Cancer and Obesity

Obesity and cancer
National Press Foundation, Cancer Program 2016

Kim Robien, PhD, RD, CSO, FAND
Associate Professor
Department of Exercise and Nutrition Sciences
Milken Institute School of Public Health
George Washington University
krobien@gwu.edu
Obesity
Defined as the presence of excess body fat
Adipose tissue is metabolically active and critical to

health
Storage of energy for periods of fasting

Cushioning to protect organs and bones from injury
Important for maintaining body temperature
Endocrine functions: production of hormones such as leptin,
adiponectin, angiotensin, estradiol
Involved in production of other important proteins: aromatase,
cytokines
Not all body fat is equal: visceral fat may be more

metabolically active than subcutaneous
Medical Complications of Obesity

Pulmonary disease
abnormal function
obstructive sleep apnea
hypoventilation syndrome
Nonalcoholic fatty liver

disease
Idiopathic intracranial
hypertension
Stroke
Cataracts
steatosis
steatohepatitis
cirrhosis
Coronary heart disease

Diabetes
Dyslipidemia
Hypertension
Gall bladder disease
Severe pancreatitis
Gynecologic abnormalities
abnormal menses
infertility
polycystic ovarian syndrome
Osteoarthritis
Skin
Gout
Cancer
breast, endometrial, ovarian,
prostate, colorectal,
esophagus, pancreas, liver
kidney, gall bladder
Phlebitis
venous stasis
Obesity Trends* Among U.S. Adults

BRFSS, 1985
(*BMI 30, or ~ 30 lbs. overweight for 5 4 person)
No Data
<10%
10%14%
Source: Behavioral Risk Factor Surveillance System, CDC.

BRFSS, 1986
No Data
<10%
10%14%

BRFSS, 1987
No Data
<10%
10%14%

BRFSS, 1988
No Data
<10%
10%14%

BRFSS, 1989
No Data
<10%
10%14%

BRFSS, 1990
No Data
<10%
10%14%

BRFSS, 1991
No Data
<10%
10%14%
15%19%

BRFSS, 1992
No Data
<10%
10%14%
15%19%

BRFSS, 1993
No Data
<10%
10%14%
15%19%

BRFSS, 1994
No Data
<10%
10%14%
15%19%

BRFSS, 1995
No Data
<10%
10%14%
15%19%

BRFSS, 1996
No Data
<10%
10%14%
15%19%

BRFSS, 1997
No Data
<10%
10%14%
15%19%
20%

BRFSS, 1998
No Data
<10%
10%14%
15%19%
20%

BRFSS, 1999
No Data
<10%
10%14%
15%19%
20%

BRFSS, 2000
No Data
<10%
10%14%
15%19%
20%

BRFSS, 2001
No Data
<10%
10%14%
15%19%
20%24%
25%

BRFSS, 2002
No Data
<10%
10%14%
15%19%
20%24%
25%

BRFSS, 2003
No Data
<10%
10%14%
15%19%
20%24%
25%

BRFSS, 2004
No Data
<10%
10%14%
15%19%
20%24%
25%

BRFSS, 2005
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

BRFSS, 2006
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

BRFSS, 2007
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

BRFSS, 2008
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

BRFSS, 2009
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

BRFSS, 2010
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%

BRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 54 person)
2000
1990
2010
No Data
<10%
10%14%
15%19%
20%24%
25%29%
30%
Prevalence of Self-Reported Obesity Among U.S.

Adults by State and Territory, BRFSS, 2014
Prevalence estimates reflect BRFSS methodological changes started in 2011.
These estimates should not be compared to prevalence estimates before 2011.
*Sample size <50 or the relative standard error (dividing the standard error by the prevalence) 30%.
http://www.cdc.gov/nchs/data/hestat/obesity_child_11_12/obesity_child_11_12.pdf
How do we measure obesity?
Body Mass Index

