Lower depression scores associated with greater weight loss among rural black women in a behavioral weight loss program

Heterogeneity in Health Outcomes in the Strong Hearts, Healthy Communities-2.0 Multilevel Intervention in a Community-Randomized Trial: An Exploratory Study of Moderators

BACKGROUND/OBJECTIVES

Multilevel interventions have demonstrated efficacy in improving obesity and other related health outcomes. However, heterogeneity in individual responses indicates the need to identify the factors associated with responses and non-responses to multilevel interventions. The objective of this report is to identify the potential sources of heterogeneity through the exploration of the moderation effects of participant characteristics (sociodemographic and baseline physical/mental health) in the Strong Hearts, Healthy Communities-2.0 (SHHC-2.0) intervention.

METHODS

SHHC-2.0 is a 24-week multilevel intervention to improve people's diet and physical activity evaluated using a cluster-randomized, controlled trial design conducted with women aged 40 and older living in rural communities with an elevated risk of cardiovascular disease, defined as having a BMI > 30, or a BMI 25-30 plus < 1 weekly occurrence of 30 min of physical activity during leisure time. Linear mixed models were used to compare the between-group changes in the outcomes (weight, systolic blood pressure, hemoglobin A1c [HbA1c], and triglycerides), with an interaction term included for each potential moderator.

RESULTS

Within the sociodemographic characteristics, there were no differences in effectiveness by age, income, or baseline BMI status, but the participants with a high school education or less experienced less weight loss. Among their health history, only a history of hypertension was associated with differential outcomes; those with a history of hypertension demonstrated a greater reduction in systolic blood pressure. The participants with elevated depressive symptoms demonstrated greater weight loss and a greater reduction in the HbA1c level.

CONCLUSIONS

SHHC-2.0 was effective across a wide range of participants. The identified moderators (i.e., education level) may inform the future tailoring of the SHHC intervention to optimize the outcomes among participant subgroups, while more broadly, our findings can serve to inform the development and dissemination of multilevel interventions.

Protocol of the HARMONY study: A culturally relevant, randomized-controlled, stress management intervention to reduce cardiometabolic risk in African American women

BACKGROUND

African American Women (AAW) are at high risk for stress-related cardiometabolic (CM) conditions including obesity, heart disease, and diabetes. Prior interventions lack attention to culturally-nuanced stress phenomena (Superwoman Schema [SWS], contextualized stress, and network stress), which are positively and significantly associated with unhealthy eating and sedentary behavior.

PURPOSE

The HARMONY Study is designed to test a culturally tailored mindfulness-based stress management intervention to address SWS, contextualized stress, and network stress as potential barriers to adherence to healthy exercise and eating goals. The study will help AAW build on their strengths to promote cardiometabolic health by enhancing positive reappraisal, self-regulation, and self-efficacy as protective factors against chronic stress-inducing biobehavioral morbidity and mortality risk.

METHODS

This two-arm, randomized-controlled trial will test the effects of two group-based, online interventions. HARMONY 1 includes culturally-tailored exercise and nutrition education. HARMONY 2 includes mindfulness-based stress reduction, exercise, and nutrition education. We aim to recruit 200 AAW ≥ 18 years old with CM risk.

RESULTS

Primary outcomes (actigraphy and carotenoid levels) and secondary outcomes (body composition, inflammatory markers, glucose metabolism, and stress) are being collected at baseline and 4-, 8-, and 12-months post-intervention. Intent-to-treat, data analytic approaches will be used to test group differences for the primary outcomes.

DISCUSSION

This study is the first to address culturally-nuanced stress phenomena in AAW (SWS, network stress, and contextualized stress) using culturally-tailored stress management, exercise, and nutrition educational approaches to reduce biobehavioral CM risk among AAW. Quantitative and qualitative results will inform the development of scalable and sustainable CM risk-reduction programming for AAW.

TRIAL REGISTRATION

The Multiple PIs registered the clinical trial (Identifier: NCT04705779) and reporting of summary results in ClinicalTrials.gov in accordance with the NIH Policy on the Dissemination of NIH-Funded Clinical Trial Information, within the required timelines.

Depression and Obesity-Do We Know Everything about It? A Narrative Review

INTRODUCTION

Due to similarities in their pathophysiology and common psychological background, depressive disorders and obesity often occur simultaneously. The treatment of obesity can reduce the symptoms of comorbid depression and, conversely, treating depression can improve weight reduction outcomes.

PURPOSE OF THIS STUDY

This review aimed to analyze the available literature on the subject of various methods of treating obesity and comorbid depression and to demonstrate the mutual correlation between the therapy of depressive disorders and the therapy of obesity.

METHOD

The Pubmed and Cochrane databases were searched for original articles on the subject of simultaneous depression and obesity that had been published between 2014 and 2024, using the key words "depression", "depressive symptoms", "obesity", and "behavioral therapy".

RESULTS AND CONCLUSIONS

The successful treatment of depression can help in treating obesity, especially in motivating patients to adjust their lifestyle by changing dietary habits and increasing their physical activity, which contribute to both changes in body mass index scores and reductions in depressive symptoms. Changes in self-perception, reduced daily stress, and dietary changes, as well as increased physical activity, contribute to both weight loss and the reduction of depressive symptoms. Depression and obesity should be treated as one two-dimensional disorder to achieve better long-term treatment results.

