Obesity’s ties to cancer and what we can do

By Dr. Oscar B. Goodman

Tuesday, Feb. 28, 2017 | 9:40 a.m.

We have an obesity epidemic in the United States and its impacts are startling.

According to the Centers for Disease Control and Prevention, more than one-third of U.S. adults — 36.5 percent — are obese. Clinically, obesity is defined as having a body mass index (BMI) of 30 or higher. BMI is a calculation of a person’s weight in kilograms divided by the square of height in meters.

Obesity rates are highest among non-Hispanic blacks (48.1 percent) and Hispanics (42.5 percent). Obesity is also most prevalent in the 40-59 year age demographic, with 40.2 percent of middle age adults being considered obese.

In addition to its prevalence, obesity is also making a significant impact on our pocketbooks and economy. Obese Americans spend upward of 50 percent more on their individual health care costs, compared to those at an average weight. This amounts to $150 billion to $210 billion spent annually to address and combat the condition in the United States.Statistics and costs aside, being obese has significant health impacts. Those impacted are at a much higher risk for a number of serious conditions and diseases, including Type 2 diabetes, stroke, heart disease, hypertension, gallbladder disease, anxiety and depression, among others.In the cancer realm, being obese equates to an increased risk for specific types of cancer as well.

How obesity correlates to cancer

According to the World Cancer Research Fund, obesity accounts for 20 percent of all cancer-related deaths. Cancerous diseases that can be linked to obesity include kidney cancer, endocrine cancers (breast, prostate, ovarian and endometrial), and gastrointestinal cancers (hepatoma, gallbladder, pancreas, esophageal, gastric and colorectal).

So, clinically, how exactly does obesity contribute to cancer progression?

Obesity is permissive for three key cancer-development mechanisms including inflammation, hormonal signaling and the obese milieu.

Inflammation is a double-edged sword when it comes to cancer. On one end, inflammation is crucial in combatting irritants, bad cells and bacteria. And on the other end, too much inflammation equates to the perfect storm as it allows tumors to grow and metastasize. Inflammation begins in the fatty cells; therefore, if there is an overabundance of fatty cells/tissue, it is that much more of an optimal environment for cancer to develop and spread.

Obesity can also have significant effects on metabolism and hormone production. These hormonal swings can significantly affect your risk for certain types of cancer, seeing as certain hormones can communicate with one another to promote cell adhesion, migration or metastasis. An overproduction of certain types of hormones has been directly tied to a number of cancers in targeted areas, including breast, ovarian and endometrial cancers.

And finally, obesity can throw off your body’s entire internal environment (milieu) and state of equilibrium. Visceral fat – or fat surrounding organs, typically found in the abdominal area – is especially dangerous and can make a bad situation that much worse. In addition to obesity-driven inflammation that can stress your organs, visceral fat adds that much more pressure to select organs, sparking even more, potentially cancer-promoting damage.

With the wrong mix of habits and/or conditions, obesity can quickly become a problem for almost anyone. Fortunately, there are steps you can take to stay one step ahead of obesity and a prospective obesity-related cancer diagnosis.

And, it all begins with a healthy diet.

Giving soda a pop

You’ve likely heard it your entire life: A healthy diet and regular exercise are crucial to staying healthy. Sure, it may be easier said than done at times, but eating the right foods and physical activity can go long way in preserving your health.

In terms of cancer prevention, there are some “superfoods” that truly live up their name. These foods – including pomegranate, leafy vegetables, curry, acai berries and grapes – are all high in antioxidants. Antioxidants are good chemicals that combat and destroy free radicals within the body. These free radicals, in high concentrations, have the potential to damage DNA, which could in turn evolve into cancer and/or other detrimental diseases.

As for what to avoid, there is one type of food that is considered public enemy number one. According to Amy Patton, a Southern Nevada-based registered dietitian, sugar-sweetened beverages are the top food to steer clear of, especially if cancer prevention is top-of-mind.

“Sugar is one of the primary fuels for the body in general,” said Patton, who regularly sees and advises patients at Comprehensive Cancer Centers of Nevada. “While there is an indirect link between a high-sugar diet and the development of certain types of cancer, it is not fully definitive. Whereas, there is certainly a correlation between obesity or overarching poor eating habits that may very well play in to a cancer diagnosis.”

“There are different types of sugar,” she added. “Fruit, for example, has naturally occurring sugar, in addition to fiber and other healthy components. That sugar needs to be taken in a different context than the sugar that someone is getting in a can of soda. The American Institute for Cancer Research strictly advises to limit the intake of sugar-sweetened beverages. If you look at some of the guidelines for cancer prevention, there is no broad rule to ‘never eat a cookie again,’ but there are clear guidelines to avoid sugary drinks.”

In terms of sweets, Patton advises folks who are not overweight or experiencing blood sugar issues to eat anything with refined sugar in moderation. Refined sugar starts as a sugar in its raw form and is dissolved of all suspected contaminants, resulting in a form of manufactured sugar. Refined sugars are found in sugary breakfast cereals, spaghetti sauce and pudding among common, everyday items.

With all of the aforementioned nutritional insight, Patton also notes that it’s important to keep in mind that every patient is different – a dietary regimen can be contingent on a number of personal traits or qualities, including weight, health conditions, the type of cancer a patient may have and his/her unique caloric needs.

The nutritional needs of patients who are sick dramatically increase when undergoing treatment. Their metabolism skyrockets and more calories are needed, primarily because their immune systems are cleaning up any damage made by the cancer or from any subsequent treatment. Just to maintain their existing body weight, caloric intake must increase.

Get moving

The benefits of exercise are seemingly endless. Sure, you’ve likely heard some of the big ones: sleeping better, a boost in energy and a lift in mental health and confidence. Additionally, there are a number of protective, scientific benefits of exercise when it comes to weight reduction and ultimately cancer prevention.

First and foremost, exercise increases bowel motility. Inactivity is one of the biggest risk factors for constipation and, in turn, keeping food and prospective toxins from exiting your body.

Secondly, exercise results in favorable circulating hormone profiles. Exercise equates to decreased estrogen (high amounts of estrogen in the blood has been tied to increased likelihood of breast cancer); decreased circulating IGF1

(a natural human growth hormone that is essential during childhood, but abnormal amounts can be cancerous during adulthood); and the burning of body fat, both visceral and subcutaneous (located just below the skin, whereas visceral fat is stored in the abdominal area).

Thirdly, physical activity increases the oxygenation of tumor cells, which counteracts a cancer phenomenon known as the Warburg Effect. The Warburg Effect acknowledges that cancerous cells metabolize in a different manner than healthy cells, relying primarily on sugar for energy production, whereas healthy cells depend on oxygen. This increased oxygen helps healthy cells remain so and also ensures their proper oxygen levels are met and the cells do not turn cancerous.

Obesity in Nevada

While obesity remains a national concern, we do have some elements working in our favor in the Silver State. According to the CDC, Nevada has the second lowest obesity rate in the U.S. at 22.4 percent, just .2 percent behind the District of Columbia.

This promising figure is likely attributed to our pleasant, statewide climate that is prime for recreational activities as well as an abundance of outdoor spaces utilized for hiking, walking and running.

It’s crucial that we take advantage of what we have and be as proactive as possible in maintaining a healthy weight. While the periodic soda or day on the couch may seem sweet, nothing is truly sweeter than living a long and healthy life.

Dr. Oscar B. Goodman, Jr., is a physician-scientist and medical oncologist at Comprehensive Cancer Centers of Nevada.