828-P: The Impact of Diabetes and Depression Status on Weight Loss Outcomes in Mexican Patients with Severe Obesity

Background: There is a well-known association between type 2 diabetes (T2DM) and depression, including inferior outcomes in weight loss treatments. However, obesity guidelines do not address psychiatric interventions during such programs.

Objective: We assessed the impact of T2DM in outcomes (weight loss, psychiatric diagnoses and quality of life) of a six-month public obesity program that incorporated a psychiatric intervention for patients with severe obesity.

Methods: Retrospective analysis of the registry of the behavioral obesity program at Instituto Nacional de Ciencias Médicas y Nutrición in Mexico City after implementation of a psychiatric intervention that includes diagnosis by a single psychiatrist with the DSMV criteria, psychoeducation, psychopharmacological prescription and/or psychotherapy accordingly. We determined weight loss, frequency of psychiatric diagnoses (depression, anxiety, binge eating disorder [BED]), and quality of life according with T2DM diagnosis.

Results: We included 329 subjects (66% women aged 43.7±12.2 years, initial BMI of 44.2±9.6 kg/m²). The frequency of psychiatric diagnoses in patients with and without T2DM was: Depression 43% and 32% (p=0.05), anxiety 25% and 24% (p=0.42), and BED 32% and 32% (p=0.50). Baseline quality of life (QoL) was lower in patients with T2DM than in those without it (p<0.001), and both were prescribed a pharmacological treatment similarly. Subjects with T2DM were prescribed an obesity drug more often (p=0.004) but lost similar weight (p=0.07). Patients with T2DM had higher depression remission, to similar frequency at the end (p=0.42), and QoL improved significantly (p=0.02), but remained lower than in subjects without T2DM (p<0.001).

Conclusion: In subjects with severe obesity and T2DM, pharmacological obesity treatment and a psychiatric intervention and were beneficial for weight loss and depression control. Improvement in QoL might require additional T2DM interventions.