BMJ open · 2026
Adherence and weight loss with a total diet replacement programme for increased cancer risk associated with obesity: a UK cohort study.
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Clarke Helen, Lombardelli Cheryl, Barrett Emma, Wisely Julie, Sellers Katharine, Issa Basil, Howell Anthony, Davidson Emma J, Howell Sacha, Harvie Michelle
Аннотация
OBJECTIVE: 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/m2 vs 40.0 (7.9) kg/m2 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: ISRCTN15358157.
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/m2 vs 40.0 (7.9) kg/m2 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: ISRCTN15358157.