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Objectives Obesity is associated with an increased cancer incidence and mortality and therefore cancer screening is particularly important for obese individuals. However, some US studies find lower screening uptake in this group. This study explored whether rates of breast and colorectal screening in England are lower for obese than healthy weight individuals. Setting Data were from the English Longitudinal Study of Ageing (ELSA). Methods We analysed data from adults who were eligible to have been invited to the UK national screening programmes for breast or colorectal cancer (CRC) in the last five years, and had been given the screening module in Wave 5 of ELSA (N = 1804 for CRC screening, N = 2401 for breast cancer screening). Weight and height were measured by a nurse at Wave 4 (two years earlier). Logistic regression was used to calculate the odds of breast and CRC screening (ever) for participants in higher weight categories (Body Mass Index [BMI] ≥ 25) compared with healthy weight individuals (BMI Results Of ELSA participants, 63% reported CRC screening, and 92% of the women reported breast cancer screening. Obesity was associated with lower CRC screening, but effects were strongest for class III obesity (BMI ≥40) (45% screened; OR = 0.48, 95% CI = 0.32–0.93, P = .029). There was no association between weight status and breast cancer screening. Conclusion Severe obesity appears to be a deterrent to CRC screening but not breast cancer screening. Targeted interventions may be required to promote CRC screening uptake in this group, which already has a heightened risk as a consequence of weight.

Objectives To examine the effect that health professional (HP) advice to lose weight has on overweight and obese adults’ motivation to lose weight and attempts to lose weight. Design Cross-sectional survey. Setting Great Britain. Participants 810 overweight or obese (body mass index ≥25 kg/m2) adults. Main outcome measures Participants were asked if they had ever received HP advice to lose weight and reported their desire to weigh less (ideal weight ≤95% of current weight) and whether they were attempting to lose weight. Results Only 17% of overweight and 42% of obese respondents recalled ever having received HP advice to lose weight. HP advice was associated with wanting to weigh less (89% vs 61% among those not receiving advice) and attempting to lose weight (68% vs 37%). In multivariable analyses, HP advice to lose weight was associated with increased odds of wanting to weigh less (OR=3.71, 95% CI 2.10 to 6.55) and attempting to lose weight (OR=3.53, 95% CI 2.44 to 5.10) independent of demographic characteristics and weight status. Conclusions HP advice to lose weight appears to increase motivation to lose weight and weight loss behaviour, but only a minority of overweight or obese adults receive such advice. Better training for HPs in delivering brief weight counselling could offer an opportunity to improve obese patients’ motivation to lose weight.

As dietary gatekeepers for young children, parents are often the proximal target of family-based dietary interventions. Habit theory offers a novel approach to modifying parental feeding, based on "context-dependent repetition" to promote automatic responding and to reduce decisional conflict.This exploratory trial evaluated an intervention promoting habit formation for 3 parental feeding behaviors: serving fruit/vegetables, serving healthy snacks, and serving nonsweetened drinks. The primary outcome was parental habit strength for each behavior. The secondary outcome was children's food intake.Parents of children aged 2-6 y (n = 126) were recruited from 6 children's centers in London and cluster-randomized to intervention (n = 3) or no-treatment control (n = 3) conditions. Parents in the intervention group (n = 58) received training on habit formation for 3 feeding behaviors; control participants (n = 68) were asked only to complete the measures. At baseline and after treatment, parents completed validated measures of subjective "automaticity" for feeding behaviors and a brief child food-frequency measure. Parents in the intervention group were interviewed about the program. The change between groups, after clustering was controlled for, was analyzed.For all parental feeding behaviors, automaticity increased more in the intervention group than in the control group (P0.01 for all). Significant intervention effects on children's intake of vegetables (P = 0.003), healthy snacks (P = 0.009), and water (P = 0.032) were observed. Changes in children's food intake correlated with changes in parental automaticity of feeding behaviors, and program acceptability was high.A habit-based intervention successfully modified parental feeding behaviors, affected children's diets positively, and was well received by parents. Habit theory provides a promising new tool to support family-based obesity prevention. This trial was registered as ISRCTN09910187.

