{"doi":"10.1093/tbm/ibaa024","title":"Understanding mechanisms of integrated behavioral therapy for co-occurring obesity and depression in primary care: a mediation analysis in the RAINBOW trial","abstract":"The RAINBOW trial demonstrated that an integrated collaborative care intervention was effective for improving weight and depression. This study examined mediation of the treatment effect by a priori specified lifestyle behaviors and cognitive functioning. Participants were randomized to a 12-month integrated intervention (n = 204) or usual care (n = 205). Body mass index (BMI) and 20-item Depression Symptom Check List (SCL-20) were co-primary outcomes (Y). To examine mediation, we assessed (a) the effect of the integrated intervention (X) on lifestyle behaviors (diet and physical activity) and cognitive functioning (problem-solving; M, X→M path a) and (b) the association of these behaviors with BMI and SCL-20 (M→Y path b). Mediation existed if paths a and b were significant or if path a and the product of coefficients test (paths a and b) were significant. Compared with usual care, the intervention led to significant improvements in leisure time physical activity (201.3 MET minutes/week [SD, 1,457.6]) and total calorie intake (337.4 kcal/day [818.3]) at 6 months but not 12 months (path a). These improvements were not significantly associated with improvements in BMI or SCL-20 (path b). However, avoidant problem-solving style score and increased fruit and vegetable intake significantly correlated with improvements in BMI at 6 and 12 months, respectively. Also, increased fruit and vegetable intake, higher dietary quality, and better problem-solving abilities significantly correlated with improvements in SCL-20 at 6 and 12 months. These findings did not support the hypothesized mediation, but suggest lifestyle behaviors and cognitive functioning to target in future intervention optimization.","journal":"Translational Behavioral Medicine","year":2020,"id":81834,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":13,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9504,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":397624,"name":"Lan Xiao","orcid":"0000-0002-1265-7494","position":1,"is_corresponding":false},{"id":397623,"name":"Nan Lv","orcid":"0000-0003-2063-3377","position":2,"is_corresponding":false},{"id":423391,"name":"Phillip W. Lavori","orcid":null,"position":3,"is_corresponding":false},{"id":307257,"name":"Elizabeth M. Venditti","orcid":"0000-0002-4124-6555","position":4,"is_corresponding":false},{"id":398749,"name":"Mark Snowden","orcid":null,"position":5,"is_corresponding":false},{"id":331945,"name":"Joshua M. Smyth","orcid":"0000-0002-0904-5390","position":6,"is_corresponding":false},{"id":422629,"name":"Megan A. Lewis","orcid":"0000-0002-1670-9298","position":7,"is_corresponding":false},{"id":326861,"name":"Leanne M. Williams","orcid":"0000-0001-9987-7360","position":8,"is_corresponding":false},{"id":324328,"name":"Trisha Suppes","orcid":"0000-0003-4560-6180","position":9,"is_corresponding":false},{"id":397625,"name":"Andrea Goldstein‐Piekarski","orcid":"0000-0001-6382-4312","position":10,"is_corresponding":false},{"id":397626,"name":"Jun Ma","orcid":"0000-0001-7996-6454","position":11,"is_corresponding":false},{"id":249442,"name":"Lisa G. Rosas","orcid":"0000-0003-4053-7972","position":0,"is_corresponding":true}],"reference_count":44,"raw_metadata":null,"created_at":"2026-07-18T21:52:58.921847Z","pmid":"32203569","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}