1. Obesity – the elephant in the room in cancer communities
Obesity prevention and control
Lessons from campaigns, intervention and advocacy
Obesity – the elephant in the room in cancer communities
Professor Annie S. Anderson
Centre for Public Health Nutrition Research
Centre for Research into Cancer Prevention and Screening
Ninewells Medical School,
University of Dundee

3. What % cancer could be prevented in the UK if everyone was a healthy weight?
Type of cancer
(%)
Number
Oesophagus (adenocarcinoma) 32
1700
Pancreas 15
1,400
Gallbladder 17
300
Bowel 14
6000
Breast 16
6,900
Womb 38
3300
Kidney 19
2100
Ovary 4
280
Prostate (adva) 9
940
Liver 20
1100
Stomach (cardia)
660
Total for 11cancers combined
24,700

4. Success has many parents!
Evidence Base for Action
Success has many parents!

5. 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)

6. Full RCT Trial ahead January 2017

7. 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”

8. Opportunities for advocacy in Colorectal cancer setting
In CRC Screening
Invitation
Negative results
Positive results (adenoma)

9. People know it all already

10. Link between lifestyle factors and adenoma
No information received on possible contributory factors, nor on prevention of recurrence
Most stated they didn't know what might have caused their adenoma and none had recalled receiving information on possible contributory factors.
Health status varied and many had other conditions e.g. heart disease which they reported being aware of the links with lifestyle, but hadn't been made aware of the same links with their polyps.

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

12. Adults screened positive for adenoma aged 50 to 74 years
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

13. Baseline and Clinical Characteristics at Randomisation
Intervention
(n=163)
Control
(n=166)
All
(n=329)
Age (years)
Range
63.5  7.0
50 – 75
63.6  6.7
63.6  6.8
Male gender
120 (73.6%)
123 (74.1%)
243 (73.9%)
Employment status
Retired
Employed full-time
Employed part-time
Unemployed
Other
90 (55.2%)
45 (27.6%)
18 (11.0%)
2 (1.2%)
8 (4.9%)
97 (58.4%)
41 (24.7%)
14 (8.4%)
10 (6.0%)
4 (2.4%)
187 (56.8%)
86 (26.1%)
32 (9.7%)
12 (3.6%)
SIMD* (quintiles)
1 (most deprived) 2 3 4
5 (least deprived)
25 (15.3%)
33 (20.2%)
26 (16.0%)
39 (23.9%)
40 (24.5%)
29 (17.5%)
28 (16.9%)
33 (19.9%)
45 (27.1%)
31 (18.7%)
54 (16.4%)
61 (18.5%)
59 (17.9%)
84 (25.5%)
71 (21.6%)
Data are mean ± SD or number (%) unless stated otherwise. *Scottish Index of Multiple Deprivation

14. It’s the worried well again…

15. 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%)
High risk
FPG mmol/l or
HbA1c mmol/l
(6.0 – 6.4%)
n=125 (50.0%)
Type 2 Diabetes
FPG 7.0 mmol/l or
HbA1c 48 mmol/l
(6.5%) 
n=19 (7.6%)

16. But can people really change their lifestyle?

17. 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

18. 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…………………….