BeWEL the impact of a BodyWEight and physicaL activity intervention on adults at risk of developing colorectal adenomas

Lead Research Organisation: University of Dundee
Department Name: Education, Social Work & Community Educ

Abstract

The study aims to evaluate the impact of a an intervention programme (?BeWEL?) on body weight change, cardiovascular risk factors, diet and physical activity in healthy individuals attending routine NHS clinics who have had pre-cancerous bowel polyps removed but are at risk of developing future cancer and other obesity related conditions. The findings will be relevant to increasing understanding of how the NHS can deliver effective lifestyle interventions to people from diverse backgrounds. It will also provide information on patients? experience of the BeWEL programme and on NHS cost implications.

Technical Summary

Colorectal cancer (CRC) is a major public health problem and often co-exists with other disorders including obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). The proposed work aims to evaluate the impact of the ?BeWEL? intervention programme on body weight changes, cardiovascular risk factors, diet and physical activity in healthy individuals with excess body weight attending routine NHS clinics who have had pre-cancerous bowel polyps removed, but are at risk of developing future cancer and other obesity related conditions. Men from the poorest backgrounds have the highest rates of screen detected adenomas and the proposed work offers a rare opportunity to engage with a hard to reach group. The 3 year study will be a two-arm, multi-centre, randomised controlled trial of the BeWEL intervention against usual care. Participants will be men and women aged 50 to 74 years, with a BMI 25m/kg2, who have been treated for the removal of a colorectal adenoma. They will be recruited after discharge from follow-up clinics. The pre-trial development will take 6 months, participants will be recruited over a 12 month period and undertake the intervention and follow up for 12 months with a further 6 months for data collection, analysis and interpretation. The Intervention Group (IG) will receive the ?BeWEL? personalised, multiple contact, intervention programme (based on the clinically successful US diabetes prevention programme), personal body weight scales and invitations to undertake supervised monthly body weight recordings. The impact of the programme will be assessed by quantitative, qualitative and economic analysis. The main outcomes measures will be physical activity, dietary intake and psycho-social variables as well as body weight, markers of insulin resistance and cardiovascular risk. The research will also provide information on what factors influence decisions to engage in the programme, the response to the intervention by deprivation category, patients? experience of the intervention, and the NHS cost implications. The findings will be relevant to increasing understanding of how the NHS can deliver effective lifestyle interventions to people from diverse social backgrounds and has particular relevance for combining disease prevention strategies with early detection procedures.

Publications

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Anderson AS (2013) Lifestyle issues for colorectal cancer survivors--perceived needs, beliefs and opportunities. in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

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Anderson AS (2013) Obesity and lifestyle advice in colorectal cancer survivors - how well are clinicians prepared? in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

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Anderson AS (2015) Awareness of Lifestyle and Colorectal Cancer Risk: Findings from the BeWEL Study. in BioMed research international

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Fisher A (2018) The impact of social deprivation on the response to a randomised controlled trial of a weight management intervention (BeWEL) for people at increased risk of colorectal cancer. in Journal of human nutrition and dietetics : the official journal of the British Dietetic Association

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Steele RJ (2015) Colorectal adenomas and diabetes: implications for disease prevention. in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

 
Description Citation in Obesity Route Map review (Scotland) http://www.scotphn.net/wp-content/uploads/2016/01/2016_01_06-Final-Report.pdf
Geographic Reach National 
Policy Influence Type Citation in other policy documents
 
Description Discussion of possible roll out pilot for BeWEL
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Invitation to join Scottish Gvt ministerial group on health promoting health service
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Invited meeting with members of Scottish cancer coalition to discuss prevention as a key part of all member portfolios
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact From this meeting there was an agreed course of action amongst third sector members to form to a "Stacking the odds against cancer occurrence and recurrence" campaign. POTENTIALLY, this could have a major impact as charities to date have little involvement with promoting healthy lifestyle in primary and secondary prevention.
 
