4. Discussion
cancers, cancer, adiposity, overweight or obesity, weight loss
CANCERS, BREAST CANCER, CANCER, INFLAMMATION, ADIPOSITY
Overall, the main aim of the current study was to quantify the intervention effect of a telephone-based lifestyle intervention that combined exercise and dietary modification, in comparison to an active control group, among Ohio residents living in rural counties who had overweight or obesity. Our findings suggest that a 15-week telephone-based lifestyle intervention, compared to the health education control group, can provide weight loss benefit and favorable changes in fasting blood biomarkers, such as total cholesterol.The telephone-based lifestyle intervention yielded significant weight loss in the intervention group, with an average of 4.9 kg lost between baseline and 15-week follow-up, which was greater than a recent meta-analysis that reported 1.8 kg weight loss in most rural weight loss trials [It is worth emphasizing that both groups had reductions in weight over the duration of the study, with the active control group experiencing a 2.1 kg loss of body weight at 15 weeks. The weight loss in the control group could be explained by them receiving the educational brochure which included physical activity and dietary guidelines. Two participants also acquired personal trainers to help them meet the exercise goals. Although the between-group differences in body weight were insignificant, the magnitude of the weight loss exhibited in our lifestyle intervention group is promising, especially over a short period of 15 weeks. In an urban study among women with higher risk of breast cancer, Hartman and colleagues found that self-monitoring combined with telephone-based counseling yielded significant weight loss, approximately 4.4 kg, over a 6-month study duration compared to 0.8 kg in the control group [Increased adiposity elevates the risk of cancer by the negative impacts on metabolic and inflammatory processes [Elevated levels of total cholesterol and triglycerides as well as low levels of HDL are associated with risk of cancers, suggesting that reducing total cholesterol and improving HDL may potentially reduce cancer risk [Another important aspect of reducing obesity-related cancer risk is improved inflammatory biomarkers. Healthy lifestyle, including leisure time physical activity, healthy diet, and weight loss can improve energy balance and may reduce obesity-related inflammation, such as IL-6, TNF-α, and CRP [There are several notable strengths in our study. First, this was a randomized controlled pilot study, which by design, balanced the baseline confounding. We also kept staff blinded for the baseline and 15-week assessment to reduce measurement bias. Most importantly, we are, to date, the first study utilizing a portable 3D body scanner for body composition assessment in rural settings. Together with the portable lipid analyzer, we provided a point-of-care approach that was able to show participants their body composition and lipid results at the local study site. This approach may encourage participants to maintain a healthy lifestyle after study completion.This study has several limitations. Due to the pilot study design, we conducted an exploratory analysis to quantify the intervention effect of a 15-week telephone-based intervention on weight, body composition, fasting blood lipids, and inflammatory biomarkers. We intend to use these findings as pilot data to support the design of a large-scale efficacy trial to demonstrate the metabolic benefits from weight loss interventions in rural populations with overweight/obesity. Therefore, the interpretation of these pilot study findings should be taken with caution. Additionally, participants who were interested and enrolled in the HERO study may not represent the general rural population with overweight/obesity. Moreover, although we established the feasibility of the lifestyle intervention in rural Ohio, we experienced some dropouts (17.5%). Compared to those who completed the study, those who dropped out had a higher BMI at baseline (In conclusion, our pilot study offers important preliminary data and valuable experience in delivering a telephone-based lifestyle intervention for individuals with overweight/obesity in rural Ohio. Our findings demonstrate that a 15-week telephone-based lifestyle intervention may offer health benefits and reduce cancer-risk factors in rural populations. Future large-scale randomized trials are needed to examine the efficacy of remotely accessible weight loss programs in rural populations, with the goal to reduce obesity-related disparities.