Sleep, Depression, and Stress Influence Weight Loss

Jim Kling

April 05, 2011

April 5, 2011 — A new study suggests that sleep, depression, and stress are key components of an interventional weight loss program. The study was published online March 29 in the International Journal of Obesity.

The current US obesity epidemic is believed to have a number of contributing elements, including genetic, environmental, and lifestyle factors, such as disordered sleep patterns. Multiple studies have demonstrated an inverse association between sleep duration and weight gain.

To better understand the effects of sleep, screen time, depression, and stress on weight loss success, the researchers, led by Dr. Charles Elder of the Kaiser Permanente Center for Health Research, Portland, Oregon, conducted a 2-phase randomized clinical trial. Phase 1 included a nonrandomized, 6-month behavioral weight loss intervention that included 472 adults with obesity (body mass index, 30 - 50 kg/m2). Phase 2 incorporated weight loss maintenance. The current study focuses on phase 1 results.

The phase 1 intervention included 22 group sessions, led by a behavioral counselor, during the course of 26 weeks. Participants were given recommendations to reduce food consumption by 500 calories per day, adopt the Dietary Approaches to Stop Hypertension pattern, and participate in at least 180 minutes of exercise per week.

Mean weight loss during phase 1 was 6.3 ± 7.1 kg, and 285 participants (60%) who lost a minimum of 4.5 kg were randomly selected into phase 2. Participants attended an average of 73.1% ± 26.7% of sessions. They filled out 5.1 ± 1.9 daily food records per week and reported 195.1 ± 123.1 minutes of exercise per week.

Stress and sleep time were revealed to be important factors in qualifying for phase 2. A 1-point change in the Perceived Stress Scale had an associated odds ratio of 0.966 (increased success associated with less weight loss, 95% confidence interval, 0.937 - 0.995; P = .024). Participants with a quadratic trend in sleep time had an odds ratio of 0.797 (95% confidence interval, 0.649 - 0.978; P = .030). Participants who slept 6 to 7 hours or 7 to 8 hours were more likely to qualify for phase 2 than those with other sleep times.

At entry into the program, lower stress was associated with greater ensuing weight loss (slope, 0.132; SE, 0.054; t = 2.42; P = .021).

Changes in baseline predictors during the program had significant impacts on success. Reduction in stress between entry and a post weight-loss follow-up visit as measured by the Perceived Stress Scale were associated with improved weight loss (r = 0.159; P = .048). A similar trend was seen in depression as measured by the Personal Health Questionnaire—Depression Subscale (= 0.223; P = .035).

The researchers found no correlation between screen time and weight loss success. Session attendance correlated positively with weight loss success (= −0.621), as were exercise (r = −0.361) and food records (r = −0.501; all P < .001).

"[These] results suggest that clinicians and investigators might consider targeting sleep, depression and stress as part of a behavioral weight loss intervention," the study authors conclude.

This work was funded by the National Center for Complementary and Alternative Medicine, National Institutes of Health. The study authors have disclosed no relevant financial relationships.

Int J Obesity. Published online March 29, 2011. Abstract

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