treatment and Problem-Solving Therapy on Body Mass Index and Depressive Symptoms Among Patients With Obesity and Depression The RAINBOW Randomized Clinical Trial
复制标题
DOI：
10.1001/jama.2019.0557
复制
发表时间：
2019-03-05
影响因子：
120.7
通讯作者：
Lavori, Philip W.
中科院分区：
文献类型：
--
作者：
Ma, Jun;Rosas, Lisa Goldman;Lavori, Philip W.
重要性肥胖症和抑郁症并存加剧发病率和残疾，但有效的治疗仍然habitu. Objective. To测试的假设，即一个综合的协作护理干预将显着改善肥胖和抑郁症在12个月相比，通常的护理。和参与者旨在改善情绪和体重的研究（RAINBOW）随机临床试验招募了409名体重指数（BMI）≥ 30（亚洲成人≥ 27），9项患者健康问卷（PHQ-9）评分≥ 10。从2014年9月30日至2017年1月12日招募了北方加州卫生系统的初级保健患者;最终12个月随访日期为1月17日，所有参与者被随机分配到干预组（n = 204）或常规护理对照组（n = 205）像往常一样接受私人医生的医疗护理，在诊所接受有关肥胖和抑郁症的常规服务的信息，并接受无线身体活动跟踪器。干预参与者还接受了为期12个月的干预，该干预将基于糖尿病预防计划的行为减肥治疗与抑郁症的问题解决疗法相结合，如果有指征，还将使用抗抑郁药物。（范围，0 [最好]到4 [最差]）。结果在409名随机（平均年龄51.0岁[SD，12.1岁]; 70%为女性;平均BMI为36.7 [SD，6.4];平均PHQ-9评分为13.8 [SD，3.1]; SCL-20平均评分1.5 [SD，0.5]），344例（84.1%）完成了12个月的随访。在12个月时，干预参与者的平均BMI从36.7（SD，6.9）降至35.9（SD，7.1），而常规护理参与者的平均BMI从36.6（SD，5.8）降至36.6（SD，6.0）（组间平均差异，-0.7 [95% CI，-1.1至-0.2]; P = 0.01）。SCL-20平均得分从1.5分下降到1.5分，干预参与者的平均SCL-20评分从1.5（SD，0.5）到1.1（SD，1.0），而常规护理参与者的平均SCL-20评分从1.5（SD，0.6）到1.4（SD，1.3）（组间平均差异，-0.2（95%CI，-0.4至0）; P = 0.01）。有47例不良事件或严重不良事件涉及肌肉骨骼损伤（干预组27例，常规护理组20例）。结论和相关性在患有肥胖和抑郁症的成年人中，整合行为减肥治疗，解决问题治疗，与常规治疗相比，按需抗抑郁药物治疗在12个月时显著改善了体重减轻和抑郁症状;然而，效应量是适度的，临床重要性不确定。
IMPORTANCE Coexisting obesity and depression exacerbate morbidity and disability, but effective treatments remain elusive.OBJECTIVE To test the hypothesis that an integrated collaborative care intervention would significantly improve both obesity and depression at 12 months compared with usual care.DESIGN, SETTING, AND PARTICIPANTS The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized clinical trial enrolled 409 adults with body mass indices (BMIs) of 30 or greater (>= 27 for Asian adults) and 9-item Patient Health Questionnaire (PHQ-9) scores of 10 or greater. Primary care patients at a health system in Northern California were recruited from September 30, 2014, to January 12, 2017; the date of final 12-month follow-up was January 17, 2018.INTERVENTIONS All participants randomly assigned to the intervention (n = 204) or the usual care control group (n = 205) received medical care from their personal physicians as usual, received information on routine services for obesity and depression at their clinic, and received wireless physical activity trackers. Intervention participants also received a 12-month intervention that integrated a Diabetes Prevention Program-based behavioral weight loss treatment with problem-solving therapy for depression and, if indicated, antidepressant medications.MAIN OUTCOMES AND MEASURES The co-primary outcome measures were BMI and 20-item Depression Symptom Checklist (SCL-20) scores (range, 0 [best] to 4 [worst]) at 12 months.RESULTS Among 409 participants randomized (mean age of 51.0 years [SD, 12.1 years]; 70% were women; mean BMI of 36.7 [SD, 6.4]; mean PHQ-9 score of 13.8 [SD, 3.1]; and mean SCL-20 score of 1.5 [SD, 0.5]), 344 (84.1%) completed 12-month follow-up. At 12 months, mean BMI declined from 36.7 (SD, 6.9) to 35.9 (SD, 7.1) among intervention participants compared with a change in mean BMI from 36.6 (SD, 5.8) to 36.6 (SD, 6.0) among usual care participants (between-group mean difference, -0.7 [95% CI, -1.1 to -0.2]; P = .01). Mean SCL-20 score declined from 1.5 (SD, 0.5) to 1.1 (SD, 1.0) at 12 months among intervention participants compared with a change in mean SCL-20 score from 1.5 (SD, 0.6) to 1.4 (SD, 1.3) among usual care participants (between-group mean difference, -0.2 [95% CI, -0.4 to 0]; P = .01). There were 47 adverse events or serious adverse events that involved musculoskeletal injuries (27 in the intervention group and 20 in the usual care group).CONCLUSIONS AND RELEVANCE Among adults with obesity and depression, a collaborative care intervention integrating behavioral weight loss treatment, problem-solving therapy, and as-needed antidepressant medications significantly improved weight loss and depressive symptoms at 12 months compared with usual care; however, the effect sizes were modest and of uncertain clinical importance.