Skip to main content

Preventing weight gain in African American breast cancer survivors using smart scales and activity trackers: a randomized controlled pilot study

Abstract

Purpose

This study evaluated the feasibility and preliminary efficacy of two 6-month, self-regulation interventions that focused on daily self-weighing (DSW) and used objective monitoring and tailored feedback about weight (±activity), to prevent weight gain among African American breast cancer survivors.

Methods

Participants (n = 35) were randomized to an intervention + activity monitoring (INT+), intervention (INT), or control (CON) group. Interventions included a wireless scale (±activity tracker) that transmitted objective data to a mobile app/website, emailed lessons, and tailored feedback based on objective weight (±activity data). Participants completed in-person and online assessments at baseline, 3 months, and 6 months.

Results

Ninety-four percent of participants completed assessments at 3 months, and 97 % at 6 months. Median (IQR) weight change after 6 months was −0.9 % (−4.4–0.1) in the INT+ (p = 0.075; p = 0.067 vs. CON) and −0.2 % (−4.2–1.3) in the INT groups (p = 0.463; p = 0.357 vs. CON), versus a 0.2 % (−0.7–1.7) gain in the CON group. The proportion of INT+, INT, and CON participants that were at or below baseline weight was 72.7, 53.8, and 45.5 %, respectively (effect sizes d = 0.64, d = 0.18). Most INT+ participants weighed and wore trackers ≥5 days/week (INT+, 81.9 % vs. INT, 38.5 % vs. CON, 0 %; p < 0.0005; INT+, 72.7 %). Both intervention groups perceived DSW as positive, and 100 % would recommend the program to other breast cancer survivors.

Conclusion

An intervention focused on DSW as a self-monitoring strategy shows promise for preventing weight gain in breast cancer survivors.

Implications for cancer survivors

Daily self-monitoring of weight and activity may be a feasible and accessible approach to promote weight gain prevention in breast cancer survivors.

Clinical trial registration

ClinicalTrials.gov, NCT02030353

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray, F. GLOBOCAN 2012 v1.1, cancer incidence and mortality worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer. 2014. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed January 22, 2016.

  2. American Cancer Society. Cancer treatment and survivorship facts & Figures 2014-2015. Atlanta: American Cancer Society; 2014. Available at http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-042801.pdf. Accessed January 22, 2016.

  3. Demark-Wahnefried W, Campbell KL, Hayes SC. Weight management and its role in breast cancer rehabilitation. Cancer. 2012;118(8 suppl):2277–87.

    Article  PubMed  Google Scholar 

  4. Vance V, Mourtzakis M, McCargar L, Hanning R. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011;12:282–94.

    CAS  Article  PubMed  Google Scholar 

  5. Bradshaw PT, Ibrahim JG, Stevens J, Cleveland R, Abrahamson PE, Satia JA, Teitelbau SL, Neugut AI, Gammon MD. Postdiagnosis change in bodyweight and survival after breast cancer diagnosis. Epidemiology. 2012;23:320–7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Caan BJ, Kwan ML, Shu XO, et al. Weight change and survival after breast cancer in the after breast cancer pooling project. Cancer Epidemiol Biomark Prev. 2012;21:1260–71.

    Article  Google Scholar 

  7. Truesdale KP, Stevens J, Lewis CE, Schreiner PJ, Loria CM, Cai J. Changes in risk factors for cardiovascular disease by baseline weight status in young adults who maintain or gain weight over 15 years: the CARDIA study. Int J Obes. 2006;30:1397–407.

    CAS  Article  Google Scholar 

  8. Norman JE, Bild D, Lewis CE, Liu K, Smith-West D. The impact of weight change on cardiovascular disease risk factors in young black and white adults: the CARDIA study. Int J Obes. 2003;27:369–76.

    CAS  Article  Google Scholar 

  9. Weaver KE, Foraker RE, Alfano CM, Rowland JH, Arora NK, Bellizzi KM, Hamilton AS, Oakley-Girvan I, Keel G, Aziz NM. Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care? J Cancer Surviv. 2013;7:253–61.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tammemagi CM, Nerenz D, Neslund-Dudas C, Feldkamp C, Nathanson D. Comorbidity and survival disparities among black and white patients with breast cancer. JAMA. 2005;294:1765–72.

    CAS  Article  PubMed  Google Scholar 

  11. Paxton RJ, Phillips KL, Jones LA, Chang S, Taylor WC, Courneya KS, Pierce JP. Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors. Cancer. 2012;118:4024–31.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rock CL, Flatt SW, Newman V, Caan BJ, Haan MN, Stefanick ML, Faerber S, Pierce JP, for Women’s Healthy Eating and Living Study Group. Factors associated with weight gain in women after diagnosis of breast cancer. J Am Diet Assoc. 1999;99:1212–21.

