Methods & Benefits of Weight Loss in Breast Cancer Survivors Author: Suzanne Dixon, MPH, MS, RD Summary: Review of Obes Res. 2004;12(2):306-12. A study in the medical journal Obesity Research looked at different ways to help breast cancer survivors lose weight and how weight loss may be of benefit to these women. This study found that women who received both one-on-one consultation with a dietitian along with coupons to attend Weight Watchers® meetings lost the most weight, had the biggest reduction in percent body fat, and had the most improvement in blood cholesterol and blood leptin levels after one year. We provide PRACTICAL information on what these results mean, including an explanation of why improvement in leptin levels is beneficial for women with a history of breast cancer. Maintaining a healthy body weight is an important goal for all breast cancer survivors, because being overweight may increase the risk of breast cancer recurrence. Learning how to best help women maintain a healthy body weight after a breast cancer diagnosis will allow them to take concrete and practical steps that may decrease their risk of getting this disease again. Article: Note: Numbers appearing at the end of sentences indicate research references. References are listed at the end of each article. Background Dozens of research studies tell us that nutrition-related factors, including diet and body weight, can affect the risk of breast cancer (1-54). More recently, researchers have been focusing on the importance of diet and body weight on survival after a breast cancer diagnosis (15,55-99). Many of these studies have found that being overweight at diagnosis or gaining weight after diagnosis may increase the risk of breast cancer recurrence. For this reason, it is vitally important that researchers determine the best way to help women reach and maintain a healthy body weight during and after being treated for breast cancer. A study in the medical journal Obesity Research looked at different ways to help breast cancer survivors lose weight and how weight loss may be of benefit to these women. It is hoped that this type of research will yield important information that will help women make informed decisions about the best nutrition plan to promote healing and long-term wellness after a diagnosis of breast cancer. What The Researchers Studied For this study, the researchers randomly assigned 48 female breast cancer survivors into four groups that were followed for one year (100). The four groups were: Control Group: Women did not receive any specific nutrition counseling or weight loss advice. Weight Watchers® Group: Women received free coupons to attend weekly Weight Watchers® meetings. Individualized Group: Women met with a registered dietitian (RD) for one-on-one counseling weekly for the first 3 months, every other week for the next 3 months, and monthly for the last 6 months of the study. Comprehensive Group: Women received the same individualized counseling as the Individualized Group plus coupons to attend weekly Weight Watchers® meetings. The women in the study had to have had a stage I or stage II breast cancer diagnosis within the previous 4 years and not have had a breast cancer recurrence at the time of the study. Information on other important health factors, including age and body weight, percent body fat and dietary habits at the start of the study was collected and accounted for by the researchers. All of the women in the study were classified as obese. A person is considered to be obese if her body mass index (BMI) is greater than 30 kilograms per meter squared (kg/m2) (101). Body Mass Index (BMI) is a way to measure body weight, while taking into account a person's height. On average, being 30 lbs or more over ideal body weight will place a person into the obese category. The following table provides additional information on the use of body mass index for determining healthy body weight. Standards for Body Mass Index (BMI) measured in kilograms per meter squared (kg/m2) (101) Females Males Underweight <19 <20 Healthy Weight 19-24 20-25 Overweight 25-30 26-30 Obese >30 >30 To determine your BMI, please see our Body Mass Index (BMI) Chart. What The Study Found First, the researchers found that only the women in the Individualized and the Comprehensive Groups lost a significant amount of weight over the year of the study. For these two groups, the weight loss was: Individualized Group: Women lost an average of 18 lbs at one year. Comprehensive Group: Women lost an average of 21 lbs at one year. Second, the researchers found that only the women in the Individualized and the Comprehensive Groups significantly lowered their body mass index (BMI) over the year of the study. For these two groups, the decrease in BMI was: Individualized Group: Women lowered their BMI by an average of 3 kg/m2 at one year. Comprehensive Group: Women lowered their BMI by an average of 3.7 kg/m2 at one year. Third, the researchers found that only the women in the Comprehensive Group significantly lowered their percent body fat over the year of the study. The women in the Comprehensive Group lowered their