ObjectiveTo assess attributions for overweight and the level of support for policy initiatives in Great Britain.DesignCross-sectional. Respondents indicated their agreement (5-point scales: strongly disagree to strongly agree) to three potential causes of overweight (environment, genes, willpower) and five policies (free weight-loss treatment, taxing unhealthy foods, healthy lifestyle campaigns, food labelling, advertising restrictions).SettingData were collected as part of a computer-assisted, face-to-face Omnibus survey of adults (aged >15 years) from across Great Britain in April 2012 carried out by a market research company.SubjectsA population-representative sample of British adults (n 1986).ResultsMore people attributed overweight to the food environment (61 %) and lack of willpower (57 %) than to genes (45 %). Policy support was highest for healthy lifestyle campaigns (71 %) and food labelling (66 %), and lowest for taxing unhealthy foods (32 %). Food environment attributions were associated with higher support for all policies (P < 0·001). Genetic attributions were associated with higher support for free weight-loss treatments and healthy lifestyle campaigns (P < 0·001), but not other policies. Attributions to lack of willpower were not associated differentially with support for any policies (P > 0·01).ConclusionsBelief that overweight is caused by the food environment or genes – both seen as outside individual control – was associated with greater support for government policies to prevent and treat obesity. Improving awareness of the multiple causes of obesity could facilitate acceptance of policy action to reduce obesity prevalence.

Objective To examine the prevalence and demographic predictors of clinically meaningful weight loss in community samples of obese older adults in the USA and the UK. Methods Data were from obese older adults (BMI ≥ 30 kg/m2; age ≥ 52 years), free of a cancer diagnosis, from the Health and Retirement Study (HRS; n = 3398) and the English Longitudinal Study of Ageing (ELSA; n = 998). Weight change was assessed from 2004 to 2008. Multivariable logistic regression tested whether age, sex, ethnicity, marital status, education, or BMI predicted ≥ 5% weight loss. Results Over a quarter (28.7%) of obese participants from HRS and 16.6% from ELSA lost ≥ 5% weight. Being female (odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.11-1.54) and heavier (BMI ≥ 35 kg/m2) (OR = 1.60, 95% CI = 1.37-1.87) predicted weight loss in HRS. Trends were similar in ELSA (female: OR = 1.18, 95% CI = 0.83-1.69; BMI ≥ 35 kg/m2: OR = 1.24, 95% CI = 0.85-1.82). ORs were increased in ≥ 65-year-olds in HRS (OR = 1.55, 95% CI = 1.33-1.81), and reduced in married people in ELSA (OR = 0.69, 95% CI = 0.48-1.00). Neither education nor ethnicity predicted weight loss in either cohort. Conclusion A high proportion of obese older adults experience clinically meaningful weight loss, but few demographic variables consistently predict weight loss in this population.

Background. With increasingly effective treatments, patients with Multiple Myeloma ('MM') are living longer, but burden of disease and cumulative toxicities of therapy impair quality of life ('QoL') and well-being. Fatigue and bone pain frequently persist long after treatment, and during disease stability. Research in solid cancers indicates that patients who are more physically active have reduced symptom burden, less fatigue and improved QoL. Less work has been done in MM, partly due to the older and frailer patient group, and the high prevalence of osteolytic bone disease and fracture risk. The MASCOT survivorship study aims to explore the main determinants of fatigue and QoL in patients who have completed chemotherapy, with particular emphasis on bone pain, physical fitness and strength. Methods. Multivariable linear regressions were performed between: 1) fatigue and measures of physical health and fitness and 2) each of 6 measures of QoL as outcome variables (fatigue, emotional well-being, functional well-being, global well-being, EQ5D QoL, and overall health status) with each of pain, depression and anxiety; all adjusted for age, sex, time since treatment, Hb, fat body %, fat trunk %, BMI, VO2peak, left grip strength, right grip strength, left leg muscle strength, right leg muscle strength, and muscle mass. Results are shown as regression coefficients B (change in fatigue score for 1 unit increase in physical health or fitness; or a change in QoL for 1 unit increase in pain, depression or anxiety). 80 patients aged 36-78 years (male, n=46), were studied at median 13.5 months (range 2-161) since last treatment. Physical health and cardiovascular fitness were assessed using objective measures: % body and trunk adiposity, muscle mass, body mass index (TANITA scales), VO2peak (CPET on a cycle ergometer), leg muscle strength and grip strength. The presence of bone pain was self-reported and evaluated in a clinical consultation. Standardised questionnaires were used to assess mood (HADS), fatigue (FACIT), functional and emotional well-being (FACT-G) and health related QoL (EQ5D). Higher scores on FACT-G and FACIT, health status scales and lower scores on HADS and EQ5D indicated better quality of life. Results. We investigated the influence of physical fitness on levels of fatigue, using multivariable regression. We found that higher levels of fatigue were associated with higher BMI (B = -1.28, CI =-2.28 to -0.28, p=0.013) and greater left leg muscle strength (B=0.16, CI=0.003 to 0.32, p=0.046) were linked to lower levels of fatigue independent of sex, age, time since treatment, pain and all other indicators of physical fitness. We observed that pain was associated with more fatigue (B = -6.80, CI = -11.45 to -2.15, p=0.005), decreased well-being (emotional: B = -1.92, CI =-3.50 to -0.35, p=0.018; global: B = -2.55, CI -4.59 to -0.51, p=0.015), decreased health related QoL (B =1.34, CI=0.42 to 2.26, p=0.005) and worse depression (B = 1.37, CI=-0.01 to 2.74, p=0.05), even when adjusting for sex, age, time since treatment and physical health and fitness. Depression was found to be an independent predictor of QoL with higher depression scores associated with greater fatigue (B = -2.52, CI=-3.09 to -1.96,p= Conclusions. Our findings confirm the important contribution of physical fitness to fatigue and QoL in these patients. Regardless of physical fitness status, however, the presence of pain and impaired psychological health remain independent drivers of fatigue and diminished QoL. Research involving exercise programmes designed to improve physical strength and fitness combined with effective pain management and psychological support are needed to provide the evidence base for much needed rehabilitative interventions. Disclosures Yong: Autolus Ltd: Equity Ownership, Patents & Royalties: APRIL based chimeric antigen receptor; Janssen: Research Funding.

Background Genetic testing for risk of weight gain is already available over the internet despite uncertain benefits and concerns about adverse emotional or behavioral effects. Few studies have assessed the effect of adding genetic test feedback to weight control advice, even though one of the proposed applications of genetic testing is to stimulate preventive action. This study will investigate the motivational effect of adding genetic test feedback to simple weight control advice in a situation where weight gain is relatively common. Methods/design First-year university students (n = 800) will be randomized to receive either 1) their personal genetic test result for a gene (FTO) related to weight gain susceptibility in addition to a leaflet with simple weight control advice (‘Feedback + Advice’ group, FA), or 2) only the leaflet containing simple weight control advice (‘Advice Only’ group, AO). Motivation to avoid weight gain and active use of weight control strategies will be assessed one month after receipt of the leaflet with or without genetic test feedback. Weight and body fat will be measured at baseline and eight months follow-up. We will also assess short-term psychological reactions to the genetic test result. In addition, we will explore interactions between feedback condition and gene test status. Discussion We hope to provide a first indication of the clinical utility of weight-related genetic test feedback in the prevention context. Trial registration Current controlled trials ISRCTN91178663

The scientific community's understanding that cancer is not a single entity has been an important theme in oncology over the past century (Mukherjee, 2011). However, popular discourse and media stories often imply a single entity: ‘the war on cancer', ‘finding a cure for cancer', ‘one in three of us will get cancer'. There is concern that the general public may not realise that different cancers have very different outcomes. Overestimating cancer survival (equivalent to underestimating its seriousness) may be associated with poor health behaviours such as smoking (Donovan et al, 2006). Underestimating survival may be associated with reluctance to participate in early detection. In previous studies, the belief that cancer is a ‘death sentence' has been found to be associated with negative attitudes towards early detection (Facione and Dodd, 1995; Burgess et al, 2001) and with lower screening participation (Chavez et al, 1997; Pearlman et al, 1999). Research in the United States indicates that the public are aware of variations in outcome: people rated skin cancer as more survivable than colorectal cancer (CRC), which was rated as more survivable than lung cancer (Rutten et al, 2009). Similarly, an Australian study found that breast cancer was perceived as most survivable, followed by CRC, and then lung cancer (Jones et al, 2005). However, no similar study has been carried out in Britain despite the fact that cultural differences could limit generalisation across countries. We therefore used data from a British population sample to compare estimated survival for three common cancers distributed across the survival spectrum (breast, colorectal and lung).