Description Invited to contribute to Cancer Plan refresh
Geographic Reach Asia 
Policy Influence Type Participation in a national consultation
 
Description Invited to discuss BeWEl (and other studies) with Scot Gvt Detect Cancer Early executive board
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact There was general agreement by the board that this work requires further exploration in the DCE setting and we have been invited to propose further work in the real life setting
 
Description Invited to discuss opportunities for lifestyle management with Acting CMO
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact There is clearly significant interest in turning the cancer screening setting into the cancer screening and prevention setting. Public Health England have now announced that and Scotland is likely follow suit. Scottish Gvt have also brokered a third sector party to allow us to do a fully powered trial in the breast cancer screening setting
 
Description Invited to give evidence to parliamentary committee
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description Invited to membership of Scottish Gvt Scottish Cancer Taskforce
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Lifestyle information in CRC screening
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Repeated discussions with Chair of Scottish Cancer Taskforce has resulted in agreement that the screening setting is an opportunity for prevention messages. This is illustrated by change of information to all screening patients
 
Description Presentation at cross party group on cancer
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Raises profile of the importance of cancer prevention amongst MSP's
 
Description Speaker at fringe event at SNP party conference
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
Impact This has raised awareness of cancer prevention and lifestyle
 
Description Work cited by Deputy CMO as exemplar in cancer prevention in Scotland
Geographic Reach National 
Policy Influence Type Participation in advisory committee
 
Description consultancy forWHO IARC Member working group on diet, obesity alcohol, physical activity for the review of the European Code Against cancer
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
 
Description Chief Scientist Office (CSO) Health Services Reserach Committee
Amount £221,220 (GBP)
Funding ID CZH/4/745 
Organisation Chief Scientist Office 
Sector Public
Country United Kingdom
Start 12/2012 
End 04/2014
 
Description Chief Scientist Office Health services research committee
Amount £138,721 (GBP)
Funding ID CZH/4/939 
Organisation Chief Scientist Office 
Sector Public
Country United Kingdom
Start 12/2013 
End 04/2015
 
Description Dundee cancer centre
Amount £30,000 (GBP)
Organisation University of Dundee 
Department Dundee Cancer Centre
Sector Academic/University
Country United Kingdom
Start 07/2013 
End 08/2013
 
Description Public Health, NIHR
Amount £800,000 (GBP)
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 06/2011 
End 12/2014
 
Description Scottish Government
Amount £60,000 (GBP)
Organisation Government of Scotland 
Department Scottish Government Health Directories
Sector Academic/University
Country United Kingdom
Start 12/2017 
End 04/2019
 
Description Scottish Government cancer funds
Amount £71,741 (GBP)
Organisation Government of Scotland 
Department Scottish Government Health Directories
Sector Academic/University
Country United Kingdom
Start 07/2018 
End 03/2019
 
Title BeWel data collection tool 
Description This data collection tool will allow analysis by Open Clinica 
Type Of Material Database/Collection of Data/Biological Samples 
Provided To Others? No  
Impact None anticipted 
 
Description BUYWELL TEAM 
Organisation University of Stirling
Department Stirling Management School
Country United Kingdom 
Sector Academic/University 
PI Contribution shared discussion on importance of food and health
Collaborator Contribution Joint planning and undertaking of formative research drawing on consumer issues and food in BuyWEll and BeWEL
Impact See Publication by Stead et al
 
Description Bowel cancer UK 
Organisation Bowel Cancer UK
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Work completed as part of the formative phase of this award has led us to do further work on preventability concepts in cancer survivors.The award from Bowel cancer UK has led to qualitative research (focus groups) investigating Lifestyle issues for Colorectal cancer survivors - perceived needs, beliefs and opportunities.
Impact A end of study report was provided to the funding body. Outputs Presentation at ISBNPA meeting June Melbourne 2011 Presentation at Scottish cancer prevention Network Conference, Nov Edinburgh 2011 Invited presentation (part of) at NCRI conference Liverpool , Nov 2011 Multi-disciplinary with social science (Dr Joanne Coyle)
Start Year 2010
 
Description FFIT 
Organisation Medical Research Council (MRC)
Country United Kingdom 
Sector Public 
PI Contribution Guidance on intervention evaluation
Collaborator Contribution Publications pendingLink with wider networks
Impact Multi disciplinary.. with social sciences
Start Year 2010
 
Description FFIT 
Organisation University of Glasgow
Department Institute of Health and Wellbeing
Country United Kingdom 
Sector Academic/University 
PI Contribution Guidance on intervention evaluation
Collaborator Contribution Publications pendingLink with wider networks
Impact Multi disciplinary.. with social sciences
Start Year 2010
 
Description University of Stirling 
Organisation University of Stirling
Department Faculty of Psychology
Country United Kingdom 
Sector Academic/University 
PI Contribution new grant award
Collaborator Contribution original idea
Impact CSO funded grants (ActWELL and TreatWELL)
Start Year 2012
 
Title BeWel intervention programme 
Description Lifestyle intervention for weight management focus on education and behavioural change techqniques 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Refinement. Non-clinical
Year Development Stage Completed 2010
Development Status Under active development/distribution
Clinical Trial? Yes
Impact Funding for piloting roll out now in place 
URL http://www.controlled-trials.com/ISRCTN53033856
 
Description Bowel Cancer UK membership 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Type Of Presentation Paper Presentation
Geographic Reach National
Primary Audience Health professionals
Results and Impact Research discussion on lifestyle assessment research

Further colloborations planned
Year(s) Of Engagement Activity 2006,2007,2008,2009,2010,2011,2012
 
Description Breakthrough Breast Cancer 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Further discussions on prevention research to add to agenda

Meeting with UK group in London (presentation) and detailed meetingw ith Chief Exec on prevention issues in Breast Cancer
Year(s) Of Engagement Activity 2012
 
Description Cafe science presentation Dundee 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Public engagement event organised by University
Year(s) Of Engagement Activity 2018
URL https://www.dundee.ac.uk/news/2018/a-decade-of-cancer-prevention---cafe-science-on-22-january.php
 
Description Cafe science presentation Newcastle 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Publicity on sociail media about obesity and cancer
Year(s) Of Engagement Activity 2018
URL https://getnorth2018.com/inspired-by/cafe-scientifique-obesity-and-cancer-the-unspoken-link/
 
Description Invited presentation to Joint meeting of RCGP and RCN 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Further discussion and networking

further links with colleges
Year(s) Of Engagement Activity 2014
 
Description Media coverage of NCRI presentation 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Press release covered BeWEL work plus other colorectal studies from our group. Reported in Scotsman Herald and Daily Mail. Also Radio inteviews


Subsequentlty Radio Scotland did a phone in programme on Doctors promotion of lifestyle change 9/11/11 and Scotsman feature which mentioned our work
Year(s) Of Engagement Activity 2011
 
Description Presentation to Scottish Cancer Taskforce 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Contacted by members for slides
Invitation to dicuss further with Deputy CMO and Policy lead for health improvements

Major message about lack of prevention info in screening which was clearly brought up by our work (see Stead et al) has to some extent been addressed by new leaflet information for all screening patients
Year(s) Of Engagement Activity 2011
 
Description Public Lecture at Royal College of Physicians Edinburgh 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact 170 members of general public and clinicians attended the public lecture.

This meeting has been followed by an invitation to discuss resources and approaches that might be useful within Lothian Breast cancer screening and to meet other screening staff.
Year(s) Of Engagement Activity 2012
 
Description Public engagement meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Around 70 people attended, quetsions and email follow up. Alos found patient volunteer for steering group

Invitation to speak to patient /professional group
Year(s) Of Engagement Activity 2011
 
Description Public lecture 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Invited to present the Jerry Morris public lecture at Uni of Bristol
Year(s) Of Engagement Activity 2019
 
Description Scottish Primary Care Cancer Group workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Health professionals
Results and Impact Invited workshop "Cancer Prevention in Scotland", which incorporated details about the BeWEL study.

Further email correspondence with group
Year(s) Of Engagement Activity 2012
 
Description Study visit with cancer Council WA Public lectures on cancer prevention (using BeWEL as exemplar for lifestyle change), 7, Western Australia 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Widespread discussions of lifestyle change for cancer prevention
Year(s) Of Engagement Activity 2015
 
Description UKSBM Invited workshop 2011 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach National
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Invited workshop "Why should the devil have all the best tunes?", which involved presenting the formative findings from the BeWEL study.

Further invitation to speak at academic seminar
Year(s) Of Engagement Activity 2011
 
Description University Discovery day 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Open day showcasing recent Professorial appointments and announcement of Stephen Fry award for Public engagement
Year(s) Of Engagement Activity 2019
URL https://www.dundee.ac.uk/news/2019/former-rector-hails-dundee-academics.php
 
Description conference presentation 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Third sector organisations
Results and Impact Presentation at Scottish Cancer Prevention Network conference on cancer prevention activties. Public Health minister present
Year(s) Of Engagement Activity 2019
 
Description invitation from Irish government to talk about cancer prevention sctivties 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Ireland has now established an Irish Cancer Prevention Network based on our Scottish network and related reserach
Year(s) Of Engagement Activity 2018
 
Description invitation to join scientific committee of World Cancer Research Fund 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact assessing research grants related to cancer prevention
Year(s) Of Engagement Activity 2017
 
Description invited visits to men shed organisation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact involvement in future research
Year(s) Of Engagement Activity 2018