percent body fat by 3.7%. Fourth, the researchers found that the women in the Individualized and the Comprehensive Groups significantly lowered their calorie intake and their blood cholesterol from baseline levels. For these two groups, the decreases in calorie intake and total cholesterol were: Individualized Group: Women lowered their calorie intake by an average of 515 calories per day and they lowered their blood cholesterol levels by an average of 59 mg/dL. Comprehensive Group: Women lowered their calorie intake by an average of 393 calories per day and they lowered their blood cholesterol levels by an average of 31 mg/dL. Fifth, the researchers found that only the women in the Comprehensive Group significantly lowered their blood levels of a blood protein called leptin. Finally, the researchers considered all of the women in the study together and divided them into those who had lost greater than 10% of their baseline body weight and those who had not lost 10% of their baseline weight. The researchers found that at the end of the 12 months of study, the women who had lost 10% or more of their baseline weight had a lower BMI, reported consuming fewer calories and less fat in their diet, had higher HDL cholesterol ("good" cholesterol), and had greater reductions in percent body fat, blood triglyceride levels (fat in the blood), and blood leptin levels as compared to women who lost less than 10% of their baseline weight. What do these results mean? If the women in this study are similar to other obese women with a history of breast cancer, then this study suggests that individualized dietary counseling from a registered dietitian, alone or in combination with attending Weight Watchers® meetings, are important ways to help with weight loss. In particular, the combination of regular consultations with a registered dietitian along with attending Weight Watchers® meetings helped to make positive changes in levels of a blood protein called leptin. When we consider these study results, we need to look at some of the flaws of this research. The major weakness of this particular study is that it was very small. A study of only 48 women is not large enough to know with certainty that these results will apply to most women with a history of breast cancer. However, even considering this weakness, the research does provide important information. It tells us that there are positive things that a woman can do to help herself, after a breast cancer diagnosis, that may help her avoid getting this disease again! Moreover, maintaining a healthy body weight is important for health in so many other ways. Read on to learn more about why leptin and body weight are important issues for breast cancer survivors. Why is leptin important for breast cancer survivors? To understand why keeping leptin in the body at normal levels is important for women with breast cancer, consider the following information: Leptin is a hormone that is produced in the body by fat tissue. For this reason, obese people often have higher blood levels of leptin than normal weight individuals (105-108). Research shows that leptin may encourage cancer cells to be more aggressive by forming their own blood supply, which allows for enhanced cancer cell growth (109-115). 115). Research suggests that leptin levels can be higher in women with breast cancer (116). When we consider these three points, we can see why a weight loss program that both helps women to reach a healthier body weight and decreases leptin levels in the body may help to reduce the risk of getting breast cancer again in women with a history of this disease. Why is a healthy body weight important for breast cancer survivors? For over a decade, researchers have been studying how body weight and weight gain after breast cancer might affect a woman's likelihood of getting the disease again (recurrence). This research tells us that being significantly overweight or obese at diagnosis, as well as gaining weight after diagnosis, may increase the chances that a woman has a recurrence of breast cancer. In other words, being overweight and weight gain appear to increase the risk of getting breast cancer again (55,60,61,63-66,69,73,81-83,85,86,94,98). Researchers have not yet determined if losing weight will help to reduce the risk of breast cancer in overweight and obese women. However, based on what we know about the connection between body weight and risk of getting breast cancer the first time, it makes sense that maintaining a healthy body weight will help a person stay healthier and avoid breast cancer recurrence over the long term. Plus, there are no downsides to maintaining a healthy body weight. Being obese increases the risk of many other diseases, including heart disease, which is the number one killer of women in the United States (102-104). Losing weight is very challenging, but you can succeed! Use the following tips to get started on a weight management program today. Healthy Approaches To Weight Management The first thing to remember is that weight loss is not easy. Don't be hard on yourself if you've struggled with maintaining a healthy weight. This is