    CAS  Article  PubMed  Google Scholar 

  13. Smith SA, Claridy MD, Whitehead MS, Sheats JQ, Yoo W, Alema-Mensah EA, et al. Lifestyle modification experiences of African American breast cancer survivors: a needs assessment. JMIR Cancer. 2015;1:e9. doi:10.2196/cancer.4892.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Stolley MR, Sharp LK, Oh A, Schiffer L. A weight loss intervention for African American breast cancer survivors, 2006. Prev Chronic Dis. 2009;6:A22.

    PubMed  Google Scholar 

  15. Wilson DB, Porter JS, Parker G, Kilpatrick J. Anthropometric changes using a walking intervention in African American breast cancer survivors: a pilot study. Prev Chronic Dis. 2005;2:A16.

    PubMed  PubMed Central  Google Scholar 

  16. Sheppard VB, Hicks J, Makambi K, Hurtado-de-Mendoza A, Demark-Wahnefried W, Adams-Campbell L. The feasibility and acceptability of a diet and exercise trial in overweight and obese black breast cancer survivors: the Stepping STONE study. Contemp Clin Trials. 2016;46:106–13.

    Article  PubMed  Google Scholar 

  17. Griffith KA, Royak-Schaler R, Nesbitt K, Zhan M, Kozlovsky A, Hurley K, et al. A culturally specific dietary plan to manage weight gain among African American breast cancer survivors: a feasibility study. Nutr Health. 2012;21:97–105.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Djuric Z, Mirasolo J, Kimbrough L, Brown DR, Heilbrun LK, Canar L, et al. A pilot trial of spirituality counseling for weight loss maintenance in African American breast cancer survivors. J Natl Med Assoc. 2009;101:552–64.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Demark-Wahnefried W, Platz EA, Ligibel JA, et al. The role of obesity in cancer survival and recurrence. Cancer Epidemiol Biomark Prev. 2012;21:1244–59.

    Article  Google Scholar 

  20. Institute of Medicine. The role of obesity in cancer survival and recurrence: workshop summary. Washington, DC: The National Academies Press; 2012.

    Google Scholar 

  21. Loprinzi CL, Athmann LM, Kardinal CG, O'Fallon JR, See JA, Bruce BK, et al. Randomized trial of dietician counseling to try to prevent weight gain associated with breast cancer adjuvant chemotherapy. Oncology. 1996;53:228–32.

    CAS  Article  PubMed  Google Scholar 

  22. Demark-Wahnefried W, Case LD, Blackwell K, Marcom PK, Kraus W, Aziz N, et al. Results of a diet/exercise feasibility trial to prevent adverse body composition change in breast cancer patients on adjuvant chemotherapy. Clin Breast Cancer. 2008;8:70–9.

    Article  PubMed  Google Scholar 

  23. Djuric Z, Ellsworth JS, Weldon AL, Ren J, Richardson CR, Resnicow K, et al. A diet and exercise intervention during chemotherapy for breast cancer. Open Obes J. 2011;3:87–97.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. Wing RR, Tate DF, Espeland MA, Lewis CE, LaRose JG, Gorin AA, Bahnson J, Perdue LH, Hatley KE, Ferguson E, Garcia KR, Lang W. Innovative self-regulation strategies reduce weight gain in young adults: the study of novel approaches to weight gain prevention (SNAP) randomized controlled trial. JAMA Internal Med. 2016;176:755–62.

    Article  Google Scholar 

  25. Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006;35515:1563–71.

    Article  Google Scholar 

  26. Zheng Y, Klem ML, Sereika SM, Danford CA, Ewing LJ, Burke LE. Self-weighing in weight management: a systematic literature review. Obesity. 2015;232:256–65.

    Article  Google Scholar 

  27. VanWormer JJ, French SA, Pereira MA, Welsh EM. The impact of regular self-weighing on weight management: a systematic literature review. Int J Behav Nutr Phys Act. 2008;5:54. doi:10.1186/1479-5868-5-54.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Steinberg DM, Tate DF, Bennett GG, Ennett S, Samuel-Hodge C, Ward DS. The efficacy of a daily self-weighing weight loss intervention using smart scales and email. Obesity. 2013;21:1789–97. doi:10.1002/oby.20396.

    PubMed  PubMed Central  Google Scholar 

  29. Gokee-LaRose J, Gorin A, Wing RR. Behavioral self-regulation for weight loss in young adults: a randomized controlled trial. Int J Behav Nutr Phys Act. 2009;6:10. doi:10.1186/1479-5868-6-10.

