Treating obese women's depression may help them lose weight, a new study suggests. Although researchers couldn't determine which condition may cause the other, obesity and depression frequently strike together. Obese women who saw their depression lessened in a treatment program also lost more weight than women whose depression didn't improve or worsened, researchers said.
“I expect that the relationship between depression and physical activity goes in both directions,” said study researcher Dr. Gregory Simon, a senior investigator and psychiatrist at Group Health Research Institute in Seattle. “Increased physical activity leads to improvement in depression, and improvement in depression leads to increased physical activity.” “You can't prove which came first.”
The researchers evaluated 203 women, ages 40 to 65, who had an average body mass index of 38.3 at the study's start, and found that obesity increased a woman's risk of depression by 50 percent to 150 percent.
Participants were then split into two groups: one focused only on helping the women lose weight, and the other also treating the women's depression. The researchers held 26 group treatment sessions over 12 months, and checked in on the women six, 12 and 24 months after the study began.
Of those whose depression had loosened its grip — as measured by a small drop on a test called the Hopkins Symptom Checklist depression score — 38 percent had lost at least 5 percent of their body weight. Of those whose depression scores stayed the same or increased, 21 percent lost that much weight.
While the study's purpose wasn't to make recommendations about exercise, Simon said, it's advisable for people suffering from depression to seek more opportunities for physical activity. “There certainly is evidence that exercise alone is an effective treatment for depression, whether you're overweight or obese or not, or even if you're a normal weight,” he said.
The study was unusual because it focused on the sometimes-overlooked link between depression and obesity, without focusing solely on the role of weight loss, said Robert E. Thayer, a psychology professor at California State University in Long Beach who has researched how people regulate their moods with food and exercise.
“These findings suggest that, like other negative moods that motivate eating as a kind of self-medication, depression is no exception,” said Thayer, who was not involved with the study. “It's a useful addition to the scientific literature.”
Simon said future studies could focus on learning which antidepressants — many of which can bring on weight gain as a side effect — contribute most to that situation. “Losing weight can certainly have a positive effect on people's moods,” he said.
The research was published in the November/December issue of the journal General Hospital Psychiatry.
The lead author of the latest research, Joan Sabaté, says the study “confirms that nuts, indeed, lower cholesterol.” A professor and the chairman of the department of nutrition at Loma Linda University, in Loma Linda, Calif., Dr. Sabaté was among the group of researchers that first linked nut consumption to a lower risk of heart attack several years ago.
That finding and others led the Food and Drug Administration in 2003 to allow processors to state on labels that “eating 1.5 ounces per day of most nuts … as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.”
Dr. Sabaté said the research indicated that for the average person, a slightly higher amount of nuts—about 2.4 ounces, or two servings—does a better job than one serving of lowering cholesterol and triglycerides, another type of fat in the blood.
Still, he said, “we do not need many to get the benefit.” One serving of almonds is about eight nuts; a serving of smaller nuts such as peanuts is about 15 to 20 nuts.
Dr. Sabaté's analysis involved nearly 600 people with high or normal blood cholesterol levels. None of the study participants were taking cholesterol-lowering medications.
The analysis compared a control group with two groups assigned to consume two different quantities of nuts.
People in one of the nut groups consumed an average of 67 grams of nuts, or about 2.4 ounces, per day.
These people had an average reduction in total blood cholesterol concentration of 5.1%, and a reduction in low-density lipoprotein, or so-called LDL or “bad” cholesterol, of 7.4%.
For the people who consumed about 1.5 ounces of nuts, total cholesterol fell by 3.2%, while “bad” cholesterol fell by 4.9%—suggesting a dose-related response.
Those who consumed about one ounce daily of nuts, total cholesterol fell by 2.8% while LDL cholesterol fell by 4.2%.
Significantly, however, the drops in cholesterol weren't seen in people considered obese—a new finding.
More studies are needed to understand why nuts are less effective at lowering blood cholesterol concentration among obese people, the researchers said.
Dr. Sabaté said the biggest improvement in blood lipid levels were seen among people who started out with higher cholesterol levels, as well as among those who consumed a “Western” diet of high-fat meats, dairy products and refined grains, compared with people consuming a “Mediterranean” diet emphasizing whole grains, lots of fruits and vegetables, fish and relatively little red meat.
“For the general population consuming a Western diet, the incorporation of nuts into their daily diet will result in greater improvement of blood lipid levels than for individuals already following a healthy Mediterranean or low-fat diet,” researchers wrote.
Of the 25 studies, about two-thirds of them involved almonds or walnuts. The other one-third of studies looked at either macadamia, pistachio, hazelnuts or peanuts. The studies didn't include pine nuts or Brazil nuts.
The study was funded by Loma Linda University in California and by the International Tree Nut Council Nutrition Research and Education Foundation, an international group that represents the tree nut industry.
A referral to Nastaran Habibi should be made when your patient needs more intensive dietary, nutritional and lifestyle behavior education than you can provide in your office environment. Nastaran can help particularly when the patient is in the preparation, action or relapse stages of change.
A consultation generally includes a diet and lifestyle assessment, and nutrition education and counselling. Nastaran will review your patient’s medical and social status, including biochemistry and othe relevant test results, dietary and family history and home environment. In addition she will take anthropometric measurements and collect information on the patient’s individual food preferences and cultural, socio-economic and lifestyle needs. Taking into account the patient’s own goals, knowledge, skills and access to resources, Nastaran will custom design a program for your patient based on the principles of Medical Nutrition Therapy. She integrates self-management training regarding information on nutrient content, food choices, and meal preparation based on each patient’s particular and unique circumstances. Initial appointments are more than 1 hour.
What happens next:
- You will receive a formal report assessing your patient’s nutritional, physical activity and lifestyle status including Nastaran’s recommendations for improvement, possible barriers to success and guidelines for evaluating progress.
- During the 45-90 minute follow-up visits, Nastaran will review your patient’s progress, provide further education, encourage continued adherence to the plan and identify any obstacles to success.
In order for your patient to qualify for a Medicare rebate, referral must be through an Enhanced Care Plan. Referrals outside Medicare will still qualify for a Health Fund rebate.