a health concern for many people. If you've tried to lose weight in the past and have not succeeded, don't give up! Just because you haven't met your weight loss goals in the past does not mean you won't be able to succeed this time! We know that many, many people struggle with weight loss. Nobody is immune from the difficulty of making healthy food choices when confronted with fast food restaurants and vending machines! However, by changing the way you think about food and health and improving a few habits, you CAN succeed at weight loss. Use the tips below to get started on the road to maintaining a healthy, long-term body weight. Consult with a Registered Dietitian (RD)! The research we reviewed (100) showed that working with a dietitian can significantly increase the likelihood that you lose weight and keep it off. Many people feel that they don't want to spend the money for individual weight management counseling with a dietitian. However, when it comes to successful weight loss, the research tells us that dietitians can help you get results! To Find a Dietitian: Request an appointment with the dietitian who works in the clinic where you were treated for your cancer. If the clinic or cancer center where you were treated for your cancer does not have a dietitian available, ask if they are affiliated with a hospital or other health care center that does have a dietitian. Often, a cancer care facility may not have a dietitian on staff, but they may have someone available on a "per request" basis. They can refer you to this person if you ask. If you ask for a dietitian and still cannot obtain an appointment to see one, try the "Find A Nutrition Professional Service" of the American Dietetic Association to help yourself locate a dietitian in your area. If you have trouble using the web-based "Find A Nutrition Professional Service", you may contact the American Dietetic Association directly to request help by emailing or calling: Email: knowledge@eatright. or Phone: 1-800-366-165 Receive support from a weight loss organization such as Weight Watchers®. A weight loss program with group meetings can help you develop a sensible and successful weight loss plan. Try both a dietitian AND a Weight Watchers® program. The more support and help you get with your weight management efforts, the more likely you will be to succeed. Be sure you think about weight loss and healthy eating as a lifestyle rather than a temporary diet. This is important! For long-term weight loss success, you must change your eating and exercise habits permanently. Please see our Tips for Weight Loss Success for more ideas on getting started toward maintaining a healthy weight. Examine Your Risk Look at your current height and weight and be honest with yourself about whether you are overweight or obese. This may be harder than it sounds! Researchers have found that many overweight and obese adults do not know that they are above a healthy body weight and therefore at increased risk of many serious conditions and diseases (117-119). This is the first step to managing weight and improving health, including reducing cancer risk! How do you know if you're overweight or obese? You can use a measure called Body Mass Index (BMI). BMI is a way to measure body weight, while taking into account a person's height. To determine your BMI, please see our article Body Mass Index (BMI) Chart. If your BMI is 25 kilograms per meter squared (kg/m2) or higher, you are overweight. If your BMI is 30 kg/m2 or higher, you are obese. Find A Supportive Health Care Provider! This is one of the most important things you can do to help yourself succeed. Research tells us that many health care providers have a very negative view of men and women who are obese (120). When you want to lose weight and improve your health, the last thing you need is a health care provider who is critical and unsupportive! Talk to your doctor honestly about your desire to lose weight and improve your health. Tell him/her that you would like help with your goals. Ask for a referral to a weight loss specialist such as a Registered Dietitian. If your doctor is not supportive of your goals or places the focus on blaming you for being overweight, consider finding a more supportive health care provider. Modify Your Views & Goals One of the most important things you can do to increase your chances of success with weight loss is to view these changes as A GIFT! Losing weight to improve your health is NOT a punishment. It is a gift. Realize that weight loss won't be easy, but when you succeed, you will feel better, you will have a better quality of life, you will decrease your risk of many serious diseases, and you will live longer! This is a gift to you, but it is also a gift to your family and friends. Anyone who cares about you will benefit from the gift of health that YOU give yourself by maintaining a healthy body weight! Make your goal IMPROVED health, NOT 'looking better'. While improvements in appearance are a great benefit of weight loss, focusing on the HEALTH benefits of weight loss will help you meet your goals today and for the long-term! Health benefits include