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Cited by 133Obesity and Health PracticesObesity, Physical Activity, DietEating Disorders and Behaviors

Effect of Integrated Behavioral Weight Loss Treatment and Problem-Solving Therapy on Body Mass Index and Depressive Symptoms Among Patients With Obesity and Depression: The RAINBOW Randomized Clinical Trial

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Ma, Jun, Rosas, Lisa Goldman, Lv, Nan, Xiao, Lan, Snowden, Mark B., Venditti, Elizabeth M., Lewis, Megan A., Goldhaber-Fiebert, Jeremy D. +1 more·2019·JAMA
DOI 10.1001/jama.2019.0557PMC PMC6439596
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Abstract

Importance: Coexisting obesity and depression exacerbate morbidity and disability, but effective treatments remain elusive. Objective: To test the hypothesis that an integrated collaborative care intervention would significantly improve both obesity and depression at 12 months compared with usual care. Design, Setting, and Participants: The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized clinical trial enrolled 409 adults with body mass indices (BMIs) of 30 or greater (≥27 for Asian adults) and 9-item Patient Health Questionnaire (PHQ-9) scores of 10 or greater. Primary care patients at a health system in Northern California were recruited from September 30, 2014, to January 12, 2017; the date of final 12-month follow-up was January 17, 2018. Interventions: All participants randomly assigned to the intervention (n = 204) or the usual care control group (n = 205) received medical care from their personal physicians as usual, received information on routine services for obesity and depression at their clinic, and received wireless physical activity trackers. Intervention participants also received a 12-month intervention that integrated a Diabetes Prevention Program-based behavioral weight loss treatment with problem-solving therapy for depression and, if indicated, antidepressant medications. Main Outcomes and Measures: The co-primary outcome measures were BMI and 20-item Depression Symptom Checklist (SCL-20) scores (range, 0 [best] to 4 [worst]) at 12 months. Results: Among 409 participants randomized (mean age of 51.0 years [SD, 12.1 years]; 70% were women; mean BMI of 36.7 [SD, 6.4]; mean PHQ-9 score of 13.8 [SD, 3.1]; and mean SCL-20 score of 1.5 [SD, 0.5]), 344 (84.1%) completed 12-month follow-up. At 12 months, mean BMI declined from 36.7 (SD, 6.9) to 35.9 (SD, 7.1) among intervention participants compared with a change in mean BMI from 36.6 (SD, 5.8) to 36.6 (SD, 6.0) among usual care participants (between-group mean difference, -0.7 [95% CI, -1.1 to -0.2]; P = .01). Mean SCL-20 score declined from 1.5 (SD, 0.5) to 1.1 (SD, 1.0) at 12 months among intervention participants compared with a change in mean SCL-20 score from 1.5 (SD, 0.6) to 1.4 (SD, 1.3) among usual care participants (between-group mean difference, -0.2 [95% CI, -0.4 to 0]; P = .01). There were 47 adverse events or serious adverse events that involved musculoskeletal injuries (27 in the intervention group and 20 in the usual care group). Conclusions and Relevance: Among adults with obesity and depression, a collaborative care intervention integrating behavioral weight loss treatment, problem-solving therapy, and as-needed antidepressant medications significantly improved weight loss and depressive symptoms at 12 months compared with usual care; however, the effect sizes were modest and of uncertain clinical importance. Trial Registration: ClinicalTrials.gov Identifier: NCT02246413.

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  • Electronic lifestyle programs targeting physical and mental health simultaneously provide success in weight and depression symptom reduction.

    “These programs also provide success in weight and depression symptom reduction.”

    From Efficacy of eHealth interventions to reduce depression symptoms in individuals with obesity: a systematic review of randomized controlled trials (2024) · cites this paper as [38]

    The Primary Outcomes section reports significantly greater reductions in BMI and depressive symptom scores at 12 months than with usual care. The Intervention section describes videos and optional online access, but the treatment also involved a health coach, problem-solving therapy, and potentially antidepressant medication. The results therefore support the reductions, not the characterization of an electronic lifestyle program alone as producing them. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Consideration of dietary factors within mental healthcare may help improve physical health outcomes, given the higher rates of cardiometabolic diseases observed in people with mental illness.

    “Nonetheless, even aside from psychological effects, consideration of dietary factors within mental healthcare may help improve physical health outcomes, given the higher rates of cardiometabolic diseases observed in people with mental illness.33”

    From Food and mood: How do diet and nutrition affect mental wellbeing? (2020) · cites this paper as [33]

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Research works printed but not linked: 12

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  9. LeBlanc ES, Patnode CD, Webber EM, et al. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults. JAMA. 2018;320(11):1172-1191.
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  12. Tice JA, Chapman RS, Seidner M, Ollendorf DA, Weissberg J, Pearson SD. Diabetes Prevention Programs: effectiveness and value: final evidence report and meeting summary. https://icer-review. org/wp-content/uploads/2016/07/CTAF_DPP_Final_ Evidence_Report_072516.pdf. Accessed July 29, 2018.

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Authors
Ma, J., Rosas, L. G., Lv, N., Xiao, L., Snowden, M. B., Venditti, E. M., Lewis, M. A., Goldhaber-Fiebert, J. D., & Lavori, P. W.
Affiliations
  • University of Illinois Chicago (US)
  • Stanford University (US)
  • University of Washington (US)
  • University of Pittsburgh (US)
  • RTI International (US)
  • Department of Medicine, Stanford University, Palo Alto, California
Corresponding author
Ma, Jun
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2019-03-05
Volume
321
Issue
9
Pages
869
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2019.0557
PMC
PMC6439596
OpenAlex
W2919588399
Cited by
133
References
35
Citations by year
2026: 4 · 2025: 17 · 2024: 21 · 2023: 17 · 2022: 19 · 2021: 26 · 2020: 20 · 2019: 9
FWCI
34.31
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Heart, Lung, and Blood Institute (R01HL119453)
Topics
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Keywords
obesity, depression, behavioral weight loss, problem-solving therapy, collaborative care, integrated care, body mass index, depressive symptoms, wearable activity trackers, antidepressants, primary care, RAINBOW trial, Diabetes Prevention Program, weight loss maintenance, relapse prevention, relapse prevention training
MeSH terms
Adult, Analysis of Variance, Antidepressive Agents, Behavior Therapy, Combined Modality Therapy, Depression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Obesity, Problem Solving, Weight Loss, Body Mass Index, Single-Blind Method, Actigraphy

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