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 email: a.s.anderson@dundee.ac.uk @anniescotta @thescpn

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 http://www.wcrf-uk.org/uk/preventing-cancer/lifestyle-st19atistics/body-fatness

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

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)

Full RCT Trial ahead January 2017

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”

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

People know it all already

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.

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

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

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

It’s the worried well again…

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 5.5 - 6.9 mmol/l or HbA1c 42 - 47 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%)

But can people really change their lifestyle?

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

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…………………….