Conditions: Obesity Apathy
Keywords: apathy obesity methylphenidate MOVE medical crisis counselling
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 101
Healthy volunteers: no

Brief 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

Arms:
arm 1: standard nutrition counselling arm 2: MOVE -weight loss intervention arm 3: MOVE plus medical crisis counselling arm 4: MOVE plus methylphenidate arm 5: MOVE plus methyphenidate plus medical crisis counselling

Interventions: intervention 1: MOVE intervention 2: medical crisis councelling intervention 3: MOVE intervention 4: methyphenidate intervention 5: MOVE intervention 6: methyphenidate intervention 7: medical crisis councelling intervention 8: MOVE
Intervention descriptions: intervention 1: is a VA based multidesciplinary weight loss intervention intervention 2: group counselling sessions intervention 3: is a VA based multidesciplinary weight loss intervention intervention 4: methyphenidate will be used to treat apathy dose 10mg bid intervention 5: is a VA based multidesciplinary weight loss intervention intervention 6: methyphenidate will be used to treat apathy dose 10mg bid intervention 7: group counselling sessions intervention 8: is a VA based multidesciplinary weight loss intervention

Protocol document: