Obese endometrial cancer survivors’ perceptions of weight loss strategies and characteristics that may influence participation in behavioral interventions

Abstract

Objectives: Endometrial cancer is strongly linked to obesity and obesity-related comorbidities, making weight management a vital aspect of survivorship care. Understanding the health determinants that factor into weight management among survivors can help providers more effectively promote interventions among their patients. To that end, we aimed to evaluate obese endometrial cancer survivors’ perceptions of barriers to weight loss and previously attempted weight loss strategies and aimed to identify characteristics that predict willingness to enroll in a behavioral weight loss intervention trial. Methods: A 29-question baseline survey was administered at a single academic institution to all endometrial cancer survivors with body mass index >30 kg/m2 approached for enrollment in a weight loss intervention trial. Prior to any interventions, survivors were queried on their health habits and lifestyles, previous weight loss strategies, and perceived barriers to weight loss. Fisher's Exact, Kruskal-Wallis, and univariate and multivariate regressions were used to analyze data. Results: 155 of 358 (43.3%) eligible obese endometrial cancer survivors were surveyed. 80 (51.6%) enrolled in a randomized weight loss intervention trial. In a multivariate model, adjusting for race and disease stage, survivors without recurrence were 4.3 times more likely to enroll in the behavioral weight loss intervention trial compared to survivors with recurrence. Nearly all survivors (n=148, 95.5%) had considered losing weight, and 77% (n=120) had tried two or more strategies. Few survivors had undergone bariatric surgery (n=5, 3.3%), met with psychologists (n=2, 1.3%), or met with physical therapists (n=9, 5.8%). Lower income was associated with survivors’ perceptions of difficulty in accessing interventions. Survivors commented that negative self-perceptions and difficulties with follow-through were barriers to weight loss, and that fear of complications and self-perceived lack of qualification were deterrents to bariatric surgery. Conclusions: Most obese endometrial cancer survivors have tried multiple strategies to lose weight, but remain interested in behavioral weight loss interventions, especially women who have never experienced recurrence. Providers should encourage weight loss interventions early, at the time of initial endometrial cancer diagnosis, and promote underutilized strategies such as psychological counseling, physical therapy, and bariatric surgery via multidisciplinary team approaches. Endometrial cancer is strongly linked to obesity and obesity-related comorbidities, making weight management a vital aspect of survivorship care. Understanding the health determinants that factor into weight management among survivors can help providers more effectively promote interventions among their patients. To that end, we aimed to evaluate obese endometrial cancer survivors’ perceptions of barriers to weight loss and previously attempted weight loss strategies and aimed to identify characteristics that predict willingness to enroll in a behavioral weight loss intervention trial. A 29-question baseline survey was administered at a single academic institution to all endometrial cancer survivors with body mass index >30 kg/m2 approached for enrollment in a weight loss intervention trial. Prior to any interventions, survivors were queried on their health habits and lifestyles, previous weight loss strategies, and perceived barriers to weight loss. Fisher's Exact, Kruskal-Wallis, and univariate and multivariate regressions were used to analyze data. 155 of 358 (43.3%) eligible obese endometrial cancer survivors were surveyed. 80 (51.6%) enrolled in a randomized weight loss intervention trial. In a multivariate model, adjusting for race and disease stage, survivors without recurrence were 4.3 times more likely to enroll in the behavioral weight loss intervention trial compared to survivors with recurrence. Nearly all survivors (n=148, 95.5%) had considered losing weight, and 77% (n=120) had tried two or more strategies. Few survivors had undergone bariatric surgery (n=5, 3.3%), met with psychologists (n=2, 1.3%), or met with physical therapists (n=9, 5.8%). Lower income was associated with survivors’ perceptions of difficulty in accessing interventions. Survivors commented that negative self-perceptions and difficulties with follow-through were barriers to weight loss, and that fear of complications and self-perceived lack of qualification were deterrents to bariatric surgery. Most obese endometrial cancer survivors have tried multiple strategies to lose weight, but remain interested in behavioral weight loss interventions, especially women who have never experienced recurrence. Providers should encourage weight loss interventions early, at the time of initial endometrial cancer diagnosis, and promote underutilized strategies such as psychological counseling, physical therapy, and bariatric surgery via multidisciplinary team approaches.