Adherence and weight loss with a total diet replacement programme for increased cancer risk associated with obesity: a UK cohort study
Helen Clarke, Cheryl Lombardelli, Emma Barrett, Julie Wisely, Katharine Sellers, Basil Issa, Anthony Howell, Emma J Davidson, Sacha Howell, Michelle HarvieObjective
To evaluate engagement and weight loss with a 12-month total diet replacement (TDR) programme in women with increased risk of breast and endometrial cancer, living with obesity.
Design
Prospective cohort study.
Setting
Secondary care.
Participants
47 premenopausal women living with obesity.
Intervention
12-month programme including a 12-week TDR phase with biopsies of the breast and endometrium, before and after, followed by 4 weeks of diet reintroduction and a weight maintenance/continued weight loss phase (weeks 17–52). Primary and secondary outcome measures: This paper reports retention and adherence to the programme, weight loss, changes in mental well-being, quality of life (QoL), weight loss self-efficacy, physical activity and fidelity of delivery of the programme.
Results
37 women (79%) completed the whole programme. Completers and those who withdrew, respectively, had a mean (SD) age of 41.4 years (5.7) vs 38.1 (5.8) and baseline body mass index of 36.2 (4.9) kg/m 2 vs 40.0 (7.9) kg/m 2 and 76% vs 90% had children 18 or younger living at home. Median (IQR) weight was reduced at all time points; −10.8 kg (−13.8, −7.2) at 3 months, −11.5 kg (−15, −7.6) at 6 months, −11.0 kg (−16.4, −7.8) at 9 months and −8.4 kg (−13.9, −3.7) at 12 months. Across the 12-month programme, the median (IQR) contacts with the study dietitians per participant was 28 (25, 33) and median contact hours were 7.6 (6.6, 10.6). 68% received psychological support. QOL improved; OWL-QOL (Obesity and Weight Loss)−17 (−24.8, −7.8) and EQ5D 1 (0, 2), with reductions in binge eating scores −4 (−6.5, −0.8) but no changes in mental health or physical activity scales.
Conclusions
TDR could be a weight loss programme for women at increased risk of breast and endometrial cancers related to obesity. Future controlled trials with extended follow-up are required before recommending routine implementation of TDR in high-risk clinics.
Trial registration number