Obesity is a serious and prevalent condition, with grave risks for morbidity and mortality. While the physical consequences of obesity have been well studied, the psychological correlates are less well understood. Theory and research suggest that obesity and depression may be causally linked. We propose a bidirectional theoretical model identifying the behavioral, cognitive, physiological, and social mechanisms that may be responsible for the pathway between obesity and depression, and vice versa. We investigate the research that supports this model, and identify areas of need for future research. In addition, we discuss the clinical implications of this literature, including the need for integrated care in this population.

Depression in patients with diabetes is associated with poorer adherence and worse health outcomes, however treating depression may help improve these outcomes. The present systematic review identified published papers evaluating treatments for depression in patients with diabetes. Seventeen studies that met criteria were identified, indicating that psychosocial interventions, particularly cognitive-behavior therapy, anti-depressant medications, and collaborative care are effective in the treatment of depression in patients with diabetes. Evidence for the efficacy of these interventions in improving glycemic control was mixed. No study targeted adherence to treatment or health behaviors in addition to depression, which may be necessary to maximize improvement in diabetes outcomes such as glycemic control.

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OBJECTIVERapid advances in diabetes genetic epidemiology may lead to a new era of “personalized medicine” based on individual genetic risk assessment. There is minimal experience to guide how best to clinically implement such testing so that results (e.g., “higher” or “lower” relative genetic risk) improve rather than reduce patient motivation for behavior change.RESEARCH DESIGN AND METHODSBetween November 2009 and May 2010, we conducted in-depth interviews with 22 overweight participants at high phenotypic risk for type 2 diabetes to explore perceptions of diabetes genetic risk testing compared with currently available prediction using nongenetic risk factors (e.g., family history, abnormal fasting glucose, obesity). We used hypothetical scenarios to specifically investigate the impact of both “higher” and “lower” relative genetic risk results on participants’ views about diabetes prevention.RESULTSMany participants conferred a unique value on personal genetic risk information relative to nongenetic risk based on the perceived scientific certainty and durability of genetic results. In contrast, other participants considered their genetic risk within the overall context of their other measured risk factors. Reactions to diabetes genetic test results differed by current motivation levels. Whereas most subjects reported that “higher” risk results would motivate behavior change, subjects with lower current motivation often reported that “lower” genetic risk results would further reduce their motivation to engage in diabetes prevention behaviors.CONCLUSIONSTo be effective, future clinical implementation of type 2 diabetes genetic risk testing should be individualized based on each patient’s risk perception and current level of motivation to prevent diabetes.