ANYTHING that will help motivate you. This can include sleeping better; having less joint & muscle pain; having more energy; lowering your risk of cancer, heart disease, high blood pressure, diabetes, stroke and other serious conditions; improving your sense of well being and self-image; and just about any other health improvement you can think of. Weight loss will help with all of these goals!! Eliminate High Calorie/Low Nutrition Foods New research is telling us that certain parts of our diet might be contributing a lot to the problem of obesity. One potential obesity contributor is high fructose corn syrup. Studies tell us that the eating a lot of high fructose corn syrup may be making the obesity problem worse (121,122). What is high fructose corn syrup? High fructose corn syrup is a sweetener found in many commonly eaten foods and beverages. One of the biggest contributors to the higher levels of high fructose corn syrup in our diets is soda pop. There are many other sources of high fructose corn syrup too. To address this problem... DROP THE POP habit. Soda pop is nearly pure high fructose corn syrup. This includes both 'brown' and 'clear' regular soda pops. Let me say that again. DROP THE POP habit. Regular soda pop is nothing but PURE sugar, in particular, high fructose corn syrup. Worse yet, it is liquid, which means it affects your body more quickly than sugar in foods. When you switch from regular soda pop to water, decrease the amount of soda pop you drink slowly. This will help prevent symptoms of caffeine withdrawal, such as headaches. If you do not like plain water, try carbonated water that does not contain high fructose corn syrup. Look at the label. If the water contains calories, it contains sugar or high fructose corn syrup. Instead pick a brand that does not contain calories. Plain, flavored or carbonated water will not contain calories. Small amounts of diet sodas are ok, but they do not add anything of nutritional benefit to your diet. For this reason, think of a diet soda as a treat, not a daily necessity. Other sources of high fructose corn syrup include fruit punches (6 ounces of 100% fruit juice is ok to count as one serving of fruit per day); baked goods such as doughnuts, cookies, cakes, candy bars, hard candy, and other desserts; jams; jellies; sauces and dressings; and many other highly processed foods such as instant meals and snack foods. What are highly processed foods? Think of foods that are as close to their 'natural form' as possible, such as fresh vegetables and fruit. Now think of a more processed food, for example, a corn chip. A corn chip is made of corn, but it's NOT a whole food, it is highly processed! To make a corn chip, first the corn is picked, then ground and crushed. Next the fiber portion of the corn is thrown out. Then the corn is fried in processed fat (hydrogenated fat). Next it is treated with artificial flavors, dyes, and preservatives. This hardly looks like corn anymore! Now think of corn on the cob. It is picked, shipped, and ends up on your dinner table! It is not processed. It is a WHOLE food. The less processing that a food undergoes before you eat it, the better it is for you. Make dessert an OCCASSIONAL treat. There is nothing wrong with having a sweet treat now and then. Just make sure 'now and then' only means 2-3 times per week. Watch Portion Sizes If you do eat in restaurants, watch your portion sizes! Instead of eating everything on your plate, try asking for a 'to go' box at the BEGINNING of your meal. Place a portion of the food into the 'to go' box and then enjoy the rest of your meal. When eating at home, try measuring your portion sizes for a while. For example, a serving of pasta is 1/2 cup cooked. Try measuring this out to see what it looks like. If you want more than one serving, this can be ok, just be sure you KNOW you are eating more than one serving. Sometimes, just being aware of what you are eating can help you make better choices. Get Moving Talk to your health care provider about a good exercise plan for you. Be sure you receive clearance from your doctor BEFORE beginning an exercise plan!! Exercise plans do not have to be fancy or very hard. Simply taking a long, brisk walk each day can be enough to aid with weight loss and make you healthier. Find an exercise buddy such as a family member or co-worker. It is harder to skip exercise when you plan to meet someone for it. Schedule exercise, even 10 minutes, into your day. WRITE IT on your calendar. If you don't make time for it, you won't do it. NOTE: If you are in cancer treatment, these diet changes may not be right for you. Please discuss your nutrition needs with your health care team. Also, please see our section on Treatment Symptom Management to help with these issues. "Used with permission from www.cancernutritioninfo.com" "If you have found this article helpful, please take a moment to visit www.cancernutritioninfo.com, where you can find more information on the important connection between nutrition and cancer..." Used with permission of www.cancernutritioninfo.com Posted 8/05 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.