Randomized controlled trial of behavioral treatment for comorbid obesity and depression in women: the Be Active Trial

OBJECTIVE: Depression is associated with increased risk for obesity and worse weight loss treatment outcomes. The purpose of the present study was to test the hypothesis that delivering evidence-based behavior therapy for depression prior to a lifestyle weight loss intervention improves both weight loss and depression. DESIGN: In a randomized controlled trial, obese women with major depressive disorder (N=161, mean age=45.9 [SD: 10.8] years) were randomized to brief behavior therapy for depression treatment followed by a lifestyle intervention (BA) or a lifestyle intervention only (LI). Follow-up occurred at 6- and 12-months. Main outcome measures included weight loss and depression symptoms. RESULTS: Intention-to-treat analyses revealed both conditions lost significant weight, but no differences between conditions in weight change at 6-months (BA= −3.0%, SE= − 0.65%; LI=−3.7%, SE = 0.63%; p = 0.48) or 12-months (BA= −2.6%, SE= 0.77%; LI= −3.1%, SE=0.74%; p= 0.72). However, the BA condition evidenced significantly greater improvement in Beck Depression Inventory-II scores relative to the LI condition at both 6-months (BA mean change= −12.5, SD= 0.85; LI mean change= −9.2, SD=0.80, p= 0.005) and 12-months (BA mean change= −-12.6, SD= 0.97; LI mean change= −9.9, SD= 0.93; p = 0.045). Participants who experienced depression remission by 6-months (61.2%) lost greater weight (mean = −4.31%; SE=0.052) than those who did not (39.7%; mean= −2.47%, SE=0.53; p=.001). CONCLUSION: Adding behavior therapy to a lifestyle intervention results in greater depression remission but does not improve weight loss within one year. Improvement in depression is associated with greater weight loss.