Adherence to a Diet and Exercise Weight Loss Intervention amongst Women at Increased Risk of Breast Cancer
Evans, D. G. R.
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Maintained weight loss of five percent or more may reduce risk of breast cancer. We conducted a feasibility pilot study to assess adherence to an intensive 12 month diet and exercise weight control intervention aimed to achieve and maintain a five percent or greater weight loss as compared to a usual care group receiving written advice only. Overweight premenopausal women at increased risk of breast cancer were enrolled in a 12 month diet and exercise weight loss programme (n = 40) or a comparison group receiving usual care (n = 39). Changes in weight, general (DXA, bioelectrical impedance) and central adiposity (intra abdominal fat; MRI, waist), dietary intake, physical activity, cancer worry (Lerman score) and quality of life (SF-36) were assessed at 6 and 12 months, as well as long-term changes in weight and adiposity 12 and 42 months after the end of the intervention. Target weight loss (5%) was achieved by 55% of the intervention group at the end of the 12 month intervention but maintained by fewer at 24 (39%) and 54 months -(21%). Overall the intervention group achieved significant reductions in weight (mean [95% CI] -4.6 [-6.4 to -2.8] %), body fat (-4.0 [-5.2 to -2.7] ) kg, intra abdominal fat (-25.0 [-39.0 to -8.0])% and waist circumference (-4.0 [-6.8 to -2.0] cm) during the 12 month intervention and reported large reductions in intake of energy (-24.3 [-33.2 to -15.1] %), fat (-32 [-44 to -20] %), and alcohol (-35 [-52 to -13] %), and increased moderate activity (27 [7 to 44] minutes/day). These parameters did not change in the usual care group (all P < 0.05). A small proportion of the usual care group lost and maintained > 5% of their weight at 6 (16%), 12 (11%), 24 (11%) and 54 (13%) months (P < 0.05 at all time points). The intervention increased physical well being (SF-36; P < 0.05) but had no measurable effect on mental well being or cancer worry. Weight loss is achievable within our high risk women but not more so than in previous studies in the general population. Further studies are required to better understand factors which can promote compliance in women at increased risk of breast cancer.