title: The impact of a bodyweight and physical activity intervention (BeWEL) initiated through a national colorectal cancer screening programme: randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the impact of a diet and physical activity intervention (BeWEL) on weight change in people with a body mass index >25 weight (kg)/height (m)(2) at increased risk of colorectal cancer and other obesity related comorbidities.
  
  
  METHODS
  Multicentre, parallel group, randomised controlled trial.
  
  
  METHODS
  Four Scottish National Health Service health boards.
  
  
  METHODS
  329 overweight or obese adults (aged 50 to 74 years) who had undergone colonoscopy after a positive faecal occult blood test result, as part of the national bowel screening programme, and had a diagnosis of adenoma confirmed by histopathology. 163 were randomised to intervention and 166 to control.
  
  
  METHODS
  Participants were randomised to a control group (weight loss booklet only) or 12 month intervention group (three face to face visits with a lifestyle counsellor plus monthly 15 minute telephone calls). A goal of 7% reduction in body weight was set and participants received a personalised energy prescription (2508 kJ (600 kcal) below that required for weight maintenance) and bodyweight scales. Motivational interviewing techniques explored self assessed confidence, ambivalence, and personal values concerning weight. Behavioural strategies included goal setting, identifying intentions of implementation, self monitoring of body weight, and counsellor feedback about reported diet, physical activity, and weight change.
  
  
  METHODS
  The primary outcome was weight change over 12 months. Secondary outcomes included changes in waist circumference, blood pressure, fasting cardiovascular biomarkers, and glucose metabolism variables, physical activity, diet, and alcohol consumption.
  
  
  RESULTS
  At 12 months, data on the primary outcome were available for 148 (91%) participants in the intervention group and 157 (95%) in the control group. Mean weight loss was 3.50 kg (SD 4.91) (95% confidence interval 2.70 to 4.30) in the intervention group compared with 0.78 kg (SD 3.77) (0.19 to 1.38) in the control group. The group difference was 2.69 kg (95% confidence interval 1.70 to 3.67). Differences between groups were significant for waist circumference, body mass index, blood pressure, blood glucose level, diet, and physical activity. No reported adverse events were considered to be related to trial participation.
  
  
  CONCLUSIONS
  Significant weight loss can be achieved by a diet and physical activity intervention initiated within a national colorectal cancer screening programme, offering considerable potential for risk reduction of disease in older adults.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN53033856.
authors.affiliation: Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Ninewells Medical School, Dundee, UK.
authors.forename: Annie S
authors.initials: AS
authors.lastname: Anderson
authors.forename: Angela M
authors.initials: AM
authors.lastname: Craigie
authors.forename: Stephen
authors.initials: S
authors.lastname: Caswell
authors.forename: Shaun
authors.initials: S
authors.lastname: Treweek
authors.forename: Martine
authors.initials: M
authors.lastname: Stead
authors.forename: Maureen
authors.initials: M
authors.lastname: Macleod
authors.forename: Fergus
authors.initials: F
authors.lastname: Daly
authors.forename: Jill
authors.initials: J
authors.lastname: Belch
authors.forename: Jackie
authors.initials: J
authors.lastname: Rodger
authors.forename: Alison
authors.initials: A
authors.lastname: Kirk
authors.forename: Anne
authors.initials: A
authors.lastname: Ludbrook
authors.forename: Petra
authors.initials: P
authors.lastname: Rauchhaus
authors.forename: Patricia
authors.initials: P
authors.lastname: Norwood
authors.forename: Joyce
authors.initials: J
authors.lastname: Thompson
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.forename: Robert J C
authors.initials: RJ
authors.lastname: Steele
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis*; D000368:Aged; D001294:Attitude to Health; D001786:Blood Glucose; D001794:Blood Pressure; D015992:Body Mass Index; D001835:Body Weight; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis*; D004032:Diet; D037001:Directive Counseling; D055088:Early Detection of Cancer; D005246:Feedback; D005260:Female; D006040:Goals; D006801:Humans; D033182:Intention; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009765:Obesity / Q000150:complications / Q000523:psychology / Q000628:therapy*; D020377:Self Efficacy; D016037:Single-Blind Method; D055105:Waist Circumference
chemical_list: D001786:Blood Glucose