Role of Apathy in the Effectiveness of Weight Loss Interventions
Condition: Obesity; Apathy
MeSH terms: Weight Loss
Study type: Interventional

Summary: 
      The purpose of this study is to determine whether treating apathy with methylphenidate or
      medical Crisis counselling will increase adherence to weight loss programs thereby increasing
      their effectiveness
    

Detailed description: 
      Title: The role of Apathy in the effectiveness of weight loss interventions in obese patients

      Objective: Obesity is a major public health problem. Apathy is a common behavioral problem
      characterized by loss of initiative, poor motivation and persistence. Presence of apathy
      impairs the self-care behavior in obese patients. Lack of novelty might impair a patient's
      ability to seek new interactions, life styles and new treatment options for obesity. Lack of
      motivation might impair a patient's ability to initiate exercise regimen or diet whereas lack
      of persistence impairs the compliance with these regimens. Thus, apathy influences all stages
      of self-care. We hypothesize that the treatment of apathy will result in better adherence to
      weight loss interventions in obese veterans enrolled in the MOVE program.

      Research Design: A prospective open label randomized study. Group 1 will have patients with
      obesity as defined as BMI>30, and apathy defined as AES score of > 40. This group will be
      treated with standard nutrition counseling. Group 2 will have patients with obesity and
      apathy as defined above and will receive the MOVE enhancement program alone (The MOVE program
      is a national VA weight loss program). Group 3 will be treated with methylphenidate along
      with the MOVE enhancement program. Group 4 will be treated with medical crisis counseling
      along with the MOVE enhancement program. Group 5 will be treated with methylphenidate, and
      the medical crisis counseling along with the MOVE enhancement program.

      Methodology: 30 patients meeting the criteria will be enrolled in each of the five arms. All
      patients will be in the study for duration of six months. All patients in the methylphenidate
      arm will be started at 5mg twice daily and titrated to 10mg twice daily at two weeks.
      Patients will be assessed on regular intervals using the Apathy Evaluation Scale, Hamilton
      Depression Scale and the Patient activation measure. MOVE sessions will be held once weekly
      from the 2nd visit to the end of the study. Medical Crisis Counseling visits will be every
      week for nine sessions and then every other week till the end of the study

      Clinical Relationships/Significance: The prevalence of obesity in the general population is
      over 30%. However the prevalence of obesity in the VA health system is almost 70%. Since
      obesity predisposes to several co-morbid conditions such as hypertension, diabetes and
      cardiovascular disease, it is important to develop interventions that are effective in
      inducing weight loss. Since apathy plays a large role in the self care behaviours that lead
      to obesity, treating apathy may improve adherence to weight loss programs
    

Intervention name(s): MOVE; medical crisis councelling; MOVE; methyphenidate; MOVE; methyphenidate; medical crisis councelling; MOVE
Intervention type(s): Behavioral; Behavioral; Behavioral; Drug; Behavioral; Drug; Behavioral; Behavioral
Intervention description(s): is a VA based multidesciplinary weight loss intervention; group counselling sessions; is a VA based multidesciplinary weight loss intervention; methyphenidate will be used to treat apathy dose 10mg bid; is a VA based multidesciplinary weight loss intervention; methyphenidate will be used to treat apathy dose 10mg bid; group counselling sessions; is a VA based multidesciplinary weight loss intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: apathy; obesity; methylphenidate; MOVE; medical crisis counselling