Psychosocial assessment prior to haematopoietic stem cell transplants (HSCT) can help to identify patients at risk of impaired health-related quality of life (HRQOL) post-transplant. According to the response-shift model, certain antecedents and mechanisms, along with changes in internal standards, values or conceptualisations of HRQOL, facilitate adjustment to changes in health circumstances. This study sought to explore the role of psychosocial variables in adjustment to compromised HRQOL following HSCT, from the theoretical basis of the response-shift model. Semi-structured interviews were conducted with 28 patients (15 women, 13 men; 22–71 years), post-HSCT. Time since transplant ranged from 1 month to 28 years. Verbatim transcripts were analysed using template analysis. Patients provided narrative examples of changing their values and internal standards. Optimism, social support, social comparisons, changing expectations and setting goals were identified as important in managing threats to HRQOL. The response-shift model is a useful theoretical basis for exploring HRQOL in HSCT patients. Response shifts and psychosocial variables may help patients to cope and enabling them to experience good HRQOL despite the negative effects of HSCT. Understanding the adjustment processes has implications for patient care.

Background National obesity rates have dramatically risen over the last decade. Being obese significantly reduces life expectancy, increases the risk of a range of diseases, and compromises quality of life. Costs to both the National Health Service and society are high. An increased prevalence of obesity in people with learning disabilities has been demonstrated. The consequences of obesity are particularly relevant to people with learning disabilities who are already confronted by health and social inequalities. In order to provide healthcare for all, and ensure equality of treatment for people with learning disabilities, services must be developed specifically with this population in mind. The aim of this project is to pilot the evaluation of a manualised weight management programme for overweight and obese persons with mild-moderate learning disabilities (Shape Up-LD). Methods/Design An individually randomised, controlled pilot trial in 60 overweight and obese (body mass index ≥ 25) adults (age ≥ 18) with mild-moderate learning disabilities and their carers will be carried out, comparing “Shape Up-LD” with usual care. The manualised Shape Up-LD intervention will involve 12 weekly sessions, which include healthy eating messages, advice on physical activity and use of behaviour change techniques to help people manage their weight. Assessments of participants will be conducted at baseline, 12 weeks and 6 months. Service users and their carers and service providers will also give their perspectives on the experience of Shape Up-LD in qualitative interviews at 12 weeks. Feasibility outcomes will include recruitment rates, loss to follow-up, compliance rates, completion rates, collection of information for a cost-effectiveness analysis and an estimation of the treatment effect on weight. Discussion The findings from this study will inform our preparation for a definitive randomised controlled trial to test the efficacy of the programme with respect to weight loss and maintenance in this population. Weight loss through Shape Up-LD could lead to improvements in health and quality of life. Costs to the National Health Service might be reduced through decreased overall service use because of improved health. The programme would also ensure a more equitable service for overweight service users with learning disabilities and fill the current gap in weight management services for this population. Trial registration International Standard Randomised Controlled Trial No ISRCTN39605930

Background Primary care is the first port of call for advice about weight control. There is hence a need for simple, effective interventions that can be delivered without specialist skills. We have developed such an intervention; the 10 Top Tips (10TT). This intervention was effective with respect to weight loss in a volunteer population, but has yet to be tested in primary care. The aim of this trial is therefore to test the effectiveness of the 10TT intervention in primary care, incorporating clinical outcomes and health economic analyses. Methods/Design The trial is a two-arm, individually-randomised, controlled trial in obese (BMI ≥ 30) adults (n = 520) in primary care, comparing weight loss in patients receiving the 10TT intervention with weight loss in a control group of patients receiving usual care. The intervention is based on habit formation theory, using written materials to take people through a set of simple weight control behaviours with strategies to make them habitual; an approach that could make it more successful than others in establishing long-term behaviour change. Patients will be recruited from 14 General Practices across England. Randomisation will be through telephoning a central randomisation service using a computer-generated list of random numbers. Patients are followed up at 3, 6, 12, 18 and 24 months. The primary outcome is weight loss at 3 months, with assessment by a health professional who is blind to group allocation. Other follow-ups will be un-blinded. We will examine whether weight loss is maintained up to 24 months. We will also assess changes in the automaticity of the 10TT target behaviours and improvement in clinical markers for potential co-morbidities. Finally, we will undertake a full economic evaluation to establish cost-effectiveness in the NHS context. Discussion If proven to be effective when delivered through primary care, 10TT could make a highly cost-effective contribution to improvements in population health. Trial Registration ISRCTN16347068