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Weighing the Options: Criteria for Evaluating Weight-Management Programs
(Stunkard and Rush, 1974), more recent reviews (Wing et al., 1984) do not find increases in measures of depression or anxiety as a result of weight loss. Perhaps this is because later studies are often more group-oriented and provide emotional buffers or social support. Nonetheless, some patients may experience problem mood states, such as depression, that need to be assessed. Although few studies have examined the psychological consequences of regaining weight, Brownell and Stunkard (1981) found that although patients' depression scores decreased as they lost weight, depression levels rose for those patients who regained weight during a one-year follow-up period. The Beck Depression Inventory and the Hamilton Psychiatric Rating Scale for Depression are two frequently used measures of depression.
Beck Depression Inventory (BDI) BDI is used to detect possible depression and to assess its severity (Beck et al., 1961, 1988). It measures cognitive, affective, somatic, and performance-related symptoms of depression. BDI can be self-administered or administered orally and takes 5–15 minutes to complete. The scale consists of a total score of 21 items, or sets of statements, answered on a 0-to-3 scale of severity of depressive problems. The possible score range is from 0 to 63, with higher scores indicating greater severity of depression. The subject is asked to consider feelings in the last week. The internal consistency coefficient alpha for the BDI ranges from 0.73 to 0.95. Test-retest correlations range from 0.48 to 0.86. Discriminant validity has been reported to be fairly strong, and the scale has been shown to correlate well with biological and somatological issues, suicidal behaviors, alcoholism, adjustment, and life crisis. Concurrent validity studies show correlations between 0.60 and 0.76 with clinical ratings and other depression scales (Conoley, 1992; Sundberg, 1992).
Hamilton Psychiatric Rating Scale for Depression This scale consists of 17 items presented by an interviewer in a semistructured interview (Hamilton, 1960). Items are scored 0–2 or 0–4 to reflect increasing severity of the symptom. Scores are totaled, and higher scores indicate more severe depression. Inter-rater reliability has ranged between 0.80 and 0.90 (Goldman and Mitchell, 1990).
Stress and Social Support
Untoward life events often have a substantial impact on obese patients' psychosocial functioning and their ability to control weight. Such events include loss of a family member and work, financial, or health problems. Four examples of measures designed to assess major life events and social readjustment are the Social Readjustment Rating Scale, Life