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