BMI = weight (kg)/ height (m 2)
NHLBI BMI Calculator:
Weight status category
http://www.nhlbisupport.com/bmi
BMI
Under weight
< 18.5
Healthy weight
18.5 24.9
Overweight
25.0 29.9
Obese I
30.0 34.9
Obese II
35.0 39.9
Extreme obesity
40.0
BMI
Strengths:
Provides a more accurate measure of total body fat compared with
the assessment of body weight alone.
Inexpensive, easily calculated
Most practical method of assessing body composition for large
epidemiologic studies.
Limitations:
Overestimates body fat in persons who are very muscular.
Can underestimate body fat in persons who have lost muscle mass
(example: many elderly)
Other methods of measuring body

composition (primarily used in research)
Method
Strengths
Limitations
Hydrostatic
(underwater) weighing
Considered the gold

standard
Limited availability
Burdensome/traumatic for participants
Computed tomography
(CT)
Can quantify composition

in specific body parts
Expensive
Magnetic resonance
imaging (MRI)

Expensive
Dual X-ray
absorptiometry (DEXA)
Moderately expensive
Bioelectric impedence
analysis (BIA)
Portable
Somewhat expensive
Highly dependent on hydration status,
time of day
BodPod
Low participant burden
Moderately expensive
Skin fold
measurements
Relatively inexpensive
Portable
Not terribly accurate

Significant variation between operators
Obesity and cancer
World Cancer Research Fund (2007)
Food, Nutrition, Physical

Activity and the Prevention of
Cancer: A Global Perspective
Systematic review of the nutrition, physical activity and cancer literature
Detailed review of the evidence supporting an association between

obesity and cancer risk.
Entire document can be downloaded for free:

www.dietandcancerreport.org
Now being conducted as a Continuous Update Project
Maintenance of a healthy weight throughout life may be one

of the most important ways to protect against cancer
Cancer risk associated with 5 unit change

in BMI by individual cancer site
http://wcrf.org/int/cancer-facts-figures/link-between-lifestyle-cancer-risk/cancers-linked-greater-body-fatness
Cancer preventability estimates for body

fatness
http://wcrf.org/int/cancer-facts-figures/preventability-estimates/cancer-preventability-estimates-body-fatness
Possible biologic mechanisms

Inflammation
Diabetes
Alterations in hormone, growth factor levels
Adipose tissue may serve as a storage site for
environmental toxins
Persistent organic pollutants (PCB, DDT, dioxins)
Heavy metals (mercury, arsenic, cadmium, lead)
Endocrine disrupting chemicals (bisphenol A, phthalates)
Obesity may influence cancer screening

behaviors
Morbidly obese women are significantly less likely to

report recent mammography (PMID: 19277790)
Obese white women are less likely to report being

screened for cervical cancer than their lean counterparts,
and this does not hold true for black women
(PMID: 18997682)
BMI was not associated with colon cancer screening

(PMID: 22492832)
Obesity and cancer survival
Obesity and survival after a cancer

diagnosis
People who are overweight/obese at cancer diagnosis tend
to have poorer outcomes
Associations between obesity and cancer recurrence
Increased risk of complications following surgical

resection
Unclear how to dose chemotherapy for overweight

and obese patients
http://wcrf.org/sites/default/files/Breast-Cancer-Survivors-2014-Report.pdf
IOM Conference on Obesity and

Cancer Survival and Recurrence
http://www.iom.edu/Reports/2012/The-Role-of-Obesityin-Cancer-Survival-and-Recurrence.aspx
Report available as a free PDF download from the
National Academies Press
http://www.nap.edu/catalog.php?record_id=13348
Summary article published in Cancer Epidemiology
Biomarkers and Prevention, August 2012
PMID: 22695735

Cancer and Obesity

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Cancer and Obesity

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Obesity and cancer

National Press Foundation, Cancer Program 2016

Defined as the presence of excess body fat

Adipose tissue is metabolically active and critical to

Storage of energy for periods of fasting

Not all body fat is equal: visceral fat may be more

Medical Complications of Obesity

Nonalcoholic fatty liver

Coronary heart disease

Gall bladder disease

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.

Obesity Trends* Among U.S. Adults

Source: Behavioral Risk Factor Surveillance System, CDC.