Effect of an Intervention for Obesity and Depression on Patient-Centered Outcomes: An RCT.

INTRODUCTION: An integrated collaborative care intervention was successful for treating comorbid obesity and depression. The effect of the integrated intervention on secondary outcomes of quality of life and psychosocial functioning were examined, as well as whether improvements in these secondary outcomes were correlated with improvements in the primary outcomes of weight and depressive symptoms. STUDY DESIGN: This RCT compared an integrated collaborative care intervention for obesity and depression to usual care. Data were analyzed in 2018. SETTING/PARTICIPANTS: Adult primary care patients (n=409) with a BMI ≥30 (≥27 if Asian) and 9-Item Patient Health Questionnaire score ≥10 were recruited from September 30, 2014 to January 12, 2017 from primary care clinics in Northern California. INTERVENTION: The 12-month intervention integrated a behavioral weight loss program and problem-solving therapy with as-needed antidepressant medications for depression. MAIN OUTCOME MEASURES: A priori secondary outcomes included health-related quality of life (Short Form-8 Health Survey), obesity-specific quality of life (Obesity-Related Problems Scale), sleep disturbance and sleep-related impairment (Patient-Reported Outcomes Measurement Information System), and functional disability (Sheehan Disability Scale) at baseline and 6 and 12 months. RESULTS: Participants randomized to the intervention experienced significantly greater improvements in obesity-specific problems, mental health-related quality of life, sleep disturbance, sleep-related impairment, and functional disability at 6 months but not 12 months. Improvements in obesity-related problems (ß=0.01, 95% CI=0.01, 0.02) and sleep disturbance (ß= -0.02, 95% CI= -0.04, 0) were associated with lower BMI. Improvements in the physical (ß= -0.01, 95% CI= -0.01, 0) and mental health components (ß= -0.02, 95% CI= -0.03, -0.02) of the Short Form-8 Health Survey as well as sleep disturbance (ß=0.01, 95% CI=0.01, 0.02) and sleep-related impairment (ß=0.01, 95% CI=0, 0.01) were associated with fewer depressive symptoms. CONCLUSIONS: An integrated collaborative care intervention for obesity and depression that was shown previously to improve weight and depressive symptoms may also confer benefits for quality of life and psychosocial functioning over 6 months. TRIAL REGISTRATION: This study is registered at clinicaltrials.gov NCT02246413.

Rangeland Condition Monitoring: A New Approach Using Cross-Fence Comparisons of Remotely Sensed Vegetation.

A need exists in arid rangelands for effective monitoring of the impacts of grazing management on vegetation cover. Monitoring methods which utilize remotely-sensed imagery may have comprehensive spatial and temporal sampling, but do not necessarily control for spatial variation of natural variables, such as landsystem, vegetation type, soil type and rainfall. We use the inverse of the red band from Landsat TM satellite imagery to determine levels of vegetation cover in a 22,672 km(2) area of arid rangeland in central South Australia. We interpret this wealth of data using a cross-fence comparison methodology, allowing us to rank paddocks (fields) in the study region according to effectiveness of grazing management. The cross-fence comparison methodology generates and solves simultaneous equations of the relationship between each paddock and all other paddocks, derived from pairs of cross-fence sample points. We compare this ranking from two image dates separated by six years, during which management changes are known to have taken place. Changes in paddock rank resulting from the cross-fence comparison method show strong correspondence to those predicted by grazing management in this region, with a significant difference between the two common management types; a change from full stocking rate to light 20% stocking regime (Major Stocking Reduction) and maintenance of full 100% stocking regime (Full Stocking Maintained) (P = 0.00000132). While no paddocks had a known increase in stocking rate during the study period, many had a reduction or complete removal in stock numbers, and many also experienced removals of pest species, such as rabbits, and other ecosystem restoration activities. These paddocks generally showed an improvement in rank compared to paddocks where the stocking regime remained relatively unchanged. For the first time, this method allows us to rank non-adjacent paddocks in a rangeland region relative to each other, while controlling for natural spatio-temporal variables such as rainfall, soil type, and vegetation community distributions, due to the nature of the cross-fence experimental design, and the spatially comprehensive data available in satellite imagery. This method provides a potential tool to aid land managers in decision making processes, particularly with regard to stocking rates.