Mutual interactions between depression/quality of life and adherence to a multidisciplinary lifestyle intervention in obesity

Context. There is scarce knowledge of the interaction between depression/health related quality of life (HRQOL) and lifestyle intervention in obesity. Objective. To establish whether baseline mood status or HRQOL affect attendance to educational or exercise sessions and whether attendance to these two components of the intervention affects mood and/or HRQOL in obesity. Design. 282 overweight/obese subjects (BMI 33.4±5.9, 103 males, 179 females, age 53.8±13.0, mean±SD) were consecutively enrolled in a multidisciplinary lifestyle intervention program. During the intensive phase of the intervention (3 months) patients were invited to attend 8 educational sessions and 26 exercise group sessions. Results. Poor adherence to exercise sessions is predicted by baseline depressive mood (p=0.006) and by low levels of HRQOL (domains of Vitality, Physical Role Functioning, Social Functioning, Mental Composite, Physical Composite Scores) (p<0.05). Attendance to the educational sessions is associated with beneficial effects of the lifestyle intervention on depressive symptoms (p<0.013) and on several mental domains of HRQOL (p<0.041); attendance to the exercise sessions predicted the beneficial effects on perceived general health (p<0.021) and BMI (p<0.011). Attendance to both educational and exercise components is associated (p<0.05) with the reductions in waist circumference, fat mass and blood pressure observed after the intensive phase of the intervention. Conclusions. Measurement of depressive mood and HRQOL before lifestyle intervention allows identification of patients at increased risk of attrition with exercise and educational sessions. Both the exercise and the educational sessions are essential for gaining the full spectrum of psychological and clinical benefits from multidisciplinary lifestyle intervention in obesity.