    Article  PubMed  PubMed Central  Google Scholar 

  30. LaRose JG, Tate DF, Gorin AA, Wing RR. Preventing weight gain in young adults: a randomized controlled pilot study. Am J Prev Med. 2010;39:63–8.

    Article  PubMed Central  Google Scholar 

  31. Bertz F, Pacanowski CR, Levitsky DA. Frequent self-weighing with electronic graphic feedback to prevent age-related weight gain in young adults. Obesity. 2015;23:2009–14.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Goode AD, Lawler SP, Brakenridge CL, Reeves MM. Telephone, print, and Web-based interventions for physical activity, diet and weight control among cancer survivors: a systematic review. J Cancer Surviv. 2015;9:660–82.

    Article  PubMed  Google Scholar 

  33. Harrigan M, Cartmel B, Loftfield E, Sanft T, Chagpar AB, Zhou Y, Playdon M, Li F, Irwin ML. Randomized trial comparing telephone versus in-person weight loss counseling on body composition and circulating biomarkers in women treated for breast cancer: the lifestyle, exercise, and nutrition (LEAN) study. J Clin Oncol. 2016;1(34):669–76. doi:10.1200/JCO.2015.61.6375.

    Article  Google Scholar 

  34. Goodwin PJ, Segal RJ, Vallis M, Ligibel JA, Pond GR, Robidoux A, Blackburn GL, Findlay B, Gralow JR, Mukherjee S, Levine M, Pritchard KI. Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol. 2014;3221:2231–9. doi:10.1200/JCO.2013.53.1517.

    Article  Google Scholar 

  35. Morey MC, Snyder DC, Sloane R, Cohen HJ, Peterson B, Hartman TJ, et al. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA. 2009;301:1883–91. doi:10.1001/jama.2009.643.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  36. Djuric Z, DiLaura NM, Jenkins I, Darga L, Jen CKL, Mood D, et al. Combining weight-loss counseling with the weight watchers plan for obese breast cancer survivors. Obes Res. 2002;10:657–65. doi:10.1038/oby.2002.89.

    Article  PubMed  Google Scholar 

  37. Hawkes AL, Pakenham KI, Courneya KS, Gollschewski S, Baade P, Gordon LG, et al. A randomised controlled trial of a tele-based lifestyle intervention for colorectal cancer survivors (‘CanChange’): study protocol. BMC Cancer. 2009;9:286. doi:10.1186/1471-2407-9-.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Reeves MM, Terranova CO, Eakin EG, Demark-Wahnefried W. Weight loss intervention trials in women with breast cancer: a systematic review. Obes Rev. 2014;15:749–68.

    CAS  Article  PubMed  Google Scholar 

  39. Spark LC, Fjeldsoe BS, Eakin EG, Reeves MM. Efficacy of a text message-delivered extended contact intervention on maintenance of weight loss, physical activity, and dietary behavior change. JMIR mHealth uHealth. 2015;3:e88. doi:10.2196/mhealth.4114.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bennett GG, Steinberg DM, Stoute C, Lanpher M, Lane I, Askew S, et al. Electronic health (eHealth) interventions for weight management among racial/ethnic minority adults: a systematic review. Obes Rev. 2014;15(Suppl 4):146–58. doi:10.1111/obr.12218.

    Article  PubMed  Google Scholar 

  41. Martin CK, Miller AC, Thomas DM, Champagne CM, Han H, Church T. Efficacy of SmartLoss, a smartphone-based weight loss intervention: results from a randomized controlled trial. Obesity. 2015;23:935–42. doi:10.1002/oby.2106.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Sheean PM, Hoskins K, Stolley M. Body composition changes in females treated for breast cancer: a review of the evidence. Breast Cancer Res Treat. 2012 Oct;135(3):663–80.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  43. Bennett GG, Foley P, Levin E, Whiteley J, Askew S, Steinberg DM, et al. Behavioral treatment for weight gain prevention among black women in primary care practice: a randomized clinical trial. JAMA Intern Med. 2013;173:1770–7.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Withings–Wireless Scale WS-30. https://withings.zendesk.com/hc/en-us/categories/200118117-Wireless-Scale-WS-30-

  45. Kanfer FH, Goldstein AP. Helping people change. New York: Pergamon Press; 1975.

    Google Scholar 

  46. Wing RR, Tate D, Espeland M, Gorin A, LaRose JG, Robichaud EF, Erickson K, Perdue L, Bahnson J, Lewis CE. Weight gain prevention in young adults: design of the study of novel approaches to weight gain prevention (SNAP) randomized controlled trial. BMC Public Health. 2013;13:300. doi:10.1186/1471-2458-13-300.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ballard-Barbash R, Hunsberger S, Ballard-Barbash R, Hunsberger S, Alciati MH, Blair SN, Goodwin PJ, McTiernan A, Wing R, Schatzkin A. Physical activity, weight control, and breast cancer risk and survival: clinical trial rationale and design considerations. J Natl Cancer Inst. 2009;101:630–43.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Withings—Pulse. http://www.withings.com/pulse

  49. National Cancer Institute. Automated self-administered 24-hour (ASA24®) dietary assessment tool. Available at http://epi.grants.cancer.gov/asa24//. Accessed 28 Aug 2016.

