Translational Behavioral Medicine

, Volume 7, Issue 2, pp 320–329 | Cite as

Lower depression scores associated with greater weight loss among rural black women in a behavioral weight loss program

  • Tiffany L. CarsonEmail author
  • Bradford E. Jackson
  • Timiya S. Nolan
  • Angela Williams
  • Monica L. Baskin
Original Research


Depression and stress have been associated with less weight loss among some participants in behavioral weight loss (BWL) programs. The purpose of this study was to (1) measure the levels of depression and stress among a sample of black women living in rural Alabama and Mississippi who were participating in a BWL program and (2) examine the association between these psychosocial variables and weight loss outcomes of participants at 6 months. Overweight and obese black women in a BWL program (n = 409) completed validated surveys to measure depression and stress at baseline and 6 months. Weight and height were also measured at baseline and 6 months. Statistical tests were conducted to examine associations between depression, stress, and weight loss. Mean BMI at baseline was 38.68 kg/m2. Participants achieved a 1.17 kg/m2 reduction in BMI at 6 months. When comparing by baseline depression or stress categories, no significant differences in weight loss outcomes were observed. Analysis of continuous data revealed a significant correlation between baseline depression score and change in BMI. In adjusted models, change in depression score over time was significantly associated with change in weight. No differences in weight loss outcomes at 6 months were observed when comparing participants with and without elevated depressive symptoms or elevated stress at baseline. This suggests that potential participants may not need to be excluded from BWL programs based on pre-specified cut points for these psychological conditions. Greater improvements in depression were associated with better weight loss outcomes suggesting that more emphasis on reducing depression may lead to greater weight losses for black women in BWL programs.


Behavioral weight loss intervention Stress Depression Black female Rural Deep South 



The work described was supported by the following grants: 1U54CA153719 and 1K01CA190559-01. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Adherence to ethical standards disclosure

1. The corresponding author, Tiffany Carson, has the approval of all other listed authors for the submission and publication of all versions of the manuscript.

2. All who have made an independent material contribution to the manuscript have been included on the author list.

3. The work submitted in the manuscript is original and has not been published elsewhere and is not presently under consideration of publication by any other journal.

4. The material in the manuscript has been acquired according to modern ethical standards and has been approved by the legally appropriate ethical committee.

5. If any of the statements above ceases to be true, the authors will notify the journal as soon as possible so that the manuscript can be withdrawn.

6. The authors have full control of all primary data and agree to allow the journal to review the data if requested.

7. All procedures and research activities were approved by the Institutional Review Board (IRB) at the University of Alabama at Birmingham. The guiding ethical principles of the IRB—respect for persons, beneficence and justice—are embodied in the “Belmont Report”: Ethical Principles and Guidelines for the Protection of Human Subjects of Research (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, April 18, 1979). All human subjects participated in the informed consent process and indicated their informed consent by signing a written document.

10. No animals were involved in the reported research.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

13142_2016_452_MOESM1_ESM.docx (149 kb)
ESM 1 (DOCX 148 kb)


