Coordinated Obesity Management for Prevention of Chronic Diseases

Breast cancer is the leading cause of cancer death among women globally, with around 31 women dying each day from the disease in the UK and a further 7 women dying each day in Australia from the disease. Breast cancer places a heavy burden on healthcare systems, and expenditure on breast cancer treatment is forecast to rise in coming years due to increasing incidence linked to  an aging population and increases in the prevalence of risk factors such as obesity, poor diet, alcohol consumption and sedentariness. These lifestyle factors when combined with overweight or obesity are estimated to contribute to 30% of breast cancers. This project will explore if information on the potential benefits of weight loss for breast cancer risk reduction can be acceptably delivered via breast screening services in Australia and the UK and how it can be most appropriately and effectively delivered via the ‘teachable moment’ to:

• Increase awareness of this risk among women with overweight/obesity
• Motivate them to participate in a breast cancer risk framed weight loss/behavioural intervention
• Minimise any harm associated with delivery of this type of education to avoid weight stigma, or discourage women from reattending breast screening in future.

We will generate data to support the acceptable and feasible delivery of risk-based education and delivery of breast cancer risk reduction weight loss/behavioural programme delivered through population-based breast screening services in the UK and Australia. This programme is important as weight loss offers a potential modifiable intervention to reduce risk of breast cancer. Information on how best to leverage a potential ‘teachable moment’ when attending screening as well as on possible recruitment /referral strategies to a breast cancer risk framed weight loss/behavioural programme will be derived from service provider and consumer perspectives. In addition, consumer perspectives on how the existing UK programme should or can be adapted, as well as acceptability of a pilot app that could also be used in the delivery of the intervention will be collected. Together these data will make an essential contribution to the co-design process, ensuring that any intervention delivered will be acceptable to as well as feasible, support both a pilot and widescale implementation

Overall, this study will inform development of a co-designed strategy around when, where and how education can be safely delivered to women with overweight / obesity, who are at higher risk of breast cancer, to motivate them to participate in a weight loss/behavioural intervention. A co-designed framework for pilot testing of a weight loss/behavioural breast cancer risk reduction programme will also be a result of this work.

In Australia and the UK, 2 in 3 people are overweight, and more 1 and 3 have obesity.  Excess weight is the leading contributor to the total disease burden in Australia and is the third largest contributor in the UK. Obesity is a risk factor for multiple chronic diseases including 17 types of cancer, cardiovascular disease, type 2 diabetes (T2D), and chronic kidney disease.

While lifestyle interventions can achieve some weight loss, this approach can be hard to sustain due to social and environmental determinants of health. New medications approved by the TGA (Australia) and NICE (UK), glucagon-like peptide 1 (GLP-1) receptor agonists like semaglutide (Ozempic/Wegovy) can result in a sustained loss of 10-20% of initial body weight, especially when provided in conjunction with psychological and dietetic support. Until recently, these medications were only indicated for treatment of T2M.

At present, for the treatment of obesity, GLP-1 medications are available only via private script (‘off label’) in Australia and through limited specialist metabolic health clinics in the UK at significant cost to the patient. In addition, increasing popularity has created a global supply shortage, anecdotal inappropriate use and a stream of alternative supply through online pharmacies, compounding pharmacies, commercial weight loss programs and other online sources, all of which are costly to purchase.

It is essential that there is equitable access to obesity treatment to reduce risk of subsequent chronic disease. Certain populations are more likely to be living with overweight/obesity when compared to their counterparts.

We will encourage the public to participate in our survey with the following key aims:

• Identify patterns of GLP-1 usage in Australia and the UK
• Understand perceptions, attitudes, and understandings the public may have about GLP-1  medication usage in Australia and the UK.
• Understand negative perceptions, attitudes, and understandings that physicians may be communicating to patients about GLP-1  medication use in Australia and the UK and the type of support being offered or suggested accessing GLP-1 medications.
• Identify barriers people might experience trying to access these medications.
• Understand the appropriateness of GLP-1 use in Australia and UK

Get involved:

• Download Participant Information PDF, 223.08 KB (opens in a new window)
• Take Survey (opens in a new window)

Ghada is a PhD candidate at THRI and her thesis is on ‘Exploring social isolation and loneliness in individuals with clinically severe obesity’.

