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 before 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 (s. d.: 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%, s.e. = - 0.65%; LI = - 3.7%, s.e.= - 0.63%; P= 0.48) or 12 months (BA = - 2.6%, s e.= 0.77%; LI = - 3.1%, s.e.= 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, s.d.= 0.85; LI mean change = - 9.2, s.d.- 0.80, P -0.005) and 12 months (BA mean change = - 12.6, s. d. 0.97; LI mean change = - 9.9, s.d. - 0.93; P 0.045). Participants who experienced depression remission by 6 months (61.2%) lost greater weight (mean = 4.31%; s.e. = 0.052) than those who did not (39.7%; mean = 2.47%, s.e. 0.53; P=.001). CONCLUSION: Adding behavior therapy to a lifestyle intervention results in greater depression remission but does not improve weight loss within 1 year. Improvement in depression is associated with greater weight loss.