Daughters and Mothers Against Breast Cancer (DAMES): main outcomes of a randomized controlled trial of weight loss in overweight mothers with breast cancer and their overweight daughters.
Bottom Line: Few studies to date have used the cancer diagnosis as a teachable moment to promote healthy behavior changes in survivors of cancer and their family members.Significant improvements in lifestyle behaviors and health outcomes are possible with tailored print interventions directed toward survivors of cancer and their family members.For greater impact, more research is needed to expand this work beyond the mother-daughter dyad.
Affiliation: Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas; Duke University School of Nursing, Durham, North Carolina.Show MeSH
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Mentions: Mothers and daughters assigned to this arm each received individually tailored print materials. For example, the initial workbook was not only personalized with the participant's name, but the initial pages also delineated individual weight goals and the kilocalorie levels required to achieve desired rates of weight loss using the Mifflin-St. Jeor equation (kcal/day = −161 + 10(wt) + 6.25 (ht) −5(age)).29 In addition, the 3 major foods contributing the highest percentage of kilocalories to each participant's diet were identified from the dietary recalls performed at baseline, and individuals were either directed to lower-calorie substitutes or provided with guidance on portion control. Introductory pages also included tailored feedback on how current intakes of saturated fat and fruits and vegetables as well as physical activity compared with the national guidelines. In keeping with social cognitive theory, which provided the primary behavioral framework for the interventions,24 participants were encouraged to keep records of their food intake and physical activity (self-monitoring), as well as to problem-solve on overcoming perceived barriers to healthy behaviors and to set incremental and achievable goals.24 As stated, participants were surveyed bimonthly on their progress and plans, as well as their perceived barriers and readiness to pursue lifestyle changes and responses were used to inform tailored messages.30 The 6 subsequent newsletters provided tailored messages regarding progress toward goals, along with appropriate reinforcement (if progress was charted) or encouragement (if progress was stalled) and feedback on portion control and overcoming barriers. Newsletter messages also were framed on readiness to pursue lifestyle changes, and thus elements of the transtheoretical model of behavior change were drawn on to engage participants with the level of information best able to motivate them.30 Mothers and daughters assigned to this arm also received supplies and equipment to assist them with self-monitoring, such as logbooks and reference manuals (T-Factor 2000; WW Norton and Company, New York, NY) or Web sites (eg, mypyramid.org) to tally their intakes of kilocalories and saturated fat. They also received portion control tableware (Portion Doctor; Portion Health Products, St. Augustine Beach, Fla); iPods with prerecorded selections to set walking pace (Apple, Cupertino, Calif); and shoe chips (Nike Inc, Beaverton, Ore) to monitor steps taken, minutes of physical activity, and kilocalories burned. Figure 2 shows an illustration of the study materials.
Affiliation: Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas; Duke University School of Nursing, Durham, North Carolina.