Impact of cognitive-behavioral interventions on weight loss and psychological outcomes: A meta-analysis.

OBJECTIVES: To examine the effects of cognitive-behavioral therapy weight loss (CBTWL) interventions on weight loss, psychological outcomes (eating behaviors [cognitive restraint, emotional/binge eating], and depressive/anxiety symptoms) in adults with overweight or obesity. METHODS: To be included, studies had to (a) be randomized controlled clinical trials of a CBTWL intervention versus a comparison intervention; (b) include weight loss and psychological outcomes; and (c) include patients who were at least overweight to obese. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (Moher, Liberati, Tetzlaff, & Altman & the PRISMA Group, 2009). RESULTS: Twelve studies (6,805 participants) were included. The average weight loss difference between arms was -1.70 kg (95% confidence interval [CI]: -2.52 to -0.86, I2 = 1%) in favor of CBTWL. The standardized mean difference on cognitive restraint was 0.72 (95% CI: 0.33 to 1.09; I2 = 81%) and -0.32 (95% CI: -0.49 to -0.16; I2 = 0%) for emotional eating in favor of CBTWL. The reduction in depressive symptoms was not statistically different between the groups (-0.10 [95% CI: 0.21 to 0.02], I2 = 36%). Meta-analyses were not possible for anxiety and binge eating. CONCLUSIONS: In addition to weight loss, current evidence suggests that CBTWL is an efficacious therapy for increasing cognitive restraint and reducing emotional eating. However, CBTWL does not seem to be superior to other interventions for decreasing depressive symptoms. Future studies should focus on understanding how psychological factors impact weight loss and management. (PsycINFO Database Record

Mediator effect of depressive symptoms on the association between BMI and asthma control in adults.

BACKGROUND: Obesity has been associated with worse asthma control. Depression has also been shown to be disproportionally prevalent among patients with asthma and among patients with obesity. However, no studies have examined the mediating effect of depression on the obesity-asthma relationship. This study examined the extent to which depressive symptoms may mediate the obesity-asthma relationship in an adult sample. METHODS: A total of 798 patients with physician-diagnosed asthma were recruited from the outpatient asthma clinic at Hôpital du Sacré-Cœur de Montréal. Patients provided demographic and medical history information and completed a battery of questionnaires, including the Beck Depression Inventory (BDI)-II and the Asthma Control Questionnaire (ACQ). BMI was calculated from self-reported height and weight. RESULTS: Analyses adjusted for age, sex, years of education, cohabitation, and inhaled corticosteroid dose revealed an association between BMI and ACQ (ß = 0.017, P = .026), between BMI and BDI-II (ß = 0.189, P = .002), and between BDI-II and ACQ (ß = 0.044, P < .001). However, when both BDI-II and BMI were entered into the same model, BDI-II (ß = 0.044, P < .001) but not BMI (ß = 0.009, P = .226) remained significantly associated with ACQ. CONCLUSIONS: The results indicate that depression and a high BMI are both associated with worse asthma control. However, consistent with our hypotheses, the relationship between BMI and worse asthma control was mediated by depressive symptoms. Future studies should examine the precise role of depressive symptoms in both weight and asthma control.

The impact of body mass index on inpatient- versus outpatient-treated chronic obstructive pulmonary disease exacerbations.

BACKGROUND: Increased body weight has been associated with worse prognoses for many chronic diseases; however, this relationship is less clear in patients with chronic obstructive pulmonary disease (COPD), with underweight patients experiencing higher morbidity than normal or overweight patients. OBJECTIVE: To assess the impact of body mass index (BMI) on the risk for COPD exacerbations. METHODS: The present study included 115 patients with stable COPD (53% women; mean [± SD] age 67±8 years). Height and weight were measured to calculate BMI. Patients were followed for a mean of 1.8±0.8 years to assess the prospective risk of inpatient-treated exacerbations and outpatient-treated exacerbations, all of which were verified by chart review. RESULTS: Cox regression models revealed that underweight patients were at greater risk for inhospital-treated exacerbations (RR 2.93 [95% CI 1.27 to 6.76) relative to normal weight patients. However, overweight (RR 0.59 [95% CI 0.33 to 1.57) and obese (RR 0.99 [95% CI 0.53 to 1.86]) patients did not differ from normal weight patients. All analyses were adjusted for age, sex, length of diagnosis, smoking pack-years, forced expiratory volume in 1 s, and time between recruitment and last exacerbation. BMI did not influence the risk of out-of-hospital exacerbations. CONCLULSIONS: The present study showed that underweight patients were at greater risk for inhospital exacerbations. However, BMI did not appear to be a risk factor for out-of-hospital exacerbations. This suggests that the BMI-exacerbation link may differ according to the nature of the exacerbation, the mechanisms for which are not yet known.

Effect of body mass index on self-reported exercise-triggered asthma.

INTRODUCTION: Exercise-induced asthma (EIA) is common in individuals diagnosed with asthma, with 80% to 90% experiencing asthma symptoms during moderate exercise. Asthma has been linked to obesity such that obesity may be a risk factor for adult-onset asthma. Adults with asthma disclose comorbid obesity as one of the most common barriers to exercise. Physical inactivity has been linked to increases in body mass index (BMI). Few studies have explicitly examined the relationship between BMI and reporting exercise as an asthma trigger. It was hypothesized that individuals with asthma who have an increased BMI will also have increased reports of exercise as an asthma trigger. METHODS: In total, 673 adult outpatients with asthma at Hôpital du Sacré-Cœur de Montréal in Montréal, Quebec, Canada underwent a brief sociodemographic and medical history interview. Patients provided information on their height, weight (used to calculate BMI), and triggers that generally provoked an asthma exacerbation (though it should be noted that a formal EIA test was not performed). RESULTS: When individuals were classified as normal, overweight, or obese, logistic regression analysis revealed that those who were overweight had a 95% increase in the likelihood of reporting exercise-triggered asthma (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.30-2.94) compared with those of normal weight, and this likelihood was more than doubled if the individuals were obese (OR, 2.34; 95% CI, 1.44-3.82). Assessing BMI as a continuous variable revealed that every 1-point increase in BMI was associated with a 9% increase in patients reporting exercise as a trigger (OR, 1.09; 95% CI, 1.04-1.14). All analyses were conducted adjusting for age, sex, asthma severity, and asthma control. CONCLUSION: Results suggest that BMI influences the likelihood of reporting exercise as an asthma trigger, such that individuals with higher BMIs report exercise as an asthma trigger more often than those with a lower BMI. Given that the current study is cross-sectional, further prospective research is needed to define the causal pathway of this relationship.