Feasibility of a lifestyle intervention for overweight/obese endometrial and breast cancer survivors using an interactive mobile application

Highlights

• The purpose of this study was to elicit weight-loss via mobile app lifestyle intervention.

• The lifestyle intervention delivered via an app showed significant reductions in body weight.

• Significant improvements were noted in the Weight Efficacy Life-Style Questionnaire.

Abstract

Objective

The study aimed to assess a one-month lifestyle intervention delivered via a web- and mobile-based weight-loss application (app) (LoseIt!) using a healthcare-provider interface.

Methods

Early-stage overweight/obese (body mass index [BMI] ≥ 25 kg/m²) cancer survivors (CS) diagnosed in the past three years, and without recurrent disease were enrolled and received exercise and nutrition counseling using the LoseIt! app. Entry and exit quality of life (FACT-G) and Weight Efficacy Lifestyle Questionnaire (WEL) measuring self-efficacy were measured along with anthropometrics, daily food intake, and physical activity (PA) using the app.

Results

Mean participant age was 58.4 ± 10.3 years (n = 50). Significant reductions (p < 0.0006) in anthropometrics were noted between pre- and post-intervention weight (105.0 ± 21.8 kg versus 98.6 ± 22.5 kg); BMI (34.9 ± 8.7 kg/m² versus 33.9 ± 8.4 kg/m²); and waist circumference (108.1 ± 14.9 cm versus 103.7 ± 15.1 cm). A significant improvement in pre- and post-intervention total WEL score was noted (99.38 ± 41.8 versus 120.19 ± 47.1, p = 0.043). No significant differences were noted in FACT-G, macronutrient consumption, and PA patterns.

Conclusion

These results indicate that a lifestyle intervention delivered via a web- and mobile-based weight-loss app is a feasible option by which to elicit short-term reductions in weight. Though these results parallel the recent survivors of uterine cancer empowered by exercise and healthy diet (SUCCEED) trial, it is notable that they were achieved without encumbering significant cost and barrier-access issues (i.e. time, transportation, weather, parking, etc.).

Introduction

Overweight/obese endometrial (EC) and breast cancer (BC) survivors face numerous co-morbidities that are the leading cause of death that supersedes cancer diagnosis [1], [2]. The majority of women in the United States of America (USA) are overweight or obese; therefore, not surprising that the majority of EC and BC survivors are overweight or obese which can interfere with a survivor's recovery and subsequent quality of life (QOL) [2], [3], [4]. Correspondingly, the majority of overweight/obese cancer survivors are not meeting public health exercise and/or nutrition recommendations [2]. There is a critical need to determine what methods of weight-loss and risk factor reduction in this population are most effective. As a result, the strategic plan for the National Institutes of Health (NIH) Obesity Research calls for innovations to improve health outcomes in populations affected by obesity using theory based approaches such as Social Cognitive Theory (SCT) and Theory of Planned Behavior (TPB) [5], [6], [7].

Recent studies have demonstrated that increased obesity or body mass index (BMI) is associated with decreased survival [8], [9]. The National Cancer Institute (NCI) emphasizes the need for interventions including weight, physical activity, nutrition counseling that contribute to survivorship, and methods to improve health outcomes and mortality for cancer survivors [10], [11]. Improving body weight in EC and BC survivors may decrease morbidity and have the potential to improve overall survival since relative risk of death for obese EC women with a body mass index (BMI) 30–34 was 2.53, and BMI > 40 was 6.25; the highest of all cancers [12], [13]. Specifically, the risk of death from cardiovascular disease (CVD) related causes begin to exceed the risk from cancer-related causes 3.5 years after EC diagnosis [14]. Thus, interventions that address dietary change and increased exercise together are necessary to elicit weight-loss and improve cardiovascular disease risk factors. Lifestyle interventions have been shown to improve wellness, self-efficacy, and QOL in cancer survivors [15], [16], [17], [18].

Mobile health (mHealth) applications (aka. “apps”) using web- and/or a mobile-based app are tools that have the potential to improve effective patient-provider communication, adherence to treatment and self-management, especially in regards to weight-loss. In recent years, mobile phones have become a major conduit for communication and information. The uses of web- and mobile-based apps as a tool for health promotion and weight-loss have been successful in randomized trials [19], [20].

The current study aimed to assess the feasibility of delivering a lifestyle intervention focusing on weight-loss using a multi-disciplinary team via popular mHealth app (LoseIt!) which offers both a website and mobile versions for users. The secondary objective was to assess characteristics of EC and BC survivors in regards to nutrient intake, physical activity (PA), self-efficacy, QOL, and correlation to patient-provider contact points. We hypothesized that EC and BC survivors would be willing to engage in a lifestyle program using mHealth technology and improve the principal co-morbidity of weight.