Engaging Self-regulation Targets to Improve Mood and Weight and Understand Mechanism in Depressed and Obese Adults

Inclusion Criteria:

   - Age: ≥18 years

   - Body mass index based on study measurements at baseline group orientation: ≥30.0 kg/m2
   (≥27.0 if Asian), and weight <350 pounds (due to fMRI scanner size limitations)

   - Elevated depressive symptoms as per 9-item Patient Health Questionnaire (PHQ-9) scores
   ≥10 on study screening

   - UI Health patient seen in primary care at least once in the preceding 18 months

   - Able and willing to enroll and provide written informed consent

Exclusion Criteria:

   - Active suicidal ideation based on PHQ-9 or the 20-item depression symptom checklist
   (SCL-20) that includes active plan and/or intent

   - Any other psychiatric disorder other than persistent depressive disorder and/or major
   depressive disorder, with the exception of any comorbid anxiety disorder

   - Active Bulimia Nervosa within the past 3 months (however Binge Eating Disorder without
   purging is not an exclusionary condition)

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

   - Currently under the care of a psychiatrist or licensed mental health therapist outside
   of UI Health

   - Had bariatric surgery (e.g., bypass, banding, sleeve, or biliopancreatic diversion
   with duodenal switch) within the past 12 months or plan to undergo bariatric surgery
   during the study period

   - Pre-existing diabetes (other than during pregnancy)

   - Pre-existing cardiovascular disease: e.g., coronary heart disease (myocardial
   infarction, angina pectoris, percutaneous coronary intervention, and coronary artery
   bypass graft surgery), cerebrovascular disease (stroke, transient ischemic attack),
   peripheral vascular disease, heart failure, or aortic aneurysm.

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

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

   - Diagnosis of a terminal illness and/or residence in a long-term care facility

   - Cognitive impairment based on the Callahan 6-item screener

   - MRI is contraindicated (weight over 350 pounds, traumatic brain injury, tumor or any
   other known structural abnormality in brain, bullet, shrapnel, or other projectile
   above the shoulder, not being able to lie down in an fMRI scanner for about an hour
   due to claustrophobia, personal history of epilepsy, convulsions, or seizures, have
   piercings that cannot be removed)

   - Traumatic brain injury; Tumor or any other known structural abnormality in brain

   - Inability to speak, read or understand English

   - No reliable telephone service, or no regular Internet access via a computer and/or
   mobile device (e.g., smartphone)

   - Plan to move out of the area or transfer care outside UI Health during the study
   period

   - Currently pregnant, lactating, or planning to become pregnant during the study period

   - Already enrolled, or planning to enroll, in another medical or behavioral intervention
   research study

   - Family/household member of another participant or of a staff member

   - Investigator discretion for clinical safety or protocol adherence reasons