  1. 1.
    Ogden, C. L., Carroll, M. D., Fryar, C. D., & Flegal, K. M. (2015). Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  2. 2.
    Hall, J. E., Crook, E. D., Jones, D. W., Wofford, M. R., & Dubbert, P. M. (2002). Mechanisms of obesity-associated cardiovascular and renal disease. Am J Med Sci, 324(3), 127–137.CrossRefPubMedGoogle Scholar
  3. 3.
    De Pergola, G., & Silvestris, F. (2013). Obesity as a major risk factor for cancer. J Obes, 2013, 291546.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in Adults—the evidence report. National Institutes of Health. Obes Res. 1998; 6 Suppl 2:51S–209S.Google Scholar
  5. 5.
    Wadden, T. A., & Stunkard, A. J. (2002). Handbook of obesity treatment. New York, NY: The Guilford Press.Google Scholar
  6. 6.
    Hammond, R. A., & Levine, R. (2010). The economic impact of obesity in the United States. Diabetes Metab Syndr Obes, 3, 285–295.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    McAllister, E. J., Dhurandhar, N. V., Keith, S. W., et al. (2009). Ten putative contributors to the obesity epidemic. Crit Rev Food Sci, 49(10), 868–913.CrossRefGoogle Scholar
  8. 8.
    West, D. S., Prewitt, T. E., Bursac, Z., & Felix, H. C. (2008). Weight loss of black, white, and Hispanic men and women in the diabetes prevention program. Obesity (Silver Spring), 16, 1413–1420.CrossRefGoogle Scholar
  9. 9.
    Hollis, J. F., Gullion, C. M., Stevens, V. J., et al. (2008). Weight loss during the intensive intervention phase of the weight-loss maintenance trial. Am J Prev Med, 35(2), 118–126.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wingo, B. C., Carson, T. L., & Ard, J. (2014). Differences in weight loss and health outcomes among African Americans and whites in multicentre trials. Obes Rev, 15(Suppl 4), 46–61.CrossRefPubMedGoogle Scholar
  11. 11.
    Davis, K. K., Tate, D. F., Lang, W., et al. (2015). Racial differences in weight loss among adults in a behavioral weight loss intervention: role of diet and physical activity. J Phys Act Health, 12(12), 1558–1566.CrossRefPubMedGoogle Scholar
  12. 12.
    Fabricatore, A. N., Wadden, T. A., Moore, R. H., Butryn, M. L., Heymsfield, S. B., & Nguyen, A. M. (2009). Predictors of attrition and weight loss success: results from a randomized controlled trial. Behav Res Ther, 47(8), 685–691.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Carson, T. L., Eddings, K. E., Krukowski, R. A., Love, S. J., Harvey-Berino, J. R., & West, D. S. (2013). Examining social influence on participation and outcomes among a network of behavioral weight-loss intervention enrollees. J Obes, 2013, 480630.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Cox, T. L., Krukowski, R., Love, S. J., et al. (2013). Stress management-augmented behavioral weight loss intervention for African American women: a pilot, randomized controlled trial. Health Educ Behav, 40(1), 78–87.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim, K. H., Bursac, Z., DiLillo, V., White, D. B., & West, D. S. (2009). Stress, race, and body weight. Health Psychol, 28(1), 131–135.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Delahanty, L. M., Meigs, J. B., Hayden, D., Williamson, D. A., Nathan, D. M., & Group DR (2002). Psychological and behavioral correlates of baseline BMI in the diabetes prevention program (DPP). Diabetes Care, 25(11), 1992–1998.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Trief, P. M., Cibula, D., Delahanty, L. M., & Weinstock, R. S. (2014). Depression, stress, and weight loss in individuals with metabolic syndrome in SHINE, a DPP translation study. Obesity (Silver Spring), 22(12), 2532–2538.Google Scholar
  18. 18.
    Aikens, J. E. (2012). Prospective associations between emotional distress and poor outcomes in type 2 diabetes. Diabetes Care, 35(12), 2472–2478.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Price, D. W., Ma, Y., Rubin, R. R., et al. (2013). Depression as a predictor of weight regain among successful weight losers in the diabetes prevention program. Diabetes Care, 36(2), 216–221.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Delahanty, L. M., Peyrot, M., Shrader, P. J., et al. (2013). Pretreatment, psychological, and behavioral predictors of weight outcomes among lifestyle intervention participants in the diabetes prevention program (DPP). Diabetes Care, 36(1), 34–40.CrossRefPubMedGoogle Scholar
  21. 21.
    Stubbs, J., Whybrow, S., Teixeira, P., et al. (2011). Problems in identifying predictors and correlates of weight loss and maintenance: implications for weight control therapies based on behaviour change. Obes Rev, 12(9), 688–708.PubMedGoogle Scholar
  22. 22.
    Svetkey, L. P., Ard, J. D., Stevens, V. J., et al. (2012). Predictors of long-term weight loss in adults with modest initial weight loss, by sex and race. Obesity (Silver Spring), 20(9), 1820–1828.CrossRefGoogle Scholar
  23. 23.
    Schulz, A., Israel, B., Williams, D., Parker, E., Becker, A., & James, S. (2000). Social inequalities, stressors and self reported health status among African American and white women in the Detroit metropolitan area. Soc Sci Med, 51(11), 1639–1653.CrossRefPubMedGoogle Scholar
  24. 24.
    Turner, R. J., & Avison, W. R. (2003). Status variations in stress exposure: implications for the interpretation of research on race, socioeconomic status, and gender. J Health Soc Behav, 44(4), 488–505.CrossRefPubMedGoogle Scholar
  25. 25.
    Grobman WA, Parker C, Wadhwa PD, et al. Racial/ethnic disparities in measures of self-reported psychosocial states and traits during pregnancy. Am J Perinatol. Aug 8 2016.Google Scholar