Topic: 'Design and Delivery of an Integrated Intervention to Maintain Treatment Outcomes During Transition from Tertiary Obesity Treatment to Community Care'

Primary Supervisor – Associate Professor Kate McBride

Co-supervisors – Associate Professor Freya MacMillan, Associate Professor Milan Piya, Dr Kathryn William

Project description:
The project will explore experiences of social isolation and loneliness (SIL) in people living with clinically severe obesity to inform future research on SIL in people with clinically severe obesity. SIL are an emerging public health issue and are associated with a range of negative health outcomes, including cognitive decline, as well as poorer cardiovascular and mental health. There is some evidence to suggest that people living with obesity may be more lonely and socially isolated than the general population, potentially impacting negatively on disease progression. Though generally, the literature on the experiences of SIL in people with clinically severe obesity is scarce. A such, qualitative data will be collected from participants and clinicians involved in their care to explore experiences of SIL in people living with obesity.

Get involved: Download Participant Information PDF, 186.44 KB (opens in a new window)

Timothy is a PhD candidate at THRI, his thesis is investigating the dietary and lifestyle behaviours of Pacific Islander children and adolescents living in Sydney that increases risk of type 2 diabetes: Pasifika Youth Diet Study.

Topic: 'Understanding the Dietary and Lifestyle Behaviours That Impact Diabetes Risk Factors in Pasifika Children and Adolescents to Develop a Family-based Intervention in Sydney, Australia'

Primary Supervisor – Associate Professor Kate McBride

Co-supervisor – Associate Professor Freya MacMillan, Distinguished Professor David Simmons, Dr Jason Wu

Finding common advocacy ground between the competing interests of prevention and treatment of obesity

THRI members A/Prof Kate McBride, Professor Phillipa Hay, Dr Cristy Brooks, and Ms Sarah Hirst attended the “Policy Roundtable: Toward a comprehensive approach to obesity advocacy” hosted by the Cancer Council, THRI, and the Public Health Association of Australia on Friday, 26th July.

Leading experts from all over Australia and organisations, including Dr Mike Freelander (Lead Federal Diabetes Inquiry), the Australian Chronic Disease Prevention Alliance, Australian Medical Association, Australian New Zealand Metabolic and Obesity Surgery Society, the Commonwealth Department of Health, Deakin University, Diabetes Australia, Health and Wellbeing Queensland, Health Consumers’ Council WA, Monash University, Preventive Health SA, Royal Australasian College of Physicians, and the Weight Issues Network, attended the event which was co-convened by Kate McBride.

The day began with presentations from experts in the field, including from Kate, who spoke about the effectiveness of different types of obesity treatment in preventing chronic disease.

The subsequent workshop discussions centred on cohesive policy priorities for obesity prevention, treatment, and management, and on mapping out the potential for a coalition to strongly advocate for obesity action across the spectrum (prevention to treatment).
Gaps were highlighted in the current research that could inform advocacy efforts including:

• A greater understanding of people's lived experiences.
• Engagement with healthcare providers across all levels and improvement in education possibilities and potential for upskilling into obesity care.
• Strategies to reduce stigma.

Also discussed was the importance of advocating for obesity policy priorities. As a coalition, we can learn from the success of the National Tobacco and Road Safety campaigns while understanding that we are competing with industries with enormous buying power and a lack of government prioritisation of obesity and chronic disease management.

It was an excellent occasion where global and local leading experts in obesity were able to agree that we should be harnessing our collaborative strengths to tackle the obesity crisis.

Associate Professor Kate McBride received a Presentation Award at the 2024 BreastScreen Australia Conference. Kate has worked closely with BreastScreen WA on her research titled "Mixed methods development of an intervention framework to improve breast screening participation among women with obesity and/or physical disability".