Often to get an audience’s attention
and hopefully to get them thinking about the systemic effects
of adiposity, I will draw the parallel between obesity and cancer.
I have often argued that we need to consider that obesity is
the result of unregulated, undifferentiated hypertrophic and
hypercellular growth of adipose cells. These cells secrete proteins
known as adiopokines (cytokines from adipocytes) that are for
the most part pro-inflammatory and pro-coagulant. When we begin
to look at adiposity as a process of poorly regulated growth,
drawing a connection to a model of a neoplastic process can
hardly be a big leap.
Weight loss and cessation of tobacco are
the two most important modifiable cancer risk factors. Obesity
has been causally associated with 20-30% of renal cell carcinomas,
40% of endometrial carcinomas, as well as an increased risk
for colon/rectal cancers and breast cancer. Obesity from an
early age, substantial weight gains in a short period of time,
as well as extreme obesity all confer higher risks than moderate
obesity. For example, endometrial cancer, compared to women
with normal weight, women who are overweight have a relative
increased risk of developing cancer of 1.5; whereas women with
class 1 obesity (BMI 30-34) have a relative increased risk of
2.9 and women with class 2 obesity (BMI 35-40) have a relative
increased risk of 6.3.
Gaining weight later in life may be worse. Eliassen et all from
Brigham and Women’s Hospital using the data from the Nurses
Health Study demonstrated an increased relative risk of 1.45
for the development of breast cancer in women who gained more
than 25 kg (55 pounds) or more.
Surprisingly few of my obese patient’s
smoke, they fear cancer too much. Most often they see their
vice of overeating as a rather benign malady, perhaps having
to deal with hypertension, diabetes but certainly not cancer.
Educating our patients on their increased health risks beyond
the well known metabolic syndrome complications may be an important
strategy. The American Cancer Society Guidelines on Nutrition
and Physical Activity for Cancer Prevention: Recommendations
for Individual Choice are a great place to start:
1. Eat a variety of healthful
foods with emphasis on plant sources 5
fruits/vegetable servings per day
Use of whole grains ; Limit of processed sugars
Limit consumption of red meat to one serving per day
2. Adopt a physically active lifestyle
30-45 minutes of activity per day for adults
3. Limit consumption of alcohol
The use of antioxidant fruits and vegetables,
prepared in their natural state, as a tool to displace other higher
caloric, less wholesome foods can be an effective way to have
your patients effectively cut calories, improve nutrition, and
at least reduce their increased risk of developing certain cancers.
About Dr. Margaret MacKrell
Gaglione
Dr. Margaret MacKrell Gaglione is the Medical Director of Tidewater
Bariatrics in Chesapeake, a practice dedicated to the care of
overweight and obese patients. She is a board-certified internal
medicine physician and bariatric specialist. She can be reached
at (757) 644-6819 or www.tidewaterbariatrics.comnecessary for
lifelong success.
Margaret M. Gaglione, MD, FACP
757-644-6819
Email: doctor@twb4u.com
Always
Consult Your Physician before beginning any Diet or Exercise Program.
