Food and exercise can treat depression as well as a psychologist, our study found. And it’s cheaper
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Around 3.2 million Australians live with depression.
At the same time, few Australians meet recommended dietary or physical activity guidelines. What has one got to do with the other?
Our world-first trial, published this week, shows improving diet and doing more physical activity can be as effective as therapy with a psychologist for treating low-grade depression.
Previous studies (including our own) have found “lifestyle” therapies are effective for depression. But they have never been directly compared with psychological therapies – until now.
Amid a nation-wide shortage of mental health professionals, our research points to a potential solution. As we found lifestyle counselling was as effective as psychological therapy, our findings suggest dietitians and exercise physiologists may one day play a role in managing depression.
What did our study measure?
During the prolonged COVID lockdowns, Victorians’ distress levels were high and widespread. Face-to-face mental health services were limited.
Our trial targeted people living in Victoria with elevated distress, meaning at least mild depression but not necessarily a diagnosed mental disorder. Typical symptoms included feeling down, hopeless, irritable or tearful.
We partnered with our local mental health service to recruit 182 adults and provided group-based sessions on Zoom. All participants took part in up to six sessions over eight weeks, facilitated by health professionals.
Half were randomly assigned to participate in a program co-facilitated by an accredited practising dietitian and an exercise physiologist. That group – called the lifestyle program – developed nutrition and movement goals:
- eating a wide variety of foods
- choosing high-fibre plant foods
- including high quality fats
- limiting discretionary foods, such as those high in saturated fats and added sugars
- doing enjoyable physical activity.
The second group took part in psychotherapy sessions convened by two psychologists. The psychotherapy program used cognitive behavioural therapy (CBT), the gold standard for treating depression in groups and when delivered remotely.
In both groups, participants could continue existing treatments (such as taking antidepressant medication). We gave both groups workbooks and hampers. The lifestyle group received a food hamper, while the psychotherapy group received items such as a colouring book, stress ball and head massager.
Lifestyle therapies just as effective
We found similar results in each program.
At the trial’s beginning we gave each participant a score based on their self-reported mental health. We measured them again at the end of the program.
Over eight weeks, those scores showed symptoms of depression reduced for participants in the lifestyle program (42%) and the psychotherapy program (37%). That difference was not statistically or clinically meaningful so we could conclude both treatments were as good as each other.
There were some differences between groups. People in the lifestyle program improved their diet, while those in the psychotherapy program felt they had increased their social support – meaning how connected they felt to other people – compared to at the start of the treatment.
Participants in both programs increased their physical activity. While this was expected for those in the lifestyle program, it was less expected for those in the psychotherapy program. It may be because they knew they were enrolled in a research study about lifestyle and subconsciously changed their activity patterns, or it could be a positive by-product of doing psychotherapy.
There was also not much difference in cost. The lifestyle program was slightly cheaper to deliver: A$482 per participant, versus $503 for psychotherapy. That’s because hourly rates differ between dietitians and exercise physiologists, and psychologists.
What does this mean for mental health workforce shortages?
Demand for mental health services is increasing in Australia, while at the same time the workforce faces worsening nation-wide shortages.
Psychologists, who provide about half of all mental health services, can have long wait times. Our results suggest that, with the appropriate training and guidelines, allied health professionals who specialise in diet and exercise could help address this gap.
Lifestyle therapies can be combined with psychology sessions for multi-disciplinary care. But diet and exercise therapies could prove particularly effective for those on waitlists to see a psychologists, who may be receiving no other professional support while they wait.
Many dietitians and exercise physiologists already have advanced skills and expertise in motivating behaviour change. Most accredited practising dietitians are trained in managing eating disorders or gastrointestinal conditions, which commonly overlap with depression.
There is also a cost argument. It is overall cheaper to train a dietitian ($153,039) than a psychologist ($189,063) – and it takes less time.
Potential barriers
Australians with chronic conditions (such as diabetes) can access subsidised dietitian and exercise physiologist appointments under various Medicare treatment plans. Those with eating disorders can also access subsidised dietitian appointments. But mental health care plans for people with depression do not support subsidised sessions with dietitians or exercise physiologists, despite peak bodies urging them to do so.
Increased training, upskilling and Medicare subsidies would be needed to support dietitians and exercise physiologists to be involved in treating mental health issues.
Our training and clinical guidelines are intended to help clinicians practising lifestyle-based mental health care within their scope of practice (activities a health care provider can undertake).
Future directions
Our trial took place during COVID lockdowns and examined people with at least mild symptoms of depression who did not necessarily have a mental disorder. We are seeking to replicate these findings and are now running a study open to Australians with mental health conditions such as major depression or bipolar disorder.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Adrienne O’Neil, Professor, Food & Mood Centre, Deakin University and Sophie Mahoney, Associate Research Fellow, Food and Mood Centre, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Longevity for the Lazy – by Dr. Richard Malish
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There are some people who devote all their resources to longevity, which can become a full-time occupation, not to mention a very expensive endeavor. This book’s for those who want to get the best possible “bang for buck” by doing the things that have the most favorable cost:worth ratio.
