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Evidence from bariatric surgery cohorts and some behavioural intervention trials supports the notion that weight loss can prevent obesity-related cancers. The introduction of glucagon-like peptide (GLP)-1 agonist drugs has rapidly revolutionised pharmacotherapy options. A cancer prevention clinical trial would be complex, lengthy, and costly; therefore, we undertook an international expert consensus to assess the need for and design of a weight-loss intervention cancer prevention trial. We used a combination of two nominal group meetings, sandwiching 3 Delphi rounds. A panel of 54 international, multi-disciplinary researchers was established, informed by patient groups. Feedback was incorporated iteratively, and borderline statements, those that did not reach consensus, were addressed in a final meeting. Through the Delphi rounds, retention rates were high (98%, 85%, 88%). Consensus was achieved on 25 statements. Including: (i) there is a need for clinical trial evidence to inform obesity-related cancer prevention strategies; (ii) a trial should reflect high-risk populations; (iii) trials should prioritise GLP-1 agonists; and (iv) future research should explore mechanistic pathways and relevant cancer precursors. This consensus underscores the need for trial evidence to inform strategies for obesity-related cancer prevention.<\/jats:p>","DOI":"10.1038\/s41416-026-03356-7","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T21:43:00Z","timestamp":1772487780000},"page":"1123-1130","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Need for and design of a trial to test efficacy of weight loss interventions for cancer prevention: an international consensus using expert nominal group and Delphi methods"],"prefix":"10.1038","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7326-3413","authenticated-orcid":false,"given":"Matthew","family":"Harris","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7663-7804","authenticated-orcid":false,"given":"David P.","family":"French","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Clare","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9761-3089","authenticated-orcid":false,"given":"Michelle","family":"Harvie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duncan T.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Brown","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8725-3283","authenticated-orcid":false,"given":"David","family":"Jayne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9115-4405","authenticated-orcid":false,"given":"Andrew G.","family":"Renehan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"3356_CR1","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1056\/NEJMsr1606602","volume":"375","author":"B Lauby-Secretan","year":"2016","unstructured":"Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. 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Target trial emulation: applying principles of randomised trials to observational studies. 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There are no other specific financial declarations of interest by all other co-authors.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study involved a consensus process with expert participants who contributed in a professional capacity. Formal ethical approval was not required in accordance with national legislation and institutional guidelines, following discussion with the University of Manchester Research Ethics Committee, due to the voluntary nature of expert participation, professionals working with their domain of expertise, anonymisation of data and the consenting process. All participants provided informed consent to participate in the study and were informed of the study aims, methodology, and their right to withdraw at any time. Study methodology was circulated prior to invitation and participation, along with information on data management and anonymisation. Prior to each in-person meeting, consent was taken from participants prior to commencement, and each Delphi form took consent from the participant for the research team to use anonymised data for analysis and future publication. Responses were anonymised to ensure confidentiality.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}]}}