Even Limited Physical Activity May Help Lower Rates of Depression in Bariatric Surgery Patients, King-Led Study Finds

Physically active adults undergoing bariatric surgery are less likely than their less-active counterparts to have depressive symptoms and to have recently received medication or counseling for depression or anxiety, according to new research led by the University of Pittsburgh Graduate School of Public Health.

“Typically, clinical professionals manage their patients’ depression and anxiety with counseling and/or antidepressant or anti-anxiety medication,” said Research Assistant Professor Wendy C. King, an epidemiologist within the Graduate School of Public Health and lead author of the research, which is reported in February’s issue of the Journal of Psychosomatic Research.

“Recent research has focused on physical activity as an alternative or adjunct treatment.”

Adults with severe obesity are nearly twice as likely to have a major depressive disorder (13.3 percent) or anxiety disorder (19.6 percent) when compared to the general population (7.2 and 10.2 percent, respectively). King noted the importance of treating these conditions prior to surgery, as preoperative depression and anxiety increase the risk of these conditions occurring after surgery—and have been shown to negatively impact long-term surgically induced weight loss.

As part of the Longitudinal Assessment of Bariatric Surgery-2, an observational study designed to assess the risks and benefits of bariatric surgery, King and her colleagues assessed participants’ physical activity for a week prior to undergoing bariatric surgery by using a small electronic device worn above the ankle. Participants also completed surveys to assess mental-health functioning, depressive symptoms, and treatment for psychiatric and emotional problems, including depression and anxiety.

The study included 850 adults who were seeking bariatric surgery between 2006 and 2009 from one of 10 different hospitals throughout the United States. About one-third of participants reported depressive symptoms, while two in five reported taking medication or receiving counseling for depression or anxiety. “Those who reported treatment were more likely to report impaired mental-health functioning and depressive symptoms, highlighting the need for better treatment modalities,” King said.

The association between physical activity and these outcomes was strongest when only physical activity of moderate intensity was considered. However, the number of steps a person walked each day, no matter the pace, also was related.“

Another goal of this study was to determine the physical activity thresholds that best differentiated mental-health status,” King said. “We were surprised that the thresholds were really low.”

Just one hour of moderate-intensity physical activity a week—or eight minutes a day—was associated with 92 percent-lower odds of treatment for depression or anxiety among adults with severe obesity. Similarly, just 4,750 steps a day—less than half the 10,000 steps recommended for a healthy adult—reduced odds of depression or anxiety treatment by 81 percent. 

“It could be that, in this population, important mental health benefits can be gained by simply not being sedentary,” King said.

Because this was an observational, cross-sectional study—meaning patients’ regular physical activity behavior and depressive symptoms were measured at the same time—it could not prove that a patient’s physical activity influenced mental-health status.

“Results of the study are provocative, but we would need further research to verify that physical activity was responsible for lower levels of depressive symptoms in this patient population,” said study coauthor Melissa A. Kalarchian, a professor of psychiatry in the Pitt School of Medicine and at Western Psychiatric Institute and Clinic of UPMC.

“Nonetheless, physical activity is a key component of behavioral weight management, and it is encouraging to consider that it may have a favorable impact on mental health as well.”The research was funded through a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases.