Evaluation of a mobile behavior change program for weight loss in breast cancer survivors: A prospective single-arm pilot study.
Authors: Shen Sherry , Salehi Erica , White Charlie , Chen Yuan , May Christine N. , McCallum Meaghan , Mitchell E. Siobhan , Lento Christopher S. , Michaelides Andreas , Iyengar Neil M. 
Published: June 2023

12070

Background: Post-diagnosis weight gain is common among women with early-stage breast cancer and is associated with increased risk of recurrence, breast cancer death, and all-cause mortality. Intentional weight loss following diagnosis is difficult to maintain. Targeted lifestyle interventions focusing on behavioral changes and education that can be implemented long-term are needed. Methods: This was a prospective single-arm pilot study in patients with history of early-stage breast cancer (NCT04753268). Key eligibility criteria included body mass index (BMI) ≥27.5 kg/m2, stage I-III breast cancer, and completion of active cancer treatment ≥6 months prior to study enrollment. Patients were recruited at the Dempsey Center in Lewiston, ME and via social media. Participants were given access to the Noom mobile application, which utilizes cognitive behavioral therapy, motivational interviewing, and self-determination theory to induce behavior change using an educational curriculum of daily articles, virtual health coaching, social networking, food records, and physical activity logs. The primary endpoint was change in self-reported weight from baseline to 26 weeks. Secondary endpoints included change in physical activity measured using step count and the Global Physical Activity Questionnaire (GPAQ), change in diet patterns analyzed using the Nutrition Data System for Research, patient-reported outcome (PRO) measures, and metrics for engagement with the mobile application. Results: 31 patients were enrolled; 24 at the Dempsey Center and 7 via social media. Mean age was 56.8 and mean baseline BMI was 33.5 kg/m2. Mean weight change was -4.8 kg (range +0.6 to -19.9 kg, p < 0.001) and mean percent weight change was -5.6%; 11/31 patients (35.5%) lost ≥5% of their initial weight. Average daily step count increased by 54.7% (p = 0.004). Mean GPAQ score for physical activity increased from 990 to 1773 (p = 0.01), and the proportion of patients who met physical activity guidelines increased from 45.1% to 74.2%. Mean energy intake did not change significantly over 26 weeks (p = 0.779). Improvements were observed in PROMIS-Physical Functioning T-scores and Body Image Scale scores (p = 0.04, p < 0.001 respectively). Metrics of engagement with Noom that were predictive of weight loss ≥5% included total articles read (p = 0.012), total weights logged (p = 0.006), total food records logged (p = 0.001), messages sent to coach (p = 0.001), and number of times the application was opened (p = 0.014). Conclusions: In this pilot study, breast cancer survivors lost weight and became more physically active using a commercially-available mobile application. This digital weight loss program is a scalable intervention, and these findings support future studies investigating impact on breast cancer outcomes. Clinical trial information: NCT04753268 .