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Johns Hopkins Health - Weighty Motivation

Fall 2014
Issue No. 26

Weighty Motivation

Date: October 9, 2014

Studies show the correlation between extra pounds and a woman’s risk of certain cancers. Johns Hopkins researchers have a clear message to women: Be at a healthy weight


For women, healthy weight is no longer just about vanity, body image or whether you can fit into those jeans from 10 years ago. As recent research—much of it done at Johns Hopkins—has proved, the stakes are much higher than that.

“It is absolutely a matter of life and death,” says Amanda Nickles Fader, M.D., director of the Johns Hopkins Kelly Gynecologic Oncology Service. “It’s not just a question of you feeling good about yourself.”

Not that feeling good about yourself isn’t important. What Fader is talking about is the recognition among oncologists—particularly those who deal with ovarian, cervical, uterine and breast cancers—that excess weight is closely associated with the incidence of certain cancers. ?

The one most linked to weight is endometrial, also known as uterine, cancer. Indeed, studies have shown that the risk increases linearly with increasing BMI (body mass index), a ratio of height to weight that measures body fat. But weight has also been found to be a key risk factor for breast, colorectal and, to a lesser extent, ovarian cancers.

Added up, they make for an alarming statistic: One-third of cancer deaths in women are now attributable to excess body weight, a fact that draws gasps when Fader presents to audiences. “Women are shocked to hear this,” Fader says. “They have no idea. But they often don’t know much about the cancers themselves, let alone the risks for those cancers.”

Dropping the pounds is a smart idea whether you are interested in preventing cancer in the first place or a recurrence. “Generally, it’s good for women to lose the weight,” says medical oncologist Kala Visvanathan, M.D., of the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. “For some cancers there is more data to show the relationship between weight and recurrence, but there’s clear-cut data that a woman’s overall survival is definitely improved by optimizing her weight.”

Contributing Factors

How is excess weight implicated in the production of cancerous cells?
The first factor is fatty tissue, which used to be thought of as inert in regard to cancer—not something desirable or cosmetically pleasing, perhaps, but certainly nothing that would play a role in a potentially life-threatening disease. “Now we know that’s not true,” says Mary-Eve Brown, an outpatient oncology dietitian at the Kimmel Cancer Center. “Fat tissue actually produces estrogen, and the overproduction of estrogen can be implicated in some types of breast and endometrial cancers.”

The second factor is insulin, which is now recognized as a growth factor for cancerous cells. “People who are overweight have more cells and more insulin,” Brown says. “If you have a malignancy, it can grab on to all that insulin and use it to grow.” In other words, the insulin becomes a nutrition source for tumors.

Scary? Yes, but the good thing is that you can do something about your weight, unlike other contributors to cancer, such as genetic predisposition. Though slimming down is not easy, Brown has found that a cancer diagnosis has a way of sharpening the focus and mobilizing resolve in her patients.

“The women I see in the cancer center are highly motivated to lose weight,” she says. “They’re looking at how they can reduce their risk of recurrence. They’re asking, ‘What risk factors can I control?’ And they know that if they go on eating the way they have been, and stay overweight, it’s not going to help them.” Brown adds that for those undergoing cancer treatment, weight loss may not be medically advised. Once treatment is finished, however, the recommendation is, as she says, to try to be “as lean as possible.”

Proper Guidance
What will help, of course, is a sensible eating plan and increased physical activity. In some cases, weight-loss surgery, known as bariatric surgery, could be beneficial. But the most effective weight plans are tailored to the individual. For cancer patients, who does the tailoring? And who is responsible for the obesity counseling?

A recent study at Johns Hopkins, co-authored by Fader and published in the American Journal of Obstetrics & Gynecology, queried oncologists on this issue. Eighty-five percent said it was important to talk to patients and explain how weight is related to cancer. But, she adds, “the majority of oncologists were referring to other providers—to nutritionists, to bariatric specialists, to internal medicine practitioners. But we still stay involved in the counseling.”

In another, currently unpublished, study, Fader and her colleagues posed the same question to survivors of uterine cancer. “We asked, ‘Are your doctors talking to you about this?’ And the response was similar. They said their doctors were but that they needed more concrete information and a specific weight-loss plan.”

Like Brown’s patients, the respondents in this study were eager to get to work on losing weight. “They were motivated,” Fader says. “They felt this was a teachable, or learnable, moment for them.”

People who come to Johns Hopkins have an advantage, Fader adds. “We have a multidisciplinary survivorship care approach here,” she says. “Our oncology division is the quarterback of the care. We meet with patients during treatment and after, identifying how we can help them live longer, higher-quality lives. And we frequently refer to other specialists, like physicians and nutritionists at the Johns Hopkins Weight Management Center, who help our patients achieve this.”

‘Be a Bit Selfish’
Of course, it shouldn’t take a cancer diagnosis to make you decide once and for all to get to a healthy weight. And yet the rising incidence of obesity among women suggests that as much as they may know about the dangers of excess weight, losing it is often set on the back burner behind family needs.

“Women are often the caregivers in their families and don’t put themselves and their health care first,” Fader says. “We see this time and time again, whether young or older. They’re always thinking of their other family members. I’d say be a bit selfish. Take care of yourself. It’s never too late to see your physician about your weight and your lifestyle. Even changes made in your 40s, 50s and 60s can make dramatic, positive changes on your health.”

Including a lower risk of cancer or the likelihood of a recurrence.

Want to Make Healthy Changes? Start Here
With excess weight implicated as a risk factor in many female cancers, isn’t it time to make the necessary changes in your life to get lean and healthy? Here are some tips.

  • Don’t be afraid to ask for help. “It’s unfair to tell women to just ‘lose weight,’” says Kala Visvanathan, M.D., a Johns Hopkins medical oncologist. “It’s OK to ask for advice, to seek the help of nutritionists or other specialists.”
  • Make gradual dietary changes. The eating habits you’ve developed over a lifetime are not going to change overnight. Start gradually, and make changes slowly. “If you’re drinking whole milk, can you get to 2 percent?” says Mary-Eve Brown, an outpatient oncology dietitian at Johns Hopkins. “Once you’ve done that, can you get to 1 percent and eventually to skim? If you eat meat five times a week, how about one vegetarian meal a week? After a few weeks, can you make it two?”
  • Follow a largely plant-based diet. That means a diet rich in colorful fruits and vegetables (the colors indicate the presence of cancer-fighting phytochemicals). Your diet should include whole grains intact with fiber. It should be low in saturated fats. Eat less red meat: Preferable protein sources include white-meat poultry, fish, nuts and legumes.
  • Get moving. Don’t forget that physical activity is part of the weight-loss formula. Most national public health agencies recommend 150 minutes a week of moderate-intensity exercise, such as brisk walking. “There’s good evidence that reducing weight and increasing the amount of physical activity can reduce the risk of many cancers,” Visvanathan says. “It doesn’t have to be that much. Even walking a half-hour is fine. As long as you do it regularly.”

Find Out If You Are Overweight
Make sure you know your body mass index (BMI), a ratio of height to weight that measures body fat. Use this calculator to determine whether your weight is in the healthy range:

Free Online Seminar
Losing Weight and Lowering Risk: What You Need to Know about Women’s Cancer and Nutrition

Tuesday, December 2, 7–8 p.m. EST

Did you know that up to one-third of cancer deaths in women are attributed to excess body weight? During this interactive webinar, director of gynecologic oncology Amanda Nickles Fader, M.D., and oncology dietitian Mary-Eve Brown, R.D., LDN, CSO, discuss the correlation between excess weight and the risk of certain women’s cancers. To register, visit