Peer Counseling for Weight Loss

Obesity has adverse effects on breast cancer survival and recurrence, and this may be
mediated via the insulin resistance that is associated with obesity. This is a matter of
exceptional concern for African-American (AA) breast cancer survivors since a greater
proportion of AAs than European Americans (EA) are obese, insulin-resistant and diabetic.
This proposal seeks to test the effects of weight loss intervention in obese and overweight
AA breast cancer survivors (body mass index 25-40 kg/m2, stage I, II, or IIIA cancer, free
of recurrence). Subjects (n=100) will be randomized across 3 arms: 1) control; 2)
individualized, dietitian-led counseling; and 3) dietitian-led counseling combined with peer
counseling using telephone counseling by trained peers who are AA breast cancer survivors
successful at weight control. Psychosocial factors that can affect the extent of weight loss
achieved will be assessed, including individual, home and community-level factors. Some of
these factors may change when weight loss is achieved and will be assessed both before and
after intervention. Genetic polymorphisms that have been shown to be associated with
increased body weight, insulin resistance, lipid metabolism, and oxidative stress will be
determined and related to both baseline and post-intervention anthropometric and biologic
measures. This should further help elucidate inter-individual differences in response to
weight loss intervention. The possible beneficial effects of weight loss on the health risks
associated with obesity will be evaluated with measures of insulin resistance, insulin-like
growth factor and lipid levels in blood samples, as well as with blood pressure and
anthropometric measures. The effects of weight loss on these measures have been studied in
other obese and overweight populations, but there is little data in breast cancer survivors.
Finally, we will attempt to determine if beneficial effects of weight loss can be detected
in the breast, since this should be related to subsequent breast cancer risk. The breast
contralateral to surgery will be subjected to ductal lavage at baseline, 12 and 24 months.
The investigators will examine the effects of weight change on markers of oxidative stress
in the breast nipple aspirate fluid that is obtained as part of the lavage procedure. Levels
of lipid peroxidation are very high in this fluid and have been related to both nuclear
atypia and breast cancer risk. The nuclear morphology of epithelial cells obtained by ductal
lavage therefore will be quantified as well. Weight loss in obese and overweight AA breast
cancer survivors should improve both psychosocial function and biological indicators of
health risks.

Inclusion Criteria:

- Overweight or obese

- African American

- Up to 7 years post breast cancer diagnosis

- Able to keep food records

- Have a telephone

- Stable weight within 5 pounds last 2 months

Exclusion Criteria:

- Breast cancer recurrence

- History of other cancers

- Uncontrolled congestive heart failure

- Untreated hypertension

- Disabling osteoarthritis

- Abusing drugs or alcohol

- Have psychiatric conditions that interfere with counseling