Technology & phone counseling to promote weight loss in women at elevated breast cancer risk: A pilot randomized controlled trial

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1 Technology & phone counseling to promote weight loss in women at elevated breast cancer risk: A pilot randomized controlled trial Sheri J. Hartman 1, Sandahl Nelson 1, Lisa Cadmus-Bertram 2, Barbara Parker 1, John Pierce 1 1 University of California, San Diego 2 University of Wisconsin Madison

2 Factors are associated with breast cancer risk Age Family history Breastfeeding Weight Alcohol Inactivity Age at menarche Parity

3 Factors are associated with breast cancer risk Age Family history Breastfeeding Weight Alcohol Inactivity Age at menarche Parity

4 Estimated % of How Much Breast Cancer Could be Prevented in the US Weight Inactivity

5 Hazard Ratio Obesity & Postmenopausal Breast Cancer Risk HR=1.71 HR=1.27 HR=1.37 Reference < >31 BMI (kg/m2) Phipps et al., (2011) Cancer Epi Bio Prev

6 How can we leverage existing technologies to enhance our weight loss interventions?

7 The Healthy Eating and Living Program (HELP) for Weight Loss Study Telephone coaching + Commercially available technology based selfmonitoring

8 Food Weight

9 Automatic wireless upload Tracker View on computer or phone

10 The Healthy Eating and Living Program (HELP) for Weight Loss Study Use mammography registry to identify high-risk population Offer weight loss program to those who are overweight/obese Use a combined intervention approach: Technology based self-monitoring tools + health coaching

11 Study Goals and Measures Weight loss goals 10% of their starting weight Individual calorie goal set by myfitnesspal for 1-2 lb per week weight loss 150 min/week of mod-vigorous activity Outcome measures Height and Weight measured at baseline and 6 month clinic visit Actigraph GT3X+ hip worn for 7 days at baseline and 6 months

12 Screened for Eligibility (n=295) Ineligible (n=207) Randomized (n=54) Intervention (n=36) Usual Care (n=18) 6-month visit (n=33) 6 month visit (n=17)

13 Intervention Usual Care 12 phone calls Months 1&2: Weekly Month 3: Bi-weekly Months 4&5: Monthly Fitbit One Fitbit.com US Dietary Guidelines for Americans given at randomization 2 Brief Phone Calls Month 2 Month 5 Myfitnesspal.com

14 Baseline Characteristics (N=54) Intervention Usual Care Mean(SD)/% Mean(SD)/% n = 36 n = 18 Demographics Age 59.4 (5.6) 59.8 (5.9) College degree or higher Non-Hispanic White Adiposity & Physical Activity BMI (kg/m 2 ) 32.2 (3.4) 31.3 (3.7) Total MVPA (min/day) 17 (20.3) 10 (10.2) MVPA in 10-min bouts (min/day) 7 (18.6)** 1 (5.3)** Breast cancer risk Gail model score 2.6 (1.7) 2.5 (0.6) *p <.01; BMI = Body mass index, MVPA = Moderate-to-vigorous intensity physical activity

15 Weight Change (kg) % Weight Change Weight Change Baseline to 6 months Intervention Usual Care Intervention Usual Care kg % kg** -4-5 **p <.01, between groups %**

16 Min/day Accelerometer Measured Moderate to Vigorous Physical Activity Min/day Minutes per day of MVPA at 6 months 32* 13* 22 Intervention Usual Care Total accumulated MVPA MVPA in 10-min bouts only *p <.05, between groups Change in MVPA from baseline to 6 months Intervention Usual Care Total accumulated MVPA MVPA in 10-min bouts only

17 Min/day MVPA Greater % weight loss with greater MVPA Association of % Weight Change and Minutes per day of MVPA MVPA 10-min bouts % Weight Change Total accumulated MVPA p <.05, for trend

18 Conclusions Technology-based self-monitoring plus telephone counseling efficacious for weight loss Intervention Group engaged in more MVPA at 6 months than the Usual Care Group; Change in MVPA was not statistically different between the groups Greater MVPA was associated with greater weight loss

19 Future Directions Integrate information from technology into counseling calls Collect objective use data of fitbit and myfitnesspal using their open API Tease apart impact of telephone counseling vs. technology based-self-monitoring Test in a larger and more generalizable sample

20 Questions? Supported by the Carol Vassiliadis Family and by the University of California (UC) Athena Breast Health Network funded by Safeway Foundation and UC Office of the President

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