摘要：Objectives. We evaluated the effect of a weight gain prevention intervention (Shape Program) on depression among socioeconomically disadvantaged overweight and obese Black women. Methods. Between 2009 and 2012, we conducted a randomized trial comparing a 12-month electronic health–based weight gain prevention intervention to usual primary care at 5 central North Carolina community health centers. We assessed depression with the Patient Health Questionnaire (PHQ-8). We analyzed change in depression score from baseline to 12- and 18-month follow-up across groups with mixed models. We used generalized estimating equation models to analyze group differences in the proportion above the clinical threshold for depression (PHQ-8 score ≥ 10). Results. At baseline, 20% of participants reported depression. Twelve-month change in depression scores was larger for intervention participants (mean difference = −1.85; 95% confidence interval = −3.08, −0.61; P = .004). There was a significant reduction in the proportion of intervention participants with depression at 12 months with no change in the usual-care group (11% vs 19%; P = .035). All effects persisted after we controlled for weight change and medication use. We saw similar findings at 18 months. Conclusions. The Shape Program, which includes no mention of mood, improved depression among socioeconomically disadvantaged Black women. Depression is one of the most common and disabling, yet treatable, mental health conditions in the United States. 1,2 Women are twice as likely as men to be affected, 3 and more than 1 in 7 (14.9%) Black women will experience major depression in their lifetime. 4 Observational evidence suggests that, although the prevalence of major depression is lower among Blacks than Whites, its severity is greater for Blacks. 5 This is likely a result of racial disparities in access to depression treatment. 6 Indeed, compared with their White counterparts, Black adults with depression are less likely to receive treatment for depression (39.7% vs 54.0%). 6 Of those who do seek treatment, Blacks are less likely than Whites to receive care that corresponds to clinical practice guidelines. 6,7 These racial disparities are magnified by socioeconomic disadvantage. 8 Depression is 3 times more common for those with incomes below the federal poverty level, compared with those with higher incomes. 9 As a consequence, the challenge remains how to effectively treat socioeconomically disadvantaged Black women with depression. Obesity is also disproportionately prevalent among Black women relative to other racial/ethnic groups. 10 The high burden of obesity among Black women not only indicates a higher prevalence of obesity-related chronic diseases (e.g., diabetes, heart disease), 11 but it may also have an impact on psychosocial outcomes such as depression. 12 As such, interventions focusing on behavioral weight control may present a useful opportunity to address both obesity and depression. Behavioral weight loss interventions typically include frequent contact with a weight loss counselor; self-monitoring of diet, exercise, and weight; and lessons that cover various topics such as problem solving, relapse prevention, and stress management. Indeed, across numerous studies, behavioral weight loss interventions have been shown to promote reductions in depression. 13,14 Such findings are generally believed to be related to weight loss 15 and mediated by improvements in body satisfaction; that is, for many, weight loss might enhance body satisfaction and, thus, improve depression outcomes. 16,17 However, this finding has most frequently been demonstrated in predominantly socioeconomically advantaged White women, who tend to exhibit strong relations between body size and mood. 16,18 In contrast, Black women have greater social acceptance of overweight, less body weight dissatisfaction, and higher body weight ideals compared with White women. 19–22 Thus, it is unclear whether Black women would experience a similar reduction in depression as a result of obesity treatment. Although weight loss is indicated for those with obesity, promoting clinically meaningful weight change among Black women has been a major challenge. 23 Across various studies, Black women achieve less weight loss relative to White women. 24–26 The reason for this racial disparity in weight loss outcomes is unclear, but may be influenced in part by differences in sociocultural norms related to weight, diet, and physical activity. 27 As a result, interventions that focus on preventing weight gain may be a useful alternative treatment approach among overweight and obese Black women. 27 We recently conducted a study titled the Shape Program, a 12-month randomized controlled trial with follow-up at 18 months, evaluating an electronic health weight gain prevention intervention among Black women compared with usual care in the primary care setting. 27 The Shape intervention was found to be effective in staving off weight gain at 12 and 18 months. 28 It is unclear whether a weight gain prevention approach, as was tested in Shape, would be helpful for treating depression among Black women. As such, we sought to examine the potential spillover benefits produced by this “maintain, don’t gain” approach on depression, compared with usual care.
