{"entity":{"id":"dietitian-led-weight-loss-breast","kind":"technology","name":"Dietitian-led weight-loss programmes in HR-positive breast cancer","aka":[],"tldr":"Being overweight after breast cancer is linked with more recurrence, so a 3,000-woman trial tested a two-year telephone weight-loss programme. Women lost weight, but the trial did not clearly show fewer recurrences.","summary":"Obesity at diagnosis is associated with roughly 30% higher breast cancer mortality in meta-analyses, and with reduced aromatase inhibitor efficacy, making intentional weight loss an attractive adjuvant strategy. The Breast Cancer Weight Loss (BWEL, Alliance A011401) trial randomised 3,181 women with stage II-III HR-positive or HER2-positive breast cancer and BMI at least 27 to a two-year telephone-based lifestyle intervention (calorie restriction, 150-225 minutes of activity a week, health coaching) plus health education, or health education alone, with invasive disease-free survival as the primary endpoint. The intervention produced clinically meaningful weight loss at one and two years; primary results presented in late 2025 were reported as not showing a statistically significant iDFS improvement at the primary analysis, with longer follow-up and subgroup analyses to come (see trial record for caveats). Whether that reflects insufficient weight loss, too short a follow-up, or a true absence of effect is now the central question, and pharmacological weight loss with GLP-1 receptor agonists is the obvious next test. Weight-loss programmes remain justified for cardiometabolic health, fitness and quality of life in survivors.","status":"phase-3","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Weight_loss","links":[{"label":"ClinicalTrials.gov NCT02750826","url":"https://clinicaltrials.gov/study/NCT02750826"},{"label":"BWEL design paper (npj Breast Cancer 2017)","url":"https://doi.org/10.1038/s41523-017-0040-8"}],"tags":[],"related":["idea-nl-glp1-adjuvant-hr-breast"],"cancers":["breast-hr-positive","breast-her2-positive"],"sections":["nutrition-lifestyle","supportive-care","hormonal"],"technologies":["endocrine-therapy","exercise-oncology","glp1-agonists-cancer-risk","structured-exercise-survivorship"],"targets":[],"drugs":["letrozole","tamoxifen","exemestane"],"companies":[],"institutions":["dana-farber"],"pathways":[],"terms":["energy-balance","obesity-related-cancers","body-composition"],"trials":["bwel"],"people":[],"bottlenecks":["b-survivorship","b-negative-results"],"keyPapers":["paper-ligibel-npj-breast-cancer"],"journals":[],"dependsOn":[],"notes":[],"principle":"Reducing adiposity lowers aromatase-driven oestrogen synthesis, insulin, leptin and inflammatory cytokines that promote growth of hormone-dependent residual disease.","strengths":["Large, well-run pragmatic trial answered a long-standing question","Telephone delivery is scalable","Weight loss achieved was real"],"limitations":["Primary cancer endpoint not met at first analysis","Weight loss of a few percent may be below the biological threshold","Adherence and attrition over two years"]},"route":"/technologies/dietitian-led-weight-loss-breast/","neighbours":{"idea":[{"id":"idea-nl-glp1-adjuvant-hr-breast","kind":"idea","name":"GLP-1 receptor agonists as adjuvant weight-loss therapy in HR-positive breast cancer","route":"/ideas/idea-nl-glp1-adjuvant-hr-breast/"}],"cancer":[{"id":"breast-her2-positive","kind":"cancer","name":"HER2-positive breast cancer","route":"/cancers/breast-her2-positive/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"hormonal","kind":"section","name":"Hormonal Therapy","route":"/fronts/hormonal/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"endocrine-therapy","kind":"technology","name":"Endocrine therapy (SERMs, AIs, SERDs)","route":"/technologies/endocrine-therapy/"},{"id":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/"},{"id":"glp1-agonists-cancer-risk","kind":"technology","name":"GLP-1 receptor agonists and obesity-related cancer risk","route":"/technologies/glp1-agonists-cancer-risk/"},{"id":"structured-exercise-survivorship","kind":"technology","name":"Structured exercise programmes after curative treatment","route":"/technologies/structured-exercise-survivorship/"}],"drug":[{"id":"exemestane","kind":"drug","name":"Exemestane","route":"/drugs/exemestane/"},{"id":"letrozole","kind":"drug","name":"Letrozole (and other aromatase inhibitors)","route":"/drugs/letrozole/"},{"id":"tamoxifen","kind":"drug","name":"Tamoxifen","route":"/drugs/tamoxifen/"}],"institution":[{"id":"dana-farber","kind":"institution","name":"Dana-Farber Brigham Cancer Center","route":"/institutions/dana-farber/"}],"term":[{"id":"body-composition","kind":"term","name":"Body composition (lean mass, fat mass, visceral fat)","route":"/terms/body-composition/"},{"id":"energy-balance","kind":"term","name":"Energy balance","route":"/terms/energy-balance/"},{"id":"obesity-related-cancers","kind":"term","name":"Obesity-related cancers (IARC list of 13)","route":"/terms/obesity-related-cancers/"}],"trial":[{"id":"bwel","kind":"trial","name":"BWEL (Breast Cancer Weight Loss, Alliance A011401)","route":"/trials/bwel/"},{"id":"whel","kind":"trial","name":"WHEL (Women's Healthy Eating and Living)","route":"/trials/whel/"}],"bottleneck":[{"id":"b-negative-results","kind":"bottleneck","name":"Failures are hidden","route":"/bottlenecks/b-negative-results/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}],"paper":[{"id":"paper-ligibel-npj-breast-cancer","kind":"paper","name":"Randomized phase III trial evaluating the role of weight loss in adjuvant treatment of overweight and obese women with early breast cancer (Alliance A011401): study design","route":"/key-papers/paper-ligibel-npj-breast-cancer/"}],"pathway":[{"id":"lipid-metabolism-cancer","kind":"pathway","name":"Lipid synthesis, uptake & cholesterol","route":"/pathways/lipid-metabolism-cancer/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"}]}}