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.