Depression, stress, and weight loss in individuals with metabolic syndrome in SHINE, a DPP translation study

Paula M Trief, Donald Cibula, Linda M Delahanty, Ruth S Weinstock, Paula M Trief, Donald Cibula, Linda M Delahanty, Ruth S Weinstock

Abstract

Objective: To examine the relationships between elevated depression symptoms (EDS) or stress and weight loss in SHINE, a telephonic, primary-care based, translation of the Diabetes Prevention Program.

Methods: N = 257 adults with metabolic syndrome were randomized to individual (IC) or group (CC) phone participation. Weight, depression, anti-depressant use (ADMs), and stress (baseline, 6 months, 1 and 2 years) were assessed. Univariate analyses used linear and logistic regression, t tests for continuous variables and exact tests for categorical variables. Stratified analyses assessed modifiers of effects of depression/stress on weight loss.

Results: Approximately 35% reported EDS, with no change over time. Approximately 28% of all participants used ADMs. Participants with EDS had lower mean % weight loss and a smaller % who achieved ≥5% weight loss. Participants with EDS were less likely to be "completers" (40.1% vs. 61.5%, P = 0.002), coached (48.0% vs. 60.7%, P = 0.049), or log diet/activity (19.4% vs. 42.7%, P < 0.001), behaviors related to weight loss. Results were similar for high stress. ADM use had no independent effect on weight loss.

Conclusions: Individuals with metabolic syndrome and EDS and/or high stress were less likely to lose significant weight. Pre-intervention depression and stress screening to intervene may improve weight loss.

Trial registration: ClinicalTrials.gov NCT00749606.

© 2014 The Obesity Society.

Figures

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Percent of subjects achieving 5% weight loss stratified by CES-D category who were “completers” (completed ≥ 9 educator sessions) vs. not completers, years 1 and 2. *** P

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Percent of subjects achieving ≥…

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Percent of subjects achieving ≥ 5% weight loss stratified by CES-D category who…

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Percent of subjects achieving ≥ 5% weight loss stratified by CES-D category who were “coached” (completed ≥ 3 coaching sessions) vs. not coached, years 1 and 2. *P

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Percent of subjects achieving ≥…

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Percent of subjects achieving ≥ 5% weight loss stratified by CES-D category who…

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Percent of subjects achieving ≥ 5% weight loss stratified by CES-D category who logged more (logged diet/activity ≥ 17 weeks) vs. logged less, years 1 and 2. ** P

Figure 4

Percent of subjects achieving ≥…

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Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

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Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who were “completers” (completion of ≥ 9 educator sessions) vs. not completers, years 1 and 2. ** P

Figure 5

Percent of subjects achieving ≥…

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Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 5
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who were “coached” (completed ≥ 3 coaching sessions) vs. not coached, years 1 and 2. *P

Figure 6

Percent of subjects achieving ≥…

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Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 6
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who logged more (logged diet/activity ≥ 17 weeks) vs. logged less, years 1 and 2. ** P
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Cited by
References
    1. Mozumdar A, Liguori G. Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999–2006. Diabetes Care. 2011 Jan;34(1):216–219. - PMC - PubMed
    1. Knowler WC, Fowler SE, Hamman RF Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss. Lancet. 2009;374:1677–1686. - PMC - PubMed
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393–403. - PMC - PubMed
    1. Ali MK, Echouffo-Tcheugui J, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the diabetes prevention program? Health Aff (Millwood) 2012 Jan;31(1):67–75. - PubMed
    1. Boltri JM, Davis-Smith M, Okosun IS, Seale JP, Foster B. Translation of the national institutes of health diabetes prevention program in african american churches. J Natl Med Assoc. 2011 Mar;103(3):194–202. - PubMed
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Figure 2
Figure 2
Percent of subjects achieving ≥ 5% weight loss stratified by CES-D category who were “coached” (completed ≥ 3 coaching sessions) vs. not coached, years 1 and 2. *P

Figure 3

Percent of subjects achieving ≥…

Figure 3

Percent of subjects achieving ≥ 5% weight loss stratified by CES-D category who…

Figure 3
Percent of subjects achieving ≥ 5% weight loss stratified by CES-D category who logged more (logged diet/activity ≥ 17 weeks) vs. logged less, years 1 and 2. ** P

Figure 4

Percent of subjects achieving ≥…

Figure 4

Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 4
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who were “completers” (completion of ≥ 9 educator sessions) vs. not completers, years 1 and 2. ** P

Figure 5

Percent of subjects achieving ≥…

Figure 5

Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 5
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who were “coached” (completed ≥ 3 coaching sessions) vs. not coached, years 1 and 2. *P

