Research Aimed at Improving Both Mood and Weight

RAINBOW

Inclusion criteria:

   - Ethnicity and race: Any;

   - Obesity: BMI≥30 kg/m2 for non-Asians; BMI≥27 kg/m2 for Asians;

   - Clinically significant depressive symptoms: PHQ-9≥10;

   - A PAMF patient for ≥1 year

   - Seen in primary care at least once in the preceding 24 months;

   - Able and willing to enroll and meet the requirements of the study

Exclusion criteria:

   - Inability to speak, read or understand English;

   - Having no reliable telephone service, no device to use to watch a DVD, or no regular
   Internet access via a computer and/or mobile device;

   - Had bariatric surgery within the past 12 months or plans to undergo bariatric surgery
   during the 24-month study period;

   - Ongoing psychiatric care outside of the PAMF network.

   - Active suicidal ideation that includes active plan and/or intent;

   - Any Axis I disorder other than Minor or Major Depressive Disorder and/or Dysthymia,
   with the exception of any comorbid Anxiety Disorder;

   - Active Bulimia Nervosa within the past 12 months (however Binge Eating Disorder
   without purging is not an exclusionary condition);

   - Active alcohol or substance use disorder (including prescription drugs).

   - Pre-existing diabetes (other than during pregnancy) or diabetes diagnosed as a result
   of fasting blood glucose or hemoglobin A1c levels obtained through study screening;

   - Pre-existing cardiovascular disease.

   - Diagnosis of cancer (other than non-melanoma skin cancer) that is/was active or
   treated with radiation or chemotherapy within the past 12 months;

   - Severe medical comorbidities that require aggressive treatment, e.g., stage 4 or
   greater renal disease, liver failure;

   - Diagnosis of a terminal illness and/or in hospice care;

   - Residence in long-term care facility;

   - Cognitive impairment based on the Callahan 6-item scale

   - Plan to move out of the area or transfer care outside PAMF during the study period;

   - Investigator discretion for reasons of clinical safety or protocol adherence.

ENGAGE

Inclusion criteria:

• RAINBOW participant

Exclusion criteria:

   - Weight over 350 pounds

   - MRI is contraindicated

   - Traumatic brain injury