Variability in engagement and progress in efficacious integrated collaborative care for primary care patients with obesity and depression: Within-treatment analysis in the RAINBOW trial

Abstract

Introduction The RAINBOW randomized clinical trial validated the efficacy of an integrated collaborative care intervention for obesity and depression in primary care, although the effect was modest. To inform intervention optimization, this study investigated within-treatment variability in participant engagement and progress. Methods Data were collected in 2014-2017 and analyzed post hoc in 2018. Cluster analysis evaluated patterns of change in weekly self-monitored weight from week 6 up to week 52 and depression scores on the Patient Health Questionnaire-9 (PHQ-9) from up to 15 individual sessions during the 12-month intervention. Chi-square tests and ANOVA compared weight loss and depression outcomes objectively measured by blinded assessors to validate differences among categories of treatment engagement and progress defined based on cluster analysis results.

Early changes in neural circuit function engaged by negative emotion and modified by behavioural intervention are associated with depression and problem-solving outcomes: A report from the ENGAGE randomized controlled trial

“…Thus, the questions of whether the findings are specific to this highly vulnerable population, as well as refinements to the precision of our effect size estimates, some of which are smaller might have been anticipated based on prior literature, will require further investigation. In the parent RAINBOW trial, the range of response differed markedly [44] as is also the case for pharmacotherapy trials, indicating that a more stratified, personalized approach focused on subgroups could be of value. In the parent RAINBOW trial, the range of response differed markedly [41] as is also the case for pharmacotherapy trials, indicating that a more stratified, personalized approach focused on subgroups could be of value.…”

Using RE-AIM to examine the potential public health impact of an integrated collaborative care intervention for weight and depression management in primary care: Results from the RAINBOW trial

“…For example, the main outcomes analysis revealed that 73.5% of intervention participants completed at least 7 of the 9 intensive treatment sessions, and 64.7% completed at least 5 of the 6 maintenance sessions [ 6 ]. Further, a priori secondary analyses revealed that (a) lifestyle and cognitive factors did not significantly mediate the main treatment effects as predicted [ 14 ], (b) sex significantly moderated treatment effects for both depression and weight, with males achieving greater reductions in BMI across multiple study time points and females achieving better depression at the 12-month timepoint [ 15 ], and (c) within-treatment analyses showed that poor engagement early in the intervention predicted treatment failure at the end of the intervention [ 16 ]. Future adaptations of I-CARE that increase the tailoring and targeting of intervention components to participants’ stated needs could also increase adherence and potentially enhance lifestyle and cognitive factors that mediate treatment effects by making I-CARE more engaging, thereby increasing effectiveness.…”

Developing weight navigation program to support personalized and effective obesity management in primary care settings: protocol for a quality improvement program with an embedded single-arm pilot study

“…Little is known about the potential weight loss effectiveness of a collaborative care approach to obesity treatment (Ma et al, 2019;Lv et al, 2020). Prior work testing a collaborative care approach for patients with depression and obesity demonstrated modest weight loss at 12 months, though the majority of participants did not achieve clinically significant weight loss (Ma et al, 2019;Pagoto et al, 2013).…”