Impact of weight loss on sexual and psychological functions and quality of life in females with sexual dysfunction: A forgotten avenue

Objectives

This study aimed to evaluate the impact of weight loss on sexual and psychological health as well as quality of life in females with sexual dysfunction.

Materials and methods

The study was done at Delta University for Science and Technology in Gamasa, Egypt, on 40 obese married females having sexual dysfunction. Their age ranged from 20 to 40 years old, with a mean of 28.98 ± 4.96 years. They followed a weight loss program in the form of diet regimen and physical training for 6 months. Anthropometric measures, Arabic Female Sexual Function Index (FSFI), Arabic version of Hospital Anxiety and Depression Scale (HADS), and Arabic version of Short-Form 36 Health Survey (SF-36) were evaluated prior to starting the study, after 3 and 6 months of the study.

Results

Statistical analysis revealed significant reductions in anthropometric measures, as well as significant improvements in HADS and SF-36 scores after both 3 and 6 months of weight loss intervention compared to the baseline measurements, while there were significant improvements in sexual arousal, lubrication, patient satisfaction as well as the total score of FSFI after 3 months and contrarily there were no statistically significant changes in any of the FSFI's domains or overall score after 6 months of the weight loss program compared to baseline.

Conclusion

Weight loss improves females' anthropometric measures, psychological function and quality of life; however, it has no direct effect on female sexual dysfunction (FSD) after 6 months compared to baseline, so increased awareness of FSD is necessary as this issue suffers from inadequate identification and management.

Psychological and behavioral pathways between perceived stress and weight change in a behavioral weight loss intervention

Black women have a higher prevalence of obesity and tend to have suboptimal outcomes in behavioral weight loss programs for reasons that are not fully understood. Studies have shown a potential relationship between perceived psychological stress and weight loss in behavioral interventions. This study sought to assess whether baseline stress was directly or indirectly associated with 6-month weight change among Black women participating in a behavioral weight loss study. Indirect pathways of interest included depressive symptoms and dietary intake. A secondary analysis of data (n = 409) collected from a cluster, randomized behavioral weight loss trial was conducted. Demographics, anthropometry, surveys, and dietary data were collected at baseline and 6 months. Path analysis was used to test for direct and indirect effects of baseline stress on 6-month weight change while controlling for sociodemographic factors and intervention group. Baseline stress was not directly associated with 6-month weight change nor was it indirectly associated via depressive symptoms in the adjusted model. However, each of the direct paths linking baseline stress to weight loss were statistically significant. Stress was not associated with 6-month weight change via dietary intake. Baseline stress was positively associated with 6-month depressive symptoms which in turn was associated with less weight change. Depressive symptoms may offer an additional psychosocial target to consider when designing behavioral weight loss interventions for Black women.

Associations between social determinants of health, perceived discrimination, and body mass index on symptoms of depression among young African American mothers

PURPOSE

The association between symptoms of depression and risks for cardiovascular disease (CVD) remains equivocal for African American (AA) mothers. We examined the association between social determinants of health (perceived discrimination), and cardiovascular risk (BMI) on symptoms of depression in a sample of young AA mothers.

METHODS

Secondary data from 219 adult AA mothers between the ages of 21 and 46 with an average BMI of 29.8 and yearly family income of $14,999 were analyzed using a latent growth model that evaluated four time points to assess changes in symptoms of depression.

RESULTS

Initial BMI was significantly associated with initial symptoms of depression (b = 0.12, p = .019). Perceived discrimination (unfair treatment) was associated with higher initial symptoms of depression (b = 1.14, p = .017).

CONCLUSION

The findings suggest that elevated BMI and perceived discrimination are associated with higher reported symptoms of depression among young, socioeconomically disadvantaged AA mothers. These results advance the scientific understanding of young AA mothers' risk for symptoms of depression and CVD by elucidating the impact of perceived discrimination and social experiences on mental health. Further studies of SDoH and CVD risk factors and perceived racism and depression are needed to shed light on the long-term mental health impact on AA mothers and their children.

Psychiatric morbidities of female obesity before and after dieting: an Egyptian sample

Background

The rate of occurrence of psychiatric morbidities like anxiety, depression, perceived stress, and the overall quality of life are very high among female patients with obesity; therefore, our study investigates such variables before and after weight loss in female patients on diet restriction; this can help obesity-multidisciplinary teams target these psychiatric correlates to reach a more satisfactory outcome.

Results

Anxiety, depression, and perceived stress scores decreased significantly in parallel to the weight loss reported (p < 0.0001). Except for social functioning, all other domains of quality of life improved significantly after weight loss. Those with higher education level showed significantly lower stress, anxiety, and depression scores before weight loss compared to married and highly educated ones respectively. After weight loss, highly educated participants showed lower perceived stress and depression scores than those with middle education.

Conclusions

Anxiety, depression, and perceived stress factors are significantly decreased after weight reduction with an improved quality of life as well compared to their scores prior.