Obesity and Cancer Survivorship



Well Survivors, the time has come.  If this blog is going to give you everything you need to know about staying well after cancer, we must discuss the unavoidable - the connection between cancer and obesity.  As you'll learn below, many cancers are highly correlated with obesity.  But before we get buried in the didactic, let me tell you a little story.

A Story About Cancer and Obesity

I had a lovely, 51 year old female patient with severe obesity.  She'd had stomach stapling surgery in the past to address the problem but it was not successful and the obesity persisted.  She then developed curable rectal cancer but unfortunately, due to her body size, she was not able to have curative surgery. 

Let me explain this.  Often times, surgeons must assess whether the patient will be safe having surgery at all - it's a risk vs. benefit decision making situation.  Morbidly obese people have very high surgical risk due to the baseline stress obesity puts on their heart and lungs.  Putting a patient under general anaesthesia can be very dangerous in these circumstances.  Morbidly obese patients have a risk of being on the ventilator longer and are thus at risk for surgical complications, including death. 

Surgery is not magic.  It's a risky decision and surgeons are experts in deciding if their procedures will place a patient in more danger than the potential benefit of the surgery.  I absolutely respected the surgeon's decision in this case.  But it was extremely unfortunate for the patient.

Instead of surgery, we offered the patient definitive chemo radiation - this is high dose radiation given with chemotherapy to sensitize the tumor to the radiation energy.  This was an attempt to cure her cancer with a less invasive (than surgery) technique. 

The treatment was not easy and our patient tolerated it very poorly.  She was hospitalized multiple times for heart and stomach complications and ultimately, she could not complete therapy.  She was placed on surveillance and her rectal cancer came back within 18 months.  Because of her poor health, our team and the patient made the decision to forego further therapy.  She was placed on hospice and the patient died peacefully.

I tell this story to illustrate that the information below is not just about numbers.  Obesity's influence on cancer is real.  And the results can be tragic.

The Definition of Overweight and Obesity

The risk of illness and death associated with being overweight or obese is well documented and results in a significant reduction in life expectancy.  The term overweight means having a body weight above the "normal" range.   Normal weight range in medicine is determined by calculating the body mass index (BMI), or weight in kilograms divided by body surface area in meters squared. 

  • Overweight is defined as a BMI of 25 to 29.9 kilograms per meters squared.

  • Obesity is a BMI of greater than 30 kilograms per meters squared.

  • Severe Obesity is defined as a BMI greater than 40 kilograms per meter squared, or greater than 35 if the person also has illnesses like diabetes, high blood pressure, or high cholesterol, to name a few.

For reference, our patient in the story above had severe obesity.  Her BMI was greater than 50 and she had many other illnesses to boot.

The Facts About Obesity and Cancer

Overweight and obesity is associated with an increased risk of multiple types of cancer including: 

  • Endometrial (uterus)

  • Kidney

  • Gastric (stomach)

  • Colon

  • Rectum

  • Liver

  • Gallbladder

  • Pancreas

  • Breast

  • Esophageal adenocarcinoma

  • Ovarian

  • Multiple myeloma

  • Thyroid

  • Meningioma

There are a few possible causes of the association between obesity and cancer:

1. Obese people have chronic, low level inflammation in their bodies.  Over time, this can lead to DNA damage which makes cells more prone to divide inappropriately.  

2. Fat tissue produces excess estrogen which encourages certain types of cells to grow out of control.  It follows that estrogen sensitive cancers like breast and endometrial are on the list above.

3. Obesity causes insulin resistance which causes high levels of insulin to circulate in the body.  Insulin can encourage cells to grow out of control.  Cancers that fit this scenario are colon, kidney, prostate, and endometrial cancer.

4. Fat cells make adipokines, another type of hormone that influences cell growth.  Fat cells may also effect cell growth regulators produced in other types of cells.

Obesity and Survivorship

So what is the data related to obesity and cancer survivors?  Most of the evidence in this area comes from research involving breast, prostate and colorectal cancer.  It says that obesity may worsen cancer survivors' quality of life, chance of cancer recurrence, cancer progression, and overall survival.  Examples include:

  • Quality of Life - Obesity is associated with worse lymphedema in breast cancer survivors and worse urinary incontinence in prostate cancer survivors who've undergone radical prostatectomy.

  • Recurrence - Obesity is linked to an increase in recurrence in stage II and III colorectal cancer survivors.

  • Cancer Progression and Survival - Death from multiple myeloma is 50% more likely in obese people than those in the normal weight range.

So, obesity increases your risk for cancer and if you survive it, obesity also decreases your quality of life and increases your recurrence risk.  This is sobering information for overweight cancer survivors.

Brio: A Non Judgmental Approach to Obesity and Fatigue

It's clear to me that finding a healthy weight is huge a priority.  Brio Survivor Wellness teaches cancer survivors action steps to conquer fatigue, heal body and mind, and achieve lasting wellness after cancer.  If you're struggling with obesity after cancer, you're not alone.  You've got this, and Brio's here to help - not to judge.

Brio's wellness philosophy is a combination of mindfulness, movement, and nourishment with "equal opportunity eating."  Chances are, if you're a cancer survivor who just finished treatment and you'd like to lose a few pounds, you're also feeling so fatigued you can't even think about planning a new diet. 

Luckily, I've got a solution for you!  I'm offering Brio's Quick Start Weight Loss Meal Plan for free!  It's a six day meal plan filled with tasty recipes, gorgeous pictures, nutrition information, and convenient shopping lists to get you started on your path to healthy weight loss.  Click the button below to get the free Weight Loss Meal Plan and taste what Brio can do for you.

I'll see you again soon, Survivor.