Participant characteristics associated with changes in mental health in a trial of behavioural weight management programmes: Secondary analysis of the WRAP trial.
Obesity facts 2022
DOI : 10.1159/000522083
PubMed ID : 35417915
On average, aspects of mental health improve following behavioural weight management programmes, yet this is not the case for all participants. It is important to identify those at risk of harm to provide more effective psychological support. We aimed to identify participant characteristics associated with changes in depression and anxiety in participants of a behavioural weight management programme.
In the Weight loss Referrals for Adults in Primary care (WRAP) trial, 1267 adults with BMI≥28 kg/m2 were randomised to brief intervention, or WW (formerly Weight Watchers) for 12-weeks or 52-weeks and followed for five years. We used linear and multinomial regression to explore the association between participant characteristics and changes in depression and anxiety (measured by Hospital Anxiety and Depression Scale). Where possible, the impact of missing data was investigated using multiple imputation.
Higher baseline anxiety was associated with decreases in anxiety symptoms and increases in depression symptoms from baseline to follow-up. Higher baseline depression was associated with decreases in depression symptoms and increases in anxiety symptoms from baseline to follow-up. The magnitude of the associations were small. No further characteristics were consistently associated with changes in mental health.
Evidence suggests that baseline depression and anxiety may indicate how depression and anxiety symptoms change during and after attending WW. Measurement of depression and anxiety at the start of a behavioural weight management programme and subsequent monitoring may facilitate timely psychological support if a deterioration in mental health is identified. Further research in large and diverse participant samples is required to clarify the findings.
What is the aim of this study?
Behavioural weight management programmes may not benefit the mental health of everyone who attends. We wanted to find those whose mental health is likely to get worse during a weight management programme so that we can provide them with additional care and support.
To do this, we studied how people’s characteristics (e.g., age, gender, education, diet and exercise habits) were related to changes in mental health both during and after taking part in the behavioural programme, WW (previously known as Weight Watchers). We also looked at whether attending more or fewer WW sessions influenced how peoples’ mental health changed.
How depressed and anxious a person feels when starting WW is likely a good indicator of how their symptoms of depression and anxiety will change up to 5 years after beginning WW. Specifically, those who feel more depressed and anxious when starting WW may be at a greater risk of their mental health getting worse during and after the programme, compared to those who feel less depressed and anxious at the start.
What was studied?
We used data from the ‘Weight loss Referrals for Adults in Primary care’ (WRAP) trial, which randomly assigned 1267 adults with overweight or obesity to one of three interventions:
(1) WW for 12 weeks, (2) WW for 52 weeks,
or (3) Brief intervention (in the form of self-help materials)
These adults completed questionnaires which measured their symptoms of anxiety and depression at the start of the trial and then at 3 months, 1 year, 2 years, and 5 years after beginning the trial.
We examined how various characteristics were related to change in symptoms of depression and anxiety. The characteristics we looked at were age, sex, BMI (body mass index), education, socioeconomic status, mental health and wellbeing, dietary control, diet and exercise habits, number of WW sessions attended, and use of the WW digital tools (such as the WW app).
What were the main results of the study?
We found that…
• Those with more symptoms of anxiety at the start of the programme were likely to feel less anxious but more depressed during and after the programme.
• Those with more symptoms of depression at the start of the programme were likely to feel less depressed but more anxious during and after the programme.
• Important: Changes in depression and anxiety were small, so it is not clear how meaningful they are.
• How often people attend the programme doesn’t appear to have an impact on changes in depression and anxiety.
Further research should look to understand why these things happen. We need to understand who is at risk of a negative effect on their mental health when joining a behavioural weight management programme so that they can be provided with help and support to reduce the potential for harm to their mental health.