  26. 26.
    Dunlop, D. D., Song, J., Lyons, J. S., Manheim, L. M., & Chang, R. W. (2003). Racial/ethnic differences in rates of depression among preretirement adults. Am J Public Health, 93(11), 1945–1952.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Centers for Disease C, Prevention (2010). Current depression among adults—United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep, 59(38), 1229–1235.Google Scholar
  28. 28.
    Samuel-Hodge, C. D., Garcia, B. A., Johnston, L. F., et al. (2013). Translation of a behavioral weight loss intervention for mid-life, low-income women in local health departments. Obesity (Silver Spring), 21(9), 1764–1773.Google Scholar
  29. 29.
    Brantley, P. J., Appel, L. J., Hollis, J., et al. (2008). Design considerations and rationale of a multi-center trial to sustain weight loss: the weight loss maintenance trial. Clin Trials, 5(5), 546–556.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Diabetes Prevention Program Research Group (2002). The diabetes prevention program:descriptive of lifestyle intervention. Diabetes Care, 25, 2165–2171.CrossRefGoogle Scholar
  31. 31.
    Ard, J. D., Cox, T. L., Zunker, C., Wingo, B. C., Jefferson, W. K., & Brakhage, C. (2010). A study of a culturally enhanced EatRight dietary intervention in a predominately African American workplace. J Public Health Manag Pract, 16(6), E1–E8.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Zunker, C., Cox, T. L., Wingo, B. C., Knight, B., Jefferson, W. K., & Ard, J. D. (2008). Using formative research to develop a worksite health promotion program for African American women. Women Health, 48(2), 189–207.CrossRefPubMedGoogle Scholar
  33. 33.
    Khan, L. K., Sobush, K., Keener, D., et al. (2009). Recommended community strategies and measurements to prevent obesity in the United States. MMWR Recomm Rep, 58(RR-7), 1–26.PubMedGoogle Scholar
  34. 34.
    Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med, 10(2), 77–84.PubMedGoogle Scholar
  35. 35.
    Irwin, M., Artin, K. H., & Oxman, M. N. (1999). Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Arch Intern Med, 159(15), 1701–1704.CrossRefPubMedGoogle Scholar
  36. 36.
    Sharp, L. K., Kimmel, L. G., Kee, R., Saltoun, C., & Chang, C. H. (2007). Assessing the perceived stress scale for African American adults with asthma and low literacy. J Asthma, 44(4), 311–316.CrossRefPubMedGoogle Scholar
  37. 37.
    Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. J Heath Soc Behav, 24(4), 385–396.CrossRefGoogle Scholar
  38. 38.
    Radloff, L. (1977). The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas, 1(3), 385–401.CrossRefGoogle Scholar
  39. 39.
    Miller, G. E., Engen, P. A., Gillevet, P. M., et al. (2016). Lower neighborhood socioeconomic status associated with reduced diversity of the colonic microbiota in healthy adults. PLoS One, 11(2), e0148952.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Bjorgvinsson, T., Kertz, S. J., Bigda-Peyton, J. S., McCoy, K. L., & Aderka, I. M. (2013). Psychometric properties of the CES-D-10 in a psychiatric sample. Assessment, 20(4), 429–436.CrossRefPubMedGoogle Scholar
  41. 41.
    Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of health. Newbury Park, CA: Sage.Google Scholar
  42. 42.
    Elder, C. R., Gullion, C. M., Funk, K. L., Debar, L. L., Lindberg, N. M., & Stevens, V. J. (2012). Impact of sleep, screen time, depression and stress on weight change in the intensive weight loss phase of the LIFE study. Int J Obes, 36(1), 86–92.CrossRefGoogle Scholar
  43. 43.
    Delahanty, L. M., Meigs, J. B., Hayden, D., Williamson, D. A., & Nathan, D. M. (2002). Diabetes prevention program research group. Psychological and behavioral correlates of baseline BMI in the diabetes prevention program (DPP). Diabetes Care, 25(11), 1992–1998.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Ard JD, Carson TL, Li Y, Shikany JM, Robinson JC, Baskin ML. Deep South network main results at 6-months. In: Carson TL, ed. Birmingham, AL: 2016.Google Scholar
  45. 45.
    Carson, T. L., Desmond, R., Hardy, S., et al. (2015). A study of the relationship between food group recommendations and perceived stress: findings from black women in the Deep South. J Obes, 2015, 7.CrossRefGoogle Scholar
  46. 46.
    Woods-Giscombe, C. L. (2010). Superwoman Schema: African American women's views on stress, strength, and health. Qual Health Res, 20(5), 668–683.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Lewis, T. T., Kravitz, H. M., Janssen, I., & Powell, L. H. (2011). Self-reported experiences of discrimination and visceral fat in middle-aged African-American and Caucasian women. Am J Epidemiol, 173(11), 1223–1231.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2016

Authors and Affiliations

  • Tiffany L. Carson
    • 1
    • 2
    • 3
    • 4
    Email author
  • Bradford E. Jackson
    • 1
    • 2
  • Timiya S. Nolan
    • 5
  • Angela Williams
    • 1
  • Monica L. Baskin
    • 1
    • 2
    • 3
    • 4
  1. 1.School of Medicine, Department of Medicine, Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Comprehensive Cancer CenterUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Nutrition Obesity Research CenterUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Minority Health and Health Disparities Research CenterUniversity of Alabama at BirminghamBirminghamUSA
  5. 5.School of NursingUniversity of Alabama at BirminghamBirminghamUSA

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