Results of the Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) Trial: A Behavioral Weight Loss Intervention in Overweight or Obese Breast Cancer Survivors.
OBJECTIVE
Obesity increases risk for all-cause and breast cancer mortality and comorbidities in women who have been diagnosed and treated for breast cancer. The Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) study is the largest weight loss intervention trial among survivors of breast cancer to date.


METHODS
In this multicenter trial, 692 overweight/obese women who were, on average, 2 years since primary treatment for early-stage breast cancer were randomly assigned to either a group-based behavioral intervention, supplemented with telephone counseling and tailored newsletters, to support weight loss or a less intensive control intervention and observed for 2 years. Weight and blood pressure were measured at 6, 12, 18, and 24 months. Longitudinal mixed models were used to analyze change over time.


RESULTS
At 12 months, mean weight loss was 6.0% of initial weight in the intervention group and 1.5% in the control group (P<.001). At 24 months, mean weight loss in the intervention and control groups was 3.7% and 1.3%, respectively (P<.001). Favorable effects of the intervention on physical activity and blood pressure were observed. The weight loss intervention was more effective among women older than 55 years than among younger women.


CONCLUSIONS
A behavioral weight loss intervention can lead to clinically meaningful weight loss in overweight/obese survivors of breast cancer. These findings support the need to conduct additional studies to test methods that support sustained weight loss and to examine the potential benefit of intentional weight loss on breast cancer recurrence and survival.
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL. clrock@ucsd.edu.
Cheryl L
CL
Rock
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Shirley W
SW
Flatt
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Tim E
TE
Byers
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Graham A
GA
Colditz
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Wendy
W
Demark-Wahnefried
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Patricia A
PA
Ganz
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Kathleen Y
KY
Wolin
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Anthony
A
Elias
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Helen
H
Krontiras
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Jingxia
J
Liu
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Michael
M
Naughton
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Bilgé
B
Pakiz
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Barbara A
BA
Parker
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Rebecca L
RL
Sedjo
Cheryl L. Rock, Shirley W. Flatt, Bilgé Pakiz, and Barbara A. Parker, University of California, San Diego, Moores Cancer Center, La Jolla; Patricia A. Ganz, Jonsson Comprehensive Cancer Center and the Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA; Tim E. Byers, Anthony Elias, Rebecca L. Sedjo, and Holly Wyatt, University of Colorado Denver, Aurora, CO; Graham A. Colditz, Jingxia Liu, and Michael Naughton, Washington University School of Medicine, St Louis, MO; Wendy Demark-Wahnefried and Helen Krontiras, University of Alabama Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; and Kathleen Y. Wolin, Coeus Health, Scale Down, and Northwestern University, Chicago, IL.
Holly
H
Wyatt
D000328:Adult; D001521:Behavior Therapy; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015897:Comorbidity; D003376:Counseling; D004032:Diet / Q000009:adverse effects; D002149:Energy Intake; D015444:Exercise; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D009752:Nutritional Status; D009765:Obesity / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D050177:Overweight / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D015431:Weight Loss