Long-term impact of a behavioral weight management program on depression and anxiety symptoms: 5-year follow-up of the WRAP trial.
Obesity (Silver Spring, Md.) 2022
DOI : 10.1002/oby.23570
PubMed ID : 36300839
Behavioral weight management programs may support short-term mental health; however, limited evidence reports the long-term impacts. This study investigated the impact of behavioral weight management programs on depression and anxiety symptoms at 5 years from baseline.
The Weight loss Referrals for Adults in Primary care (WRAP) trial randomized 1267 adults with BMI ≥ 28 kg/m to a brief intervention (BI) or commercial behavioral weight management program (WW; formerly Weight Watchers) for 12 or 52 weeks (CP12 and CP52, respectively). Linear regression was used to separately compare 5-year changes in depression and anxiety symptoms (by Hospital Anxiety and Depression Scale) between randomized groups, adjusting for baseline depression/anxiety symptoms, gender, and research center.
A total of 643 (51%) participants attended the 5-year study follow-up visit. There was no evidence of a difference between the randomized groups for 5-year changes in depression (BI: -0.08 ± 3.29; CP12: 0.02 ± 3.01; CP52: -0.09 ± 3.41) or anxiety (BI: 0.16 ± 3.50; CP12: -0.05 ± 3.55; CP52: -0.66 ± 3.59) symptoms.
This study found no evidence that commercial weight management programs differed in 5-year changes in depression and anxiety symptoms, compared with BI. These are average effects; some individuals experienced increases or decreases in symptoms. Future research should investigate who is at most risk of mental health declines and investigate how to support them. Future trials should transparently report long-term mental health outcomes to strengthen understanding.
What is the aim of this study?
Previous research suggests that behavioural weight management programmes may be supportive of some aspects of mental health in the short-term, however there is very limited research assessing the long-term impact of these programmes on mental health. Some researchers suggest that behavioural weight management programmes can lead to negative effects on mental health in the longer-term.
We aimed to understand how attending a commercial behavioural weight management programme (WW, formerly known as Weight Watchers) affects the mental health of adults with overweight and obesity up to 5 years after beginning the programme. Specifically, we compared the impact of three interventions (WW for 12 weeks, WW for 52 weeks and a self-help booklet) on 5-year changes in symptoms of anxiety and depression.
We found no difference in the impact of the three interventions on depression and anxiety symptoms at 5-years. On average, attending a commercial behavioural weight management programme does not appear to have an impact on depression and anxiety symptoms in the longer term.
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,
3) Or brief intervention (in the form of self-help materials).
Adults with overweight or obesity completed measures of anxiety and depression at the start of the trial and at 5 years follow up. We compared changes in symptoms of anxiety and depression over 5 years across the three groups.
What were the main results of the study?
At 5 years after beginning the study, we found:
• There was no difference between study groups (WW for 12 weeks, WW for 52 weeks, or self-help materials) for 5-year changes in anxiety and depression.
• On average, attending the commercial weight management programme did not result in greater positive or negative changes to symptoms of depression or anxiety compared to the self-help materials.
• Attending the programme for 52 weeks did not have a different impact to attending for 12 weeks.
It is important to remember that we were examining the average effect on depression and anxiety. Some people in all groups will have experienced increases in depression and/or anxiety symptoms, and others will have experienced a reduction in symptoms.
Further research should look to understand who benefits from attending weight management programmes and who needs greater support for their mental health. We need to understand how behavioural weight management programmes can best support the mental health of adults with overweight or obesity.