An evaluation of the occurrence and fluctuation of depression in obese patients in two types of weight reduction programmes
Abstract
This study investigated the occurrence and fluctuation of depression in obese patients in two types of weight reduction programmes at VAALMED, Vanderbijlpark. It was hypothesized that there would be a difference between the results yielded by the different depression inventories used; that depression would occur over time; that the level of depression which occurred, would differ in the different treatment programmes; that there would be a fluctuation in the level of depression which occurred over time and that there would be a difference in the depression which occurred and the outcome to treatment (weight-loss) in the different treatment programmes. In order to evaluate the hypotheses, patients who were referred to the obesity clinic at VAALMED, Vanderbijlpark, by their general practitioners were medically evaluated for contra-indications for the treatment of obesity. The patients were then randomly assigned from stratified blocks (based on percentage overweight and sex) to one of the two treatment programmes, which comprised a) both a standard behaviour therapy and a very low-calorie diet and b) a cognitive behaviour therapy, plus a very low-calorie diet. All patients attended weekly treatment sessions of 90 minutes which were conducted by two clinical psychologists and a medical practitioner. Pre-therapy measurements of depression were conducted on both experimental groups on a bi-weekly basis during the three months programme. Followup measurements were conducted for the next four months. The measuring instruments used, were self rating scales of depression i.e. the Beck Depression Inventory and the Carroll Rating Scale in order to monitor the occurrence of depression throughout the treatment programmes. A biographical questionnaire composed by the clinical psychologists and the general practitioner was used. The purpose of this questionnaire, was to obtain specific information not covered by the other measuring instruments. The observed data were analysed by applying the Statistical Analysis System (SAS) computer programme. Any results reported as significant had a probability value of p~0,1. No significant differences between the groups emerged in respect of the level of depression which occurred in the different treatment programmes or in the depression which occurred during treatment and the outcome of treatment (weight-loss) in the different treatment programmes. However, significant differences were found between the results yielded by the different depression inventories. It was also evident tpat depression occurred throughout the different treatment programmes and that there was a fluctuation in the level of depression which occurred over time. The implications of findings in this study for the planning and design of a weight-reduction programme are: measuring instruments must be carefully screened before use; pre- and post measurement of depression are inadequate to monitor for any adverse effects of the treatment programme; a behaviour therapy plus a very low-calorie diet programme does not cause adverse effects; programmes must cater for the occurrence and fluctuation of depression throughout the entire period of the programme. Problems experienced in this study are discussed and recommendations made for further research.