Depression, obesity and eating “wrong” are three very common problems that often go together. Wading into this morass by treating all three at once are two investigations reported in this week’s Journal of the American Medical Association together with editorial comment. (1,2,3) Each of these issues by themselves is difficult to define, measure and treat. So it’s not surprising that they had to admit defeat.
In the first report, called “the MooDFOOD Randomized Clinical Trial,” investigators from Amsterdam, in the Netherlands, tried giving two nutritional treatments to 1,025 overweight or obese adults from four European countries, who also had what they called subsyndromal depression meaning they had some symptoms of depression but not full major depressive disorder. They gave subgroups nutritional supplements (daily omega-3 fatty acids, folic acid, vitamin D and calcium) or behavioral therapy to try to get them to eat “right” and exercise or placebo or combinations of these three things.
They showed no effect on the prevention of major depressive disorder which was the main outcome measured. Nor did these treatment strategies make any other difference in multiple secondary outcomes.
The second project, called “The RAINBOW Randomized Clinical Trial,” was American and a multi-centered collaboration. They determined that “A collaborative care intervention integrating behavioral weight loss treatment and problem-solving therapy with as-needed antidepressant medication led to statistically significant reductions in body mass index and depressive symptoms compared with usual care; however, the effect sizes were modest and of uncertain clinical importance.”
It’s deja vu all over again. And it’s also difficult and expensive in time and money. But the editorial seems to say that we should keep trying this stuff. I think we can add depression to obesity as things we can’t fix with diet and behavioral therapy attempts to get people to diet.
1.Marisca B et al. Effect of multinutrient supplementation and food-related behavioral activation therapy on prevention of major depressive disorder among overweight or obese adults with subsyndromal depressive symptoms. JAMA. 2019;321(9):858-68.
2. Jun M et al. Effect of integrated behavioral weight loss treatment and problem-solving therapy on body mass index and depressive symptoms among patients with obesity and depression. JAMA. 2019;321(9):869-79.
3. Berk M, Jacka F. Diet and depression-from confirmation to implementation JAMA. 2019;321(9):842-3.