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Obesity prevention and control Lessons from campaigns, intervention and advocacy

Professor Annie S. Anderson Centre for Public Health Nutrition Research Centre for Research into Cancer Prevention and Screening Ninewells Medical School, University of Dundee email: a.s.anderson@dundee.ac.uk. Obesity prevention and control

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Obesity prevention and control Lessons from campaigns, intervention and advocacy

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  1. Professor Annie S. Anderson Centre for Public Health Nutrition Research Centre for Research into Cancer Prevention and Screening Ninewells Medical School, University of Dundee email: a.s.anderson@dundee.ac.uk Obesity prevention and control Lessons from campaigns, intervention and advocacy Obesity – the elephant in the room in cancer communities @anniescotta @thescpn

  2. What % cancer could be prevented in the UK if everyone was a healthy weight? http://www.wcrf-uk.org/uk/preventing-cancer/lifestyle-st19atistics/body-fatness

  3. Evidence Base for Action Success has many parents!

  4. Why explore the screening setting? • Screening “awakens curiosity” about disease and causes (Bankhead et al, 2003) • Existing healthcare setting and structure • Re-enforcement of public health efforts • Endorsement by cancer experts (as opposed to prevention messages from corn flakes packets, newspapers etc)

  5. Full RCT Trial ahead January 2017

  6. Shared and accepted understanding of lifestyle and risk? “You're lucky or you're unlucky...if it's going to be, it's going to be.” “if it's for you, it won't go by you, whether or not you do all these things”

  7. Opportunities for advocacy in Colorectal cancer setting

  8. People know it all already

  9. Link between lifestyle factors and adenoma • No information received on possible contributory factors, nor on prevention of recurrence

  10. People don’t want to know about lifestyle things at this age

  11. BeWEL Recruitment – people are interested in lifestyle intervention Adults screened positive for adenoma aged 50 to 74 years (n=997) Responded ‘No’ n= 345 (35%) Did not respond n=160 (16%) Changed mind n=42 (9%) Responded ‘Yes’ n=492 (49%) • Ineligible • BMI <25kg/m2 n=108(22%) • ‘Yes’ ineligible as reply received after study closing to recruitment n=13(3%) Randomised n=329

  12. Baseline and Clinical Characteristics at Randomisation Data are mean ± SD or number (%) unless stated otherwise. *Scottish Index of Multiple Deprivation

  13. It’s the worried well again…

  14. Worried unwell …Type 2 diabetes among an overweight population of adults screening positive for colorectal adenoma (Steele et al, 2015, Colorect Dis) Randomised n=329 Existing Type 2 Diabetes n=47(14.3%) Incomplete biochemistry n=32 (9.7%) Diabetes risk assessment n=250 Low to moderate risk FPG<5.5 mmol/l or HbA1c <42 mmol/l (6.0%)  n=106 (42.4%) Type 2 Diabetes FPG 7.0 mmol/l or HbA1c 48 mmol/l (6.5%)  n=19 (7.6%) High risk FPG 5.5 - 6.9 mmol/l or HbA1c 42 - 47 mmol/l (6.0 – 6.4%) n=125 (50.0%)

  15. But can people really change their lifestyle?

  16. Over a 12 month period: • Retention 91% • Weight loss 3.50kg (CI 2.70 to 4.30) • Significant reduction in blood pressure, blood glucose, diet, physical activity, waist circumference • Cost £172 (£3.30 pw) plus travel and admin • Recruited – 74% men, mean age 63.6 years, 35 % in SIMD 1 and 2

  17. Conclusions • Screening settings offer an opportunity for expert endorsement of lifestyle change for older adults, men and wide SES • Absence of advice may create health certificate effect • People ARE NOT knowledgeable about lifestyle and CRC • People ARE interested in lifestyle intervention related to CANCER • People with adenomas do respond positively to intervention initiation and maintenance • Interventions can have positive effects on body weight and other health outcomes Lets not wait till diagnosis…………………….

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