  50. Paffenbarger Jr RS, Wing AL, Hyde RT, Jung DL. Physical activity and incidence of hypertension in college alumni. Am J Epidemiol. 1983;117:245–57.

    PubMed  Google Scholar 

  51. The Compendium of Physical Activities Tracking Guide. Available at https://sites.google.com/site/compendiumofphysicalactivities/. Accessed June 1, 2015.

  52. Linde JA, Jeffery RW, French SA, Pronk NP, Boyle RG. Self-weighing in weight gain prevention and weight loss trials. Ann Behav Med. 2005;30:210–6. doi:10.1207/s15324796abm3003_5.

    Article  PubMed  Google Scholar 

  53. VanWormer JJ, Martinez AM, Cosentino D, Pronk NP. Satisfaction with a weight loss program: what matters? Am J Health Promo. 2010;24:238–45.

    Article  Google Scholar 

  54. Crane MM, Lutes LD, Ward DS, Bowling JM, Tate DF. A randomized trial testing the efficacy of a novel approach to weight loss among men with overweight and obesity. Obesity. 2015;23:2398–405.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Adams RN, Mosher CE, Blair CK, Snyder DC, Sloane R, Demark-Wahnefried W. Cancer survivors’ uptake and adherence in diet and intervention trials: an integrative data analysis. Cancer. 2015;121:77–83.

    Article  PubMed  Google Scholar 

  56. Greenlee HA, Crew KD, Mata JM, McKinley PS, Rundle AG, Zhang W, Liao Y, Tsai WY, Hershman DL. A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors. Obesity. 2013;21:65–76.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  57. Campbell KL, Van Patten CL, Neil SE, Kirkham AA, Gotay CC, Gelmon KA, McKenzie DC. Feasibility of a lifestyle intervention on body weight and serum biomarkers in breast cancer survivors with overweight and obesity. J Acad Nutr Diet. 2012;112:559–67. doi:10.1016/j.jada.2011.10.022.

    Article  PubMed  Google Scholar 

  58. Shih PC, Han K, Poole ES, Rosson MB, Carroll JM. Use and adoption challenges of wearable activity trackers. iConference Proceedings. 2015.

  59. Rowe-Roberts D, Cercos R, Mueller FF. Preliminary results from a study of the impact of digital activity trackers on health risk status. Stud Health Technol Inform. 2014;204:143–8.

    PubMed  Google Scholar 

  60. Gierisch JM, Goode AP, Batch BC, Huffman KM, Hall KS, Hastings SN, Allen KD, Shaw RJ, Kanach FA, McDuffie JR, Kosinski AS, Nagi A, Williams JW Jr. The impact of wearable motion sensing technologies on physical activity: a systematic review. VA ESP Project #09–009; 2015.

Download references

Acknowledgments

The authors thank the University of North Carolina at Chapel Hill (UNC) Health Registry/Cancer Survivorship Cohort participants for their important contributions. We gratefully acknowledge the staff of the UNC Weight Research Program for their valuable support, including Melissa Cochran, Dr. Melissa Crane, Dr. Brooke T. Nezami, Candice Alick, Loneke Blackman, and Rachel K. Bordogna, who provided excellent research assistance. We also wish to acknowledge Dr. Katherine Reeder-Hayes and Dr. Hyman Muss, who graciously assisted with study recruitment. Finally, we are most grateful to the cancer survivors who participated in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carmina G. Valle.

Ethics declarations

Funding sources

This study was supported by a Developmental Research Award from the University of North Carolina at Chapel Hill (UNC) Lineberger Comprehensive Cancer Center. At the time of the study, Carmina Valle was supported by the UNC Cancer Health Disparities Training Program (National Cancer Institute funded; T32CA128582). The UNC Health Registry/Cancer Survivorship Cohort is funded in part by the UNC Lineberger Comprehensive Cancer Center’s University Cancer Research Fund.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Valle, C.G., Deal, A.M. & Tate, D.F. Preventing weight gain in African American breast cancer survivors using smart scales and activity trackers: a randomized controlled pilot study. J Cancer Surviv 11, 133–148 (2017). https://doi.org/10.1007/s11764-016-0571-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-016-0571-2

Keywords

  • Breast cancer survivors
  • African American
  • Randomized trial
  • Weight gain prevention
  • Intervention
  • Technology