Survivorship Promotion In Reducing IGF-1 Trial

Inclusion Criteria:

Women and men ages 18 or older
Have been previously diagnosed with a malignant solid tumor, completed their required surgical, and/or chemotherapy and/or radiation curative intent therapy at least three months prior to enrollment, and have an anticipated treatment-free life span of 12 months or longer. Chemoprophylaxis with tamoxifen or aromatase inhibitors for breast cancer in women and anti- Luteinizing hormone-releasing hormone (LHRH) therapy for prostate cancer in men will be permitted.
Have a BMI of 25 kg/m^2 or greater and weight <=400 lbs.
Willingness to accept randomization to each of the three arms
Willingness to change diet, physical activity, and weight
Regular access to computer with a reliable Internet connection
Ability to send and receive emails
Ability to complete online forms
Access to phone
Willingness to provide written informed consent

Exclusion Criteria:

Women who are breastfeeding, pregnant, or planning pregnancy within the next year
Medication-treated diabetes
Fasting blood glucose >=200 mg/dL, or fasting blood glucose >=126 and <200 mg/dL and HbA1C >=7%
Current or prior regular use of metformin within the past 3 months
Uncontrolled concurrent medical condition likely to limit compliance with the study interventions
Received any chemotherapy (unless anti-hormonal therapy) and/or radiation three months or less prior to the proposed intervention date
Have a prior history of lactic acidosis by self-report
Prior or planned bariatric surgery
Have significant renal disease or dysfunction defined as Estimated glomerular filtration rate (eGFR)<45
Have significant hepatic dysfunction [Aspartate aminotransferase (AST)/Alanine transaminase (ALT) ≥ 2 x upper limit of normal (ULN) or reported liver disease]
Self-reported average consumption of > 14 alcoholic drink per week
Currently enrolled or planned to enroll in weight loss program
Hemoglobin <9 g/dl
Platelet count <100
White blood cell count (WBC) <2.5
Plans to relocate from the area within one years
Use of prescription weight loss medication(s) (e.g., lorcaserin, topiramate/phentermine, phentermine, liraglutide, and bupropion/naltrexone), including off label use of drugs for weight loss or over-the-counter weigh loss medications such as Orlistat within the past 6 months.