Impact of Intensive Lifestyle Intervention on Depression and Health-Related Quality of Life in Type 2 Diabetes: The Look AHEAD Trial

Abstract

OBJECTIVEWe examined the effects of an intensive lifestyle intervention (ILI), compared with a diabetes support and education (DSE) control intervention, on long-term changes in depression symptoms, antidepressant medication (ADM) use, and health-related quality of life (HRQoL) in overweight/obese individuals with type 2 diabetes.RESEARCH DESIGN AND METHODSLook AHEAD was a multisite randomized controlled trial of 5,145 overweight/obese participants assigned to ILI (designed to produce weight loss) or DSE and followed for a median of 9.6 years. The Beck Depression Inventory (BDI) was administered at baseline, annually at years 1–4, and again at year 8. Mean BDI scores and incidence of BDI scores ≥10, indicative of likely mild or greater depression, were examined. Annually through year 10, participants reported their ADM use and completed the Medical Outcomes Study Short Form 36 (SF-36) questionnaire, which yields physical component summary (PCS) and mental component summary (MCS) scores.RESULTSILI significantly reduced the incidence of mild or greater depression symptoms (BDI scores ≥10) compared with DSE (hazard ratio [HR] = 0.85; 95% CI 0.75–0.97; P = 0.0145). Although SF-36 PCS scores worsened over time in both groups, ILI participants reported better physical function than DSE throughout the first 8 years (all P values <0.01). There were no significant differences between treatment arms in the proportion of participants who used ADMs or in SF-36 MCS scores.CONCLUSIONSILI for overweight/obese patients with type 2 diabetes may reduce the risk of developing clinically significant symptoms of depression and preserve physical HRQoL. These findings should be considered when evaluating the potential benefits of ILIs.

Factor structure and clinical utility of the Beck Depression Inventory in patients with binge eating disorder and obesity

“…The BDI-II removed three items and assessing both increases and decreases in sleep and appetite. We note, however, that major studies of obese patient groups, including the landmark LookAhead study [20] continue to use earlier BDI versions. Similar to research with the BDI, emerging studies of the factor structures of the BDI-II have also reported variable findings, but generally support a 3-factor structure consisting of affective, cognitive, and somatic factors [46].…”

“…The two versions perform well psychometrically and generally converge [32, 33]. The BDI (1-A) is the depression measure used in the major Look AHEAD obesity study [20] and across clinical [21] and treatment studies of BED [34–36]. …”

“…The Beck Depression Inventory (BDI; revised in 1987 as the BDI-1A) [18, 19] remains a widely used measure of depressive symptoms and features in the mental health and obesity fields, including the major Look AHEAD study [20]. The BDI was originally designed as a unidimensional measure, but factor analyses with healthy and medical samples have suggested multi-factor structure with great variations in items representing the factors [see 21, for a review].…”

When Mood Worsens after Gastric Bypass Surgery: Characterization of Bariatric Patients with Increases in Depressive Symptoms Following Surgery

“…The BDI, a well-established measure of depressive symptoms in the mental health and obesity fields [19], is used widely in clinical evaluations of bariatric surgery patients [20, 21] and in research studies examining depression before and after obesity treatment [19] and bariatric surgery [11, 22]. The BDI is a psychometrically sound measure with excellent reliability and validity [23, 24].…”

Changes in physical activity among adults with diabetes: a longitudinal cohort study of inactive patients with Type 2 diabetes who become physically active

“…A sedentary lifestyle among patients with Type 2 diabetes increases the risk of diabetes‐related complications, coronary disease and all‐cause mortality 3, 4, 5, 6.Conversely, regular physical activity can improve blood glucose control, blood pressure and quality of life, while lowering harmful cholesterol levels and decreasing cardiovascular events and mortality 7, 8, 9, 10, 11. Given the benefit of regular physical activity among patients with diabetes, the American Diabetes Association and American College of Sports Medicine both recommend at least 150 min per week of moderate‐to‐vigorous physical activity (MVPA), which is defined as reaching ~40–60% of maximum aerobic capacity (equivalent to a brisk walk) 7.…”