Treating Co-Morbid Obesity and Major Depressive Disorder

描述（由申请人提供）：在美国，肥胖是一个严重的公共健康威胁，有31%的人口受到影响。在临床和流行病学研究中已经观察到肥胖和抑郁之间的联系，尤其是在女性中。例如，在寻求治疗的肥胖女性中，有25-50%被发现有重度抑郁症（MOD）的病史。肥胖和抑郁已经被独立研究过，所以对于这种主要影响女性的合并症的最佳治疗方法知之甚少。文献和我们的初步数据揭示了肥胖和抑郁之间的共同症状。这两种情况的特征似乎都是不活动、快感缺乏（对日常活动失去兴趣或乐趣）、运动自我效能降低和情绪调节性饮食。这些共同的症状以及抑郁情绪是女性标准减肥治疗结果较差的预测因素。在一项标准减肥治疗的初步研究中，患有合并MOD的肥胖患者的体重减轻效果仅为非抑郁症患者的一半左右。促进患有MOD和肥胖的患者减肥可能需要针对共同症状的量身定制治疗。当肥胖与MOD合并症时，行为激活（BA）治疗抑郁症可能是减肥治疗的一个潜在有用的辅助手段，因为它专门针对两种疾病共同存在的缺乏症、活动水平和情绪调节。在一项可行性研究中，我们开发了一种为期12周的行为激活修正减肥干预，以饮食、生活方式活动和情绪调节为目标。结果支持这种方法的可行性以及对体重和抑郁结果的潜在疗效。然而，我们观察到抑郁症状改善后体重减轻加快。我们的定量和定性数据都表明，抑郁咨询先于减肥咨询的交错方法可能是治疗的最佳顺序。在一项随机临床试验（RCT）中，本研究旨在测试在抑郁肥胖女性中，在体重控制治疗中加入行为激活是否比单独的体重控制治疗更能促进体重减轻。来自马萨诸塞大学纪念医疗保健系统同时符合MOD和肥胖标准的女性（n=174）将被随机分配到两种减肥干预措施中的一种：1)BA修正体重治疗条件（BA）或2)标准体重治疗条件（ST）。将在随机化后6个月、1年和2年评估结果。次要结局包括抑郁、身体活动、热量摄入、社会心理变量（快感缺乏、运动自我效能、去抑制性饮食、生活质量）和心血管危险因素（血压、血脂、c反应蛋白）。

DESCRIPTION (provided by applicant): Obesity is a serious public health threat in the US with 31% of the population affected. Links between obesity and depression have been observed in clinical and epidemiological studies, particularly among women. For example, between 25-50% of treatment-seeking obese women were found to have a history of major depressive disorder (MOD). Obesity and depression have been studied independently, so very little is known about the optimal treatment approach for this comorbidity that largely affects women. The literature and our preliminary data reveal shared symptomatology across obesity and depression. Both conditions appear to be characterized by inactivity, anhedonia (loss of interest or pleasure in daily activities), reduced exercise self-efficacy, and mood-regulatory eating. These shared symptoms along with depressed mood are predictors of worse outcomes in standard weight loss treatments among women. In a preliminary study of a standard weight loss treatment, obese patients with comorbid MOD only achieved about half the weight loss of their nondepressed counterparts. Facilitating weight loss for patients with comorbid MOD and obesity may require a tailored treatment that targets the shared symptomatology. Behavioral activation (BA) for depression may be a potentially useful adjunct to weight loss treatment when obesity is comorbid with MOD because it specifically targets anhedonia, activity levels, and mood regulation, issues common to both conditions. In a feasibility study we developed a 12-week behavioral activation-modified weight loss intervention that targets diet, lifestyle activity, and mood regulation. Results support the feasibility of this approach and potential efficacy on both weight and depression outcomes. However, we observed that weight loss accelerated after depressive symptoms improved. Both our quantitative and qualitative data suggest that a staggered approach where depressive counseling precedes weight loss counseling may the optimal sequencing for treatment. In a randomized clinical trial (RCT), the present study aims to test whether among depressed obese women, adding behavioral activation to weight control treatment facilitates greater weight loss than weight control treatment alone. Women (n=174) from the University of Massachusetts Memorial Health Care system who meet criteria for both MOD and obesity will be randomized to one of two weight loss interventions: 1) BA-modified weight treatment condition (BA) or 2) standard weight treatment condition (ST). Outcomes will be assessed at 6-months, 1- and 2-years after randomization. Secondary outcomes include depression, physical activity, caloric intake, psychosocial variables (anhedonia, exercise self-efficacy, disinhibited eating, quality of life), and cardiovascular risk factors (blood pressure, serum lipids, C-reactive protein).