ObjectivesTo assess the feasibility of delivering and evaluating a weight management (WM) programme for overweight patients with a family history (FH) of breast cancer (BC) or colorectal cancer (CRC).Study designA two-arm (intervention vs usual care) randomised controlled trial.SettingNational Health Service (NHS) Tayside and NHS Grampian.ParticipantsPeople with a FH of BC or CRC aged≥18 years and body mass index of ≥25 kg/m2 referred to NHS genetic services.InterventionParticipants were randomised to a control (lifestyle booklet) or 12-week intervention arm where they were given one face-to-face counselling session, four telephone consultations and web-based support. A goal of 5% reduction in body weight was set, and a personalised diet and physical activity (PA) programme was provided. Behavioural change techniques (motivational interviewing, action and coping plans and implementation intentions) were used.Primary outcomeFeasibility measures: recruitment, programme implementation, fidelity measures, achieved measurements and retention, participant satisfaction assessed by questionnaire and qualitative interviews.Secondary outcomesMeasured changes in weight and PA and reported diet and psychosocial measures between baseline and 12-week follow-up.ResultsOf 480 patients approached, 196 (41%) expressed interest in the study, and of those, 78 (40%) patients were randomised. Implementation of the programme was challenging within the time allotted and fidelity to the intervention modest (62%). Qualitative findings indicated the programme was well received. Questionnaires and anthropometric data were completed by >98%. Accelerometer data were attained by 84% and 54% at baseline and follow-up, respectively. Retention at 12 weeks was 76%. Overall, 36% of the intervention group (vs 0% in control) achieved 5% weight loss. Favourable increases in PA and reduction in dietary fat were also reported.ConclusionsA lifestyle programme for people with a family history of cancer is feasible to conduct and acceptable to participants, and indicative results suggest favourable outcomes.Trial registration number ISRCTN13123470; Pre-results.

The first confirmed case of COVID-19 in South Africa (SA) was reported on 5 March 2020. [1,2] Since then, SA has become the most affected country in Africa, with 2.9 million cases and >89 000 deaths due to COVID-19 as at 1 November 2021. [3] SA experienced a high number of COVID-19 infections in the first wave, peaking in July. The daily cases then declined before a major surge in December, when the country experienced its second wave of increased cases, probably fuelled by a new variant of the virus. [4] Like many other countries globally, SA implemented an unprecedented national shutdown to combat the spread of the virus. [2,5] The implementation of the National State of Disaster on 15 March gave the government the power to carry out and implement what later became a five-level COVID-19 alert system. Of the five levels of restrictions, the highest, most restrictive is alert level 5 and the lowest alert level 1. Level 5 lockdown measures included drastic restrictions on movement and the closure of all non-essential activities. During level 1, most normal activities were allowed to take place with precautions and adhering to health guidelines. [6] At the onset, on 27 March, SA went into alert level 5 and over the months that followed gradually eased to level 1 in September (at the end of the first wave) and then back to level 3 in December (during the second wave). [1,7] SA is described as having a quadruple burden of disease resulting from non-communicable diseases (such as diabetes and hypertension), communicable diseases (such as HIV/AIDS and TB), an epidemic of maternal, newborn and child illnesses, and violence and injury. [8] The emergence of COVID-19 has placed additional pressure on an already strained healthcare system and has resulted in changes both in demand for and supply of healthcare generally. [9,10] On the demand side, public anxiety and fear of contracting COVID-19 have resulted in patients postponing care. Lockdown restrictions disrupted public transport services that clients use to access health facilities, and the indirect effects of the economic downturn have made healthseeking less manageable. With regard to supply, there has been a shift of resources from other healthcare issues, as hospital wards This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

The current work aimed to assess health behaviors, perceived risk and control over breast/colorectal cancer risk and views on lifestyle advice amongst attendees at cancer family history clinics. Participants attending the East of Scotland Genetics Service were invited to complete a questionnaire (demographic data, weight and height, health behaviors and psycho-social measures of risk and perceived control) and to participate in an in-depth interview. The questionnaire was completed by 237 (49 %) of attendees, ranging from 18 to 77 years (mean age 46 (±10) years). Reported smoking rates (11 %) were modest, most (54 %) had a BMI > 25 kg/m2, 55 % had low levels of physical activity, 58 % reported inappropriate alcohol intakes and 90 % had fiber intakes indicative of a low plant diet. Regression analysis indicated that belief in health professional control was associated with higher, and belief in fatalism with poorer health behavior. Qualitative findings highlighted doubts about the link between lifestyle and cancer, and few were familiar with the current evidence. Whilst lifestyle advice was considered interesting in general there was little appetite for non-tailored guidance. In conclusion, current health behaviors are incongruent with cancer risk reduction guidance amongst patients who have actively sought advice on disease risk. There are some indications that lifestyle advice would be welcomed but endorsement requires a sensitive and flexible approach, and the acceptability of lifestyle interventions remains to be explored.

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