Figure 6

Percent of subjects achieving ≥…

Figure 6

Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 6
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who logged more (logged diet/activity ≥ 17 weeks) vs. logged less, years 1 and 2. ** P
Similar articles
Cited by
References
    1. Mozumdar A, Liguori G. Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999–2006. Diabetes Care. 2011 Jan;34(1):216–219. - PMC - PubMed
    1. Knowler WC, Fowler SE, Hamman RF Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss. Lancet. 2009;374:1677–1686. - PMC - PubMed
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393–403. - PMC - PubMed
    1. Ali MK, Echouffo-Tcheugui J, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the diabetes prevention program? Health Aff (Millwood) 2012 Jan;31(1):67–75. - PubMed
    1. Boltri JM, Davis-Smith M, Okosun IS, Seale JP, Foster B. Translation of the national institutes of health diabetes prevention program in african american churches. J Natl Med Assoc. 2011 Mar;103(3):194–202. - PubMed
Show all 25 references
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Figure 3
Figure 3
Percent of subjects achieving ≥ 5% weight loss stratified by CES-D category who logged more (logged diet/activity ≥ 17 weeks) vs. logged less, years 1 and 2. ** P

Figure 4

Percent of subjects achieving ≥…

Figure 4

Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 4
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who were “completers” (completion of ≥ 9 educator sessions) vs. not completers, years 1 and 2. ** P

Figure 5

Percent of subjects achieving ≥…

Figure 5

Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 5
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who were “coached” (completed ≥ 3 coaching sessions) vs. not coached, years 1 and 2. *P

Figure 6

Percent of subjects achieving ≥…

Figure 6

Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 6
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who logged more (logged diet/activity ≥ 17 weeks) vs. logged less, years 1 and 2. ** P
Similar articles
Cited by
References
    1. Mozumdar A, Liguori G. Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999–2006. Diabetes Care. 2011 Jan;34(1):216–219. - PMC - PubMed
    1. Knowler WC, Fowler SE, Hamman RF Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss. Lancet. 2009;374:1677–1686. - PMC - PubMed
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393–403. - PMC - PubMed
    1. Ali MK, Echouffo-Tcheugui J, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the diabetes prevention program? Health Aff (Millwood) 2012 Jan;31(1):67–75. - PubMed
    1. Boltri JM, Davis-Smith M, Okosun IS, Seale JP, Foster B. Translation of the national institutes of health diabetes prevention program in african american churches. J Natl Med Assoc. 2011 Mar;103(3):194–202. - PubMed
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Figure 4
Figure 4
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who were “completers” (completion of ≥ 9 educator sessions) vs. not completers, years 1 and 2. ** P

Figure 5

Percent of subjects achieving ≥…

Figure 5

Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 5
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who were “coached” (completed ≥ 3 coaching sessions) vs. not coached, years 1 and 2. *P

Figure 6

Percent of subjects achieving ≥…

Figure 6

Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 6
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who logged more (logged diet/activity ≥ 17 weeks) vs. logged less, years 1 and 2. ** P
Similar articles
Cited by
References
    1. Mozumdar A, Liguori G. Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999–2006. Diabetes Care. 2011 Jan;34(1):216–219. - PMC - PubMed
    1. Knowler WC, Fowler SE, Hamman RF Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss. Lancet. 2009;374:1677–1686. - PMC - PubMed
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393–403. - PMC - PubMed
    1. Ali MK, Echouffo-Tcheugui J, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the diabetes prevention program? Health Aff (Millwood) 2012 Jan;31(1):67–75. - PubMed
    1. Boltri JM, Davis-Smith M, Okosun IS, Seale JP, Foster B. Translation of the national institutes of health diabetes prevention program in african american churches. J Natl Med Assoc. 2011 Mar;103(3):194–202. - PubMed
Show all 25 references
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Figure 5
Figure 5
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who were “coached” (completed ≥ 3 coaching sessions) vs. not coached, years 1 and 2. *P

Figure 6

Percent of subjects achieving ≥…

Figure 6

Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who…

Figure 6
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who logged more (logged diet/activity ≥ 17 weeks) vs. logged less, years 1 and 2. ** P
Similar articles
Cited by
References
    1. Mozumdar A, Liguori G. Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999–2006. Diabetes Care. 2011 Jan;34(1):216–219. - PMC - PubMed
    1. Knowler WC, Fowler SE, Hamman RF Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss. Lancet. 2009;374:1677–1686. - PMC - PubMed
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393–403. - PMC - PubMed
    1. Ali MK, Echouffo-Tcheugui J, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the diabetes prevention program? Health Aff (Millwood) 2012 Jan;31(1):67–75. - PubMed
    1. Boltri JM, Davis-Smith M, Okosun IS, Seale JP, Foster B. Translation of the national institutes of health diabetes prevention program in african american churches. J Natl Med Assoc. 2011 Mar;103(3):194–202. - PubMed
Show all 25 references
Publication types
MeSH terms
Associated data
Related information
Full text links [x]
[x]
Cite
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Format: AMA APA MLA NLM
Figure 6
Figure 6
Percent of subjects achieving ≥ 5% weight loss stratified by PSS category who logged more (logged diet/activity ≥ 17 weeks) vs. logged less, years 1 and 2. ** P

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