digital InteGrated behavioral treatmeNt for comorbid obesITy and deprEssion among racial and ethnic adults age 50 and older (IGNITE)

Project Summary/Abstract Multimorbidity involving comorbid mental and medical chronic conditions such as depression and obesity is highly prevalent among middle-aged and older adults, disproportionately affecting racial and ethnic minorities. Depression and obesity contribute to greater cardiometabolic disease risk (e.g., diabetes), poorer treatment adherence, and worse quality of life than either condition alone. Both conditions are also risk factors for Alzheimer’s disease and related disorders. Behavioral interventions are traditionally designed to treat depression and obesity separately; however, few target both conditions. Moreover, scalability of traditional behavioral interventions is limited, and accessibility is generally poor, especially among racial and ethnic minorities. Our team previously demonstrated the efficacy of an integrated behavioral intervention for comorbid depression and obesity, I-CARE, which combined 2 proven treatments: an in-person problem-solving therapy (PST) for depression and a video-based behavioral weight loss intervention adapted from the Diabetes Prevention Program (DPP). Recently, we developed and pilot-tested Lumen, a first-of-its-kind, voice-based virtual coach for PST on Amazon’s Alexa platform. In a pilot randomized clinical trial of predominantly racial and ethnic minority participants, Lumen demonstrated high feasibility and usability and promising effects on depression and anxiety symptoms. The objective of the current project is to test the efficacy of a fully digital I- CARE intervention, combining the Lumen PST virtual coach for depression management with the DPP video- based program for weight loss. Patients (N=440) self-identified as a racial or ethnic minority with depression and obesity will be enrolled from a large minority-serving academic medical center in Chicago. In this fully remote clinical trial, participants will receive a tablet, a wireless weight scale, and a wearable activity tracker. Participants will be randomly assigned to the digital I-CARE intervention (with 6 months of active treatment and 6 months of maintenance) or waitlist control, and assessed at 6 and 12 months. Controls will receive active treatment in the digital I-CARE intervention after their assessment at 6 months (primary endpoint). Specific aims are to (1) determine the intervention effects on the primary depressive symptoms and weight loss outcomes, and on secondary outcomes (e.g., psychosocial and cognitive functioning); (2) identify predictors of treatment success, defined by clinically significant weight loss (5%) and depression response (50% symptom reduction) or remission (free of symptoms); and (3) characterize the experiences and perceptions of intervention participants to inform future development and translation. The proposed research is innovative, advancing minority aging research using digital health and focusing on integrated care to reduce depression, obesity, and related health risks specifically among racial and ethnic minority adults aged 50-74 years. This work aligns with NIA’s priorities to prevent multimorbidity and reduce health disparities through innovative interventions to maintain health, well-being, and function.