A Pilot Randomized Controlled Trial of a Commercial Diet and Exercise Weight Loss Program in Minority Breast Cancer Survivors

Abstract

Objective-Obesity is associated with poorer breast cancer outcomes and losing weight postdiagnosis may improve survival. As Hispanic and black women have poorer breast cancer prognosis than non-Hispanic whites diagnosed at similar age and stage, and have higher rates of obesity, effective weight loss strategies are needed. We piloted a randomized, waitlist-controlled, crossover study to examine the effects and feasibility of the commercial Curves weight loss program among Hispanic, African American and Afro-Caribbean breast cancer survivors.Design and Methods-Women with stage 0-IIIa breast cancer ≥6 months posttreatment, sedentary, and BMI ≥25 kg/m 2 were randomized to the immediate arm (IA): 6 months of the Curves program followed by 6 months of observation; or the waitlist control arm (WCA): 6 months of observation followed by 6 months of the Curves program. The Curves program uses a 30-min exercise circuit and a high-vegetable/low-fat/calorie-restricted diet.Results-A total of 42 women enrolled (79% Hispanic, 21% black), mean age 51 (range 32-69) and mean BMI 33.2(±5.9) kg/m 2 ; 91% were retained at month 12. At month 6, women in the IA lost an average 3.3% (±3.5%) of body weight (range: 1.7% gain to 10.6% loss), as compared with 1.8% (±2.9%) weight loss in the WCA (P = 0.04). At month 12, on average women in the IA regained some but not all of the weight lost during the first 6 months (P = 0.02). HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusions-Minority breast cancer survivors were recruited and retained in a weight loss study. Six months of the Curves program resulted in moderate weight loss, but weight loss was not maintained postintervention. Future interventions should identify methods to increase uptake and maintenance of weight loss behaviors.

Weight Loss Randomized Intervention Trials in Female Cancer Survivors

“…One study was limited to a subgroup of breast cancer survivors, broadly defined as those with estrogen receptor (ER) -positive tumors, 18 and two exclusively recruited African American or Hispanic women. 11,12 Five studies reported mean time since diagnosis at baseline, with this ranging from 3.5 to 5.6 years. [10][11][12]14,18 Interventions varied considerably in their behavioral targets, delivery, and duration.…”

“…11,12 Five studies reported mean time since diagnosis at baseline, with this ranging from 3.5 to 5.6 years. [10][11][12]14,18 Interventions varied considerably in their behavioral targets, delivery, and duration. Six trials targeted both diet and physical activity, [10][11][12][13][14][15] with the remaining four addressing dietary intake only.…”

“…14 Six studies evaluated interventions of # 6 months' duration, 12,[14][15][16][17][18] and the remaining four studies evaluated interventions of $ 12 months. [9][10][11]13 Weight loss was the primary outcome reported in all studies.…”

“…Six measured clinical biomarkers, 10,[12][13][14][15]18,19 with relatively consistent changes seen in reductions in LDL cholesterol and glucose in groups losing weight. Five trials reported on insulin pathways, adipokines, and inflammatory markers, all factors associated with breast cancer progression.…”

Understanding and influencing the maintenance of physical activity and dietary behaviour change in breast cancer survivors

“…A recent systematic review of weight loss trials in breast cancer survivors reported a total of 10 randomised controlled trials and four single-arm trials have evaluated interventions of two to 18 months in duration, with approximately half reporting mean successful weight loss of at least 5% at end-of-intervention . Of the two trials that reported maintenance outcomes following end-of-intervention, one reported ongoing weight loss at three-months follow-up (Campbell et al, 2012) while the other reported nearly half of initial weight loss was regained at six-months follow-up (Greenlee et al, 2013). The recently published Lifestyle Intervention in Adjuvant Treatment of Early Breast Cancer (LISA) trial randomised breast cancer survivors to a two-year weight loss intervention and reported participants lost an initial 5.3% of weight at six-months, but regained 65% of initial weight loss by two-years follow-up (Goodwin et al, 2014).…”