Depression, Stress and Weight Loss in Individuals with Metabolic Syndrome in SHINE, a DPP Translation Study

OBJECTIVE: To examine the relationships between elevated depression symptoms (EDS) or stress and weight loss in SHINE, a telephonic, primary-care based, translation of the Diabetes Prevention Program. DESIGN AND METHODS: N=257 adults with metabolic syndrome were randomized to individual (IC) or group (CC) phone participation. We assessed weight, depression, anti-depressant use (ADMs), and stress (baseline, 6 months, 1 and 2 years). Univariate analyses used linear and logistic regression, t-tests for continuous variables and exact tests for categorical variables. Stratified analyses assessed modifiers of effects of depression/stress on weight loss. RESULTS: Approximately 35% reported EDS, with no change over time. Approximately 28% of all participants used ADMs. Participants with EDS had lower mean % weight loss and a smaller % who achieved ≥ 5% weight loss. Participants with EDS were less likely to be “completers” (40.1 % vs. 61.5%, p=.002), coached (48.0% vs. 60.7%, p=.049), or log diet/activity (19.4% vs. 42.7%, p<.001), behaviors related to weight loss. Results were similar for high stress. ADM use had no independent effect on weight loss. CONCLUSIONS: Individuals with metabolic syndrome and EDS and/or high stress were less likely to lose significant weight. Pre-intervention depression and stress screening to intervene may improve weight loss.