Weight Gain During Mental Health Treatment May Negatively Impact Hopefulness, Medication Attitudes, and Depression

woman standing on scale
woman standing on scale
Researchers conducted a study to investigate the bidirectional nature of the relationship between obesity and depression.

The following article is a part of conference coverage from Psych Congress 2020 Virtual Experience, held virtually from September 10 to 13, 2020. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the Psych Congress 2020.


Patients receiving a holistic mental health intervention in a residential or outpatient rehabilitation facility experienced greater hope about their future, improved attitudes toward taking psychiatric medication, and reduced depression symptoms if they lost weight during treatment compared with patients who gained weight during therapy, according to study results presented at Psych Congress 2020, held virtually from September 10 to 13, 2020.

The study included 305 patients who were treated at a private residential and outpatient adult rehabilitation program. Patients were treated for major depression (49.5%), bipolar disorder (19.0%), anxiety (12.1%), schizophrenia (10.5%), and “other” diagnoses (8.9%). Treatment included evidence-based practices — such as pharmacologic interventions, psychotherapy, and social/vocational training — and a “Healthy Challenge” intervention comprising physical fitness (supervised by a physical trainer), psycho-education, and a low-carbohydrate/high-lean-protein nutrition plan.

Researchers obtained pre- and post-treatment data on patients’ hopes for the future, as assessed using the Beck Hopelessness Scale (BHS); medication attitudes, as assessed with the Medication Attitude Inventory (MAI); and functional gains, as assessed with the Behavior and Symptom Identification Scale (BASIS-32). The Montgomery-Asberg Depression Rating Scale (MADRS) was also used to monitor symptoms of depression among patients.

A total of 216 patients with paired measurements were included in the final analysis. Overall, patients experienced a significant increase in body mass index (BMI) during and after treatment (mean, 1.52). The rate of BMI increase was higher for men than it was for women. When stratified by diagnoses, patients with bipolar depression had the largest mean increase in BMI (mean, 1.86).

Patients who experienced reductions in BMI had an approximately 25% greater increase in hopefulness compared with patients who experienced an increase in BMI (mean BHS, 4.86 vs 3.59, respectively). Decreases in BMI also correlated with a 30% improvement in attitudes toward taking medications compared with increases in BMI (mean MAI, 3.12 vs 2.19, respectively). Weight loss was associated with a 25% greater reduction in symptoms of depression compared with weight gait (mean MADRS, 13.97 vs 10.44, respectively).

Limitations of this study were the single-center design, as well as the inclusion of only adult patients.

“These results validate the importance of prioritizing holistic lifestyle medicine interventions, and psychiatric treatments in patients with depression,” concluded study author and presenter, Raymond Kotwicki, MD.

Disclosure: This study was conducted at Skyland Trail, a private, non-profit psychiatric rehabilitation facility.

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Kotwicki R, Balzer A, Harvey P, et al. The clinical implications of weight gain on depression and anxiety in mental health treatment. Presented at: Psych Congress 2020 Virtual Experience; September 10-13, 2020. Poster 203.