Dr. Malish covers what can be done easily for personal longevity, as well as what technological advances can be enjoyed that those before us didn’t have as options. He also discusses the diseases that are most likely to kill us, and how to avoid those.
He preaches a proactive approach, but one that is simple and consistent and based in good science, and good statistics. Indeed, while he’s served 20 years as an army doctor and a cardiologist, he now works as a healthcare policy consultant, so he is well-placed to advise.
The style of the book is halfway between regular pop-science and a textbook; you can either read it cover-to-cover, or skim first though the key points, highlight boxes, summaries, and the like. He also provides a time-phased task list, for those who like things to be laid out like that.
Bottom line: this is a very good, methodical guide to living longer without making it a full-time occupation.
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Widen the Window – by Dr. Elizabeth Stanley
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Firstly, about the title… That “window” that the author bids us “widen” is not a flowery metaphor, but rather, is referring to the window of exhibited resilience to stress/trauma; the “window” in question looks like an “inverted U” bell-curve on the graph.
In other words: Dr. Stanley’s main premise here is that we respond best to moderate stress (i.e: in that window, the area under the curve!), but if there is too little or too much, we don’t do so well. The key, she argues, is widening that middle part (expanding the area under the curve) in which we perform optimally. That way, we can still function in a motivated fashion without extrinsic threats, and we also don’t collapse under the weight of overwhelm, either.
The main strength of this book, however, lies in its practical exercises to accomplish that—and more.
“And more”, because the subtitle also promised recovery from trauma, and the author delivers in that regard too. In this case, it’s about widening that same window, but this time to allow one’s parasympathetic nervous system to recognize that the traumatic event is behind us, and no longer a threat; we are safe now.
Bottom line: if you would like to respond better to stress, and/or recover from trauma, this book is a very good tool.
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Exercises for Sciatica Pain Relief
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Jessica Valant is a physiotherapist and Pilates teacher, and today she’s going to demonstrate some exercise that relieve (and also correct the cause of) sciatica pain.
Back to good health
You will need a large strap for one of these exercises; a Pilates strap is great, but you can also use a towel. The exercises are:
Pelvic Rocking Exercise:
- Lie on your back, feet flat, knees bent.
- Gently rock your pelvis forwards and backwards (50% effort, no glute squeezing).
Leg Stretch with Strap:
- Straighten your left leg and loop the strap around the ball of your right foot.
- Gently straighten and bend your right leg while holding the strap.
- Perform a “nerve glide” by flexing and pointing your foot (not a stretch, just gentle movement).
- Repeat on the left leg.
Piriformis Stretch:
- Bend your right knee and place your left ankle over it (figure-four position).
- For a deeper stretch, hold your right thigh and pull your legs inwards.
Lower Back Release:
- Let your legs fall gently to one side after stretching each leg, opening the lower back.
Back Extension:
- Lie on your belly, placing your elbows down, palms flat.
- Optional: push up slightly into a back bend if it feels comfortable.
Seated Stretching:
- Finish by sitting cross-legged or on a chair.
- Inhale while raising your arms up, exhale while lowering them down, then reach sideways with your arms to stretch.
- Perform gentle neck stretches by tilting your ear to your shoulder on each side.
She recommends doing these exercises daily for at least a few weeks, though you should start to see improvement in your symptoms immediately. Nothing here should cause a problem or make things worse, but if it does, stop immediately and consult a local physiotherapist for more personalized advice.
For more on all of this, plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
6 Ways To Look After Your Back
Take care!
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“You Just Need to Lose Weight” And 19 Other Myths About Fat People – by Aubrey Gordon
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We’ve previously reviewed another book by this author, “What We Don’t Talk About When We Talk About Fat”, and this time, she’s doing some important mythbusting.
The titular “you just need to lose weight” is a commonly-taken easy-out for many doctors, to avoid having to dispense actual treatment for an actual condition. Whether or not weight loss would help in a given situation is often immaterial; “kicking the can down the road” is the goal.
Most of the book is divided into 20 chapters, each of them devoted to debunking one myth. Think of it like 10almonds’ “Mythbusting Friday” edition (indeed, we did one about obesity), but with an entire book, and as much room as she needs to provide much more detail than we can ever get into in a single article.
And far from being a mere polemic, she does indeed provide that detail—this is clearly a very well-researched book, above and beyond the author’s own personal experience. Further, all the key points are illustrated and articulated clearly, making the book’s ideas very comprehensible.
The style is pop-science, but with frequent bibliographical references for relevant sources.
Bottom line: for some readers, this book will come as a great validation; for others, it may be eye-opening. Either way, it’s a very worthwhile read.
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Peach vs Papaya – Which is Healthier?
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Our Verdict
When comparing peach to papaya, we picked the peach.
