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04-01-2012 | Diabetes | Article

Overcoming apathy may improve weight loss among obese patients

Abstract

Free abstract

MedWire News: Targeting apathy in obese individuals may improve their chances of succeeding in weight loss programs, report researchers.

Dopaminergic agents such as methylphenidate may enhance this approach, they say.

Cyrus Desouza (Omaha Veterans Affairs Medical Centre, Nebraska, USA) and team hypothesized that obese patients with apathy, which manifests as poor persistence, lack of interest, and blunted emotional response, may find it easier to adhere to weight loss programs if they received treatment for their apathetic state.

The team tested this hypothesis in 101 individuals with obesity (defined as body mass index >30 kg/m2 and whom they defined as apathetic using the Apathy Evaluation Scale (AES).

The participants were randomized to standard nutrition counseling, the "motivate obese veterans everywhere" (MOVE) weight loss program, or methylphenidate (5-10 mg) twice daily plus the MOVE program, for a period of 26 weeks.

Patients were re-evaluated for apathy at 1, 4, 13, and 26 weeks. The team also measured depression using the 17-item version of the Hamilton depression scale (HAM-D) and assessed patients using the Patient Activation Measure (PAM), a tool used to gauge levels of knowledge, skills and confidence essential to managing one's own healthcare.

The authors found that by week 26, individuals in the counseling group lost a mean of 0.60 kg and those in the MOVE group lost 1.84 kg, while those on methylphenidate lost 4.61 kg.

Further analysis showed that, although there were no significant between-group differences in weight loss, there was a trend towards the methylphenidate group having greater weight loss.

"This indicates that the methylphenidate group tends to lose, on average, more weight than the other two groups and such differences may become statistically significant if the sample sizes are increased," writes the team in the journal Diabetes, Obesity and Metabolism.

The researchers also report that mean AES and PAM scores improved significantly in all groups whereas HAM-D scores did not improve in any group.

"This emphasizes the point that apathy may be a factor independent of depression and worth specific target in such studies," they say.

However, the authors note that the patients were preselected for apathy and hence more likely to respond.

"The usefulness of this approach is that in clinical practice, if we can differentiate those obese patients that are apathetic, they can be offered an additional modality of treatment and can enhance their chances of long-term success," conclude Desouza et al.

MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Sally Robertson