Methodology of a multispecialty outpatient Obesity Treatment Research Program.

Despite the large number of U.S. adults who overweight or obese, few providers have ready access to comprehensive lifestyle interventions, the cornerstone of medical obesity management. Our goal was to establish a research infrastructure embedded in a comprehensive lifestyle intervention treatment for obesity. The Obesity Treatment Research Program (OTRP) is a multi-specialty project at Mayo Clinic in Rochester, Minnesota designed to provide a high intensity, year-long, comprehensive lifestyle obesity treatment. The program includes a nutritional intervention designed to reduce energy intake, a physical activity program and a cognitive behavioral approach to increase the likelihood of long-term adherence. The behavioral intervention template incorporated the Diabetes Prevention Program and the Look AHEAD trial materials. The OTRP is consistent with national recommendations for the management of overweight and obesity in adults, but with embedded features designed to identify patient characteristics that might help predict outcomes, assure long-term follow up and support various research initiatives. Our goal was to develop approaches to understand whether there are patient characteristics that predict treatment outcomes.

Diabetes and obesity not associated with 6-month remission rates for primary care patients with depression.

BACKGROUND: Complex interrelationships appear to exist among depression, diabetes, and obesity, and it has been proposed that both diabetes and obesity have an association with depression. OBJECTIVE: The purpose of our study was to explore the effect of obesity and diabetes on response to the treatment of depression. Our hypothesis was that obesity and the diagnosis of diabetes in primary care patients with depression would have no effects on depression remission rates 6 months after diagnosis. METHODS: A retrospective chart review analysis of 1894 adult (age ≥18y) primary care patients diagnosed with major depressive disorder or dysthymia and a Patient Health Questionnaire-9 score ≥10 from January 1, 2008, through September 30, 2012. Multiple logistic regression modeling retaining all independent variables was performed for the outcome of remission (Patient Health Questionnaire-9 < 5) 6 months after diagnosis. RESULTS: The presence of obesity (odds ratio = 0.937, 95% CI: 0.770-1.140, p = 0.514) or the diagnosis of diabetes (odds ratio = 0.740, 95% CI: 0.535-1.022, p = 0.068) did not affect the likelihood of remission, while controlling for the other independent variables. CONCLUSIONS: In primary care patients treated for depression, the presence of diabetes or obesity at the time of diagnosis of depression does not appear to significantly affect remission of depressive symptoms 6 months after diagnosis.

Patient body mass index does not predict six-month clinical outcome of depression managed under collaborative care.

Obesity and depression are often comorbid conditions. There appears to be a bidirectional relationship between these. Obesity at baseline has been shown to increase the risk of onset of depression and depression at baseline increased the odds for developing obesity. Less is understood about the impact of obesity on depression treatment outcomes. The authors' hypothesis was that obesity (body mass index [BMI] ≥ 30 kg/m²) and morbid obesity (BMI ≥ 40 kg/m²) would each have negative effects on depression remission rates after 6 months of enrollment into collaborative care management for depression. In a retrospective analysis of 1111 depressed patients with a PHQ-9 (Patient Health Questionnaire) score of 10 or greater, multivariate analysis for the odds ratio of achieving remission at 6 months demonstrated that the patient's BMI at baseline was not an independent risk factor for depression outcome at 6 months. Collaborative care management for depression has been shown to be effective for improving depression outcomes, yet minimal prior research has focused on other clinical comorbidities that might affect outcomes. Although obesity was common in the study population, it was reassuring, based on this study that 6-month depression treatment outcomes do not appear to be significantly affected by the patient's baseline BMI.

Patient's weight 6 months after depression treatment is not affected by either clinical remission or enrolment in collaborative care management.

Objective The primary aim of this study was to determine whether enrolment in collaborative care management (CCM) for treatment of major depression would have a significant impact on 6-month changes in weight compared with patients treated by their primary care provider with usual care. The secondary aim was to determine whether clinical remission would also affect 6-month weight changes. Design A retrospective chart review study included 1550 patients who had been diagnosed with major depression or dysthymia and who had a Patient Health Questionnaire (PHQ-9) score of ≥ 10 with follow-up data (PHQ-9 score and weight) at 6 months. Subjects The study sample consisted of adult patients (aged ≥ 18 years) from primary care practices, representing all body mass index (BMI) categories. The exclusion criteria were a diagnosis of bipolar disorder, recent obstetric delivery or recent gastric bypass procedure. Measurements Weight was measured at index and 6 months, with BMI calculated from electronic medical record data. Patient assessment data (including PHQ-9 score and clinical diagnosis) and demographic variables (age, gender, marital status and clinical location) were also collected. Results With regression modelling, neither enrolment in CCM (P = 0.306) nor clinical remission (P = 0.828) was associated with a significant weight gain. Conclusion After 6 months, enrolment in CCM had no significant impact on weight gain or weight loss among patients treated for depression, nor was improvement to clinical remission a factor in the patient's weight after 6 months. Incorporating a weight loss management intervention within the model may be warranted if concomitant weight reduction is desired.