Why?
It was close!
In terms of macros, there’s not much between them; they are close to identical on protein, carbs, and fiber. Technically peach has slightly more protein (+0.4g/100g) and papaya has slightly more carbs and fiber (+1.28g/100g carbs, +0.2g/100g fiber), but since the differences are so tiny, we’re calling this section a tie—bearing in mind, these numbers are based on averages, which means that when they’re very close, they’re meaningless—one could easily, for example, pick up a peach that has more fiber than a papaya, because that 0.2g/100g is well within the margin of variation. So, as we say: a tie.
When it comes to vitamins, things are also close; peaches have more of vitamins B1, B2, B3, and E, while papaya has more of vitamins A, B6, B9, and C. This is a 4:4 tie, but since the most notable margin of difference is vitamin C (of which papayas have 9x more) while the others are much closer, we’ll call this a tie-breaker win for papaya.
The category of minerals sets things apart more: peaches have more copper, iron, manganese, phosphorus, potassium, and zinc, while papaya has more calcium, magnesium, and selenium. That’s already a 6:3 win for peaches, before we take into account that the numbers for papaya’s calcium and selenium are tiny, so adding this to the already 6:3 win for peaches makes for a clear and easy win for peaches in this category.
Adding up the sections is 1W/1D/1L for both fruits, but looking at the win/loss for each, it’s clear which won/lost on a tiebreaker, and which won/lost by a large margin, so peaches get the victory here.
Of course, enjoy either or both, though! And see below for a bonus feature of peaches:
Want to learn more?
You might like to read:
Top 8 Fruits That Prevent & Kill Cancer ← peaches are high on this list! They kill cancer cells while sparing healthy ones 🙂
Take care!
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Eating Disorders: More Varied (And Prevalent) Than People Think
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Disordered Eating Beyond The Stereotypes
Around 10% of Americans* have (or have had) an eating disorder. That might not seem like a high percentage, but that’s one in ten; do you know 10 people? If so, it might be a topic that’s near to you.
*Source: Social and economic cost of eating disorders in the United States of Americ
Our hope is that even if you yourself have never had such a problem in your life, today’s article will help arm you with knowledge. You never know who in your life might need your support.
Very misunderstood
Eating disorders are so widely misunderstood in so many ways that we nearly made this a Friday Mythbusting edition—but we preface those with a poll that we hope to be at least somewhat polarizing or provide a spectrum of belief. In this case, meanwhile, there’s a whole cluster of myths that cannot be summed up in one question. So, here we are doing a Psychology Sunday edition instead.
“Eating disorders aren’t that important”
Eating disorders are the second most deadly category of mental illness, second only to opioid addiction.
Anorexia specifically has the highest case mortality rate of any mental illness:
Source: National Association of Anorexia Nervosa & Associated Disorders: Eating Disorder Statistics
So please, if someone needs help with an eating disorder (including if it’s you), help them.
“Eating disorders are for angsty rebellious teens”
While there’s often an element of “this is the one thing I can control” to some eating disorders (including anorexia and bulimia), eating disorders very often present in early middle-age, very often amongst busy career-driven individuals using it as a coping mechanism to have a feeling of control in their hectic lives.
13% of women over 50 report current core eating disorder symptoms, and that is probably underreported.
Source: as above; scroll to near the bottom!
“Eating disorders are a female thing”
Nope. Officially, men represent around 25% of people diagnosed with eating disorders, but women are 5x more likely to get diagnosed, so you can do the math there. Women are also 1.5% more likely to receive treatment for it.
By the time men do get diagnosed, they’ve often done a lot more damage to their bodies because they, as well as other people, have overlooked the possibility of their eating being disordered, due to the stereotype of it being a female thing.
Source: as above again!
“Eating disorders are about body image”
They can be, but that’s far from the only kind!
Some can be about control of diet, not just for the sake of controlling one’s body, but purely for the sake of controlling the diet itself.
Still yet others can be not about body image or control, like “Avoidant/Restrictive Food Intake Disorder”, which in lay terms sometimes gets dismissed as “being a picky eater” or simply “losing one’s appetite”, but can be serious.
For example, a common presentation of the latter might be a person who is racked with guilt and/or anxiety, and simply stops eating, because either they don’t feel they deserve it, or “how can I eat at a time like this, when…?” but the time is an ongoing thing so their impromptu fast is too.
Still yet even more others might be about trying to regulate emotions by (in essence) self-medicating with food—not in the healthy “so eat some fruit and veg and nuts etc” sense, but in the “Binge-Eating Disorder” sense.
And that latter accounts for a lot of adults.
You can read more about these things here:
Psychology Today | Types of Eating Disorder ← it’s pop-science, but it’s a good overview
Take care! And if you have, or think you might have, an eating disorder, know that there are organizations that can and will offer help/support in a non-judgmental fashion. Here’s the ANAD’s eating disorder help resource page, for example.
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