The Obesity - Cancer Connection
Jill Weisenberger, M.S., R.D., C.D.E.
Expect to see higher rates of cancer as America packs on the pounds. Overweight and obesity come with plenty of bad news, including aches and pains and increased risks for heart disease, high blood pressure, diabetes, osteoarthritis and several types of cancer.
If you didn't know that excess body fat is a risk factor for cancer, you're not alone. According to a 2009 survey by the
Fat's dirty work
A lot goes on in the body when excess fat is hanging around. Here are some of the most significant issues impacting cancer risk:
One of those hormones produced by fat is estrogen, says
Excess body fat can promote insulin resistance, a condition in which the body doesn't respond adequately to the hormone insulin. In the early stages of the condition, the pancreas tries to compensate by producing more and more insulin, causing insulin levels in the blood to become very high. According to a 2009 study in the
"This high level of insulin and the resulting increased availability of insulin-like growth factor tends to promote cell growth and reproduction, including that of cells with damaged DNA that can develop into cancer," explains
Insulin resistance is a quiet, insidious condition. Because it comes on slowly over many years, it often brutalizes the body long before the problem is recognized. If left unchecked, the body's production of insulin will eventually dwindle, and blood glucose levels will rise, possibly reaching the level of type 2 diabetes. Though blood glucose is frequently checked at routine medical appointments, insulin levels are not. In the early stages of insulin resistance, blood glucose is likely to be normal because of the excess insulin available, thus masking that something is awry. Insulin resistance may explain, in part, the connection scientists found between type 2 diabetes and several cancers. According to the AICR, people with diabetes are twice as likely to get cancer of the liver, pancreas and endometrium, and 20 to 50 percent more likely to develop cancers of the colorectum and bladder, as well as postmenopausal breast cancer.
There may still be many other, as yet undiscovered ways in which insulin resistance boosts cancer risk. Another theory is that insulin and insulin-like growth factor inhibit apoptosis, the body's normal, programmed "death" of abnormal cells.
Body fat also secretes cytokines, proteins important in the communications between cells. An overabundance of fat cells produces an overabundance of cytokines. As they circulate through the body, these proteins promote chronic, low-level inflammation. Inflammation then leads to the production of free radicals that can damage the cells' DNA and start the cancer process, explains Collins. Additionally, inflammation may bolster cancer by stimulating the development of new blood vessels that allow cancer cells to grow and then spread.
You may want to tough it out, but if you have chronic heartburn, also called acid reflux, you need to seek treatment. When acid from the stomach backs up into the esophagus, it irritates or injures the tissue because the esophagus lacks a protective coating like the one found in the stomach. Over time, this reflux damage increases the likelihood that esophageal cancer will develop, says Byers. Obesity plays a role because it increases pressure within the stomach and allows the stomach contents to flow backward into the esophagus.
Apples and pears
If you were a fruit, what would you be? In other words, do you carry extra weight at your midsection (apple) or around your hips (pear)? Fat around the hips and thighs is stored just beneath the skin, but abdominal fat nestles deep around the liver and other organs. This deep fat, called visceral fat, is more harmful because it produces hormones and cytokines linked to insulin resistance and inflammation, says Collins. In general, men have more visceral fat than women, but women tend to lay down fat in the middle as they age. See "Measure Your Middle" (SIDEBAR) for another way to assess your cancer risk.
Both the Nurses' Health Study and the Iowa Women's Health Study, two large-population studies, suggest that overweight women can reduce their risk for postmenopausal breast cancer by losing weight, explains Collins. Other research has demonstrated that when overweight individuals lose just 5 to 10 percent of their body weight (10 to 20 pounds for someone weighing 200 pounds), both insulin resistance and inflammation decrease. "Since cancer development is an ongoing process, this suggests by changing the factors that promote the development of cancer, we can reduce risk," adds Collins.
If you are overweight, make efforts to stop gaining. The next step is to lose weight if possible. "Focus on small changes that you repeat day after day -- forget perfection," Collins urges, adding "You have to be in it for the long haul." Start by walking 10 minutes and changing one meal or one snack. Or dump sugary drinks in favor of water or tea. For more help, check out AICR's New American Plate (www.aicr.org), a long-term approach to managing what and how much you eat. Be sure to discuss your risk factors for cancer and all chronic diseases with your health care provider. If your risk is higher than average, you may need earlier screening for certain conditions.
Keep an eye on your waistline. For a lower cancer risk, a woman's waist should be no more than 31.5 inches, and a man's waist should not exceed 37 inches, states
Circle a tape measure around your midsection immediately above your hipbone.
Exhale and check the number on the tape.
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