Obesity and Cancer – Abdullah Al Zahrani, MD. Consultant upper GI and bariatric surgeon

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The WHO has defined Obesity as a condition of abnormal or excessive fat accumulation in adipose tissue to the extent that health may be impaired.

Abnormal fat will accumulate in many organs directly or indirectly and can impair the functions of these organs. Currently, researchers and clinician are studying the association of obesity and cancer and they show that obesity doesn’t affect the treatment response to cancer but clear association between obesity and cancer incidence.

Maria Kyrgiou , at al. studied the Adiposity and cancer at major anatomical sites and concluded the associations for 11 cancers (oesophageal adenocarcinoma, multiple myeloma, and cancers of the gastric cardia, colon, rectum, biliary tract system, pancreas, breast, endometrium, ovary, and kidney) were supported by strong evidence. Other associations could be genuine, but substantial uncertainty remains. Obesity is becoming one of the biggest problems in public health; evidence on the strength of the associated risks may allow finer selection of those at higher risk of cancer, who could be targeted for personalized prevention strategies.

Jennifer A. Ligibel, et al: American Society of Clinical Oncology Position Statement on Obesity and Cancer obesity is a major unrecognized risk factor for cancer.
They concluded that Obesity is associated with worsened prognosis after cancer diagnosis and also negatively affects the delivery of systemic therapy, contributes to morbidity of cancer treatment, and may raise the risk of second malignancies and comorbidities. Research shows that the time after a cancer diagnosis can serve as a teachable moment to motivate individuals to adopt risk-reducing behaviors. For this reason, the oncology care team—the providers with whom a patient has the closest relationships in the critical period after a cancer diagnosis— is in a unique position to help patients lose weight and make other healthy lifestyle changes.

The American Society of Clinical Oncology is committed to reducing the impact of obesity on cancer and has established a multipronged initiative to accomplish this goal by:
1. Increasing education and awareness of the evidence linking obesity and cancer.
2. roviding tools and resources to the oncology providers address obesity with their patients.
3. Building and fostering a robust research agenda to better u

nderstand the pathophysiology of energy balance alterations, evaluate the impact of behavior change on cancer outcomes, and determine the best methods to help cancer survivors make effective and useful changes in lifestyle behaviors.

4. Advocating for policy and systems change to address societal factors contributing to obesity and improve access to weight management services for patients with cancer.
In fifth annual Obesity Week conference, 2017. Two paper presented studying the association between obesity and cancer.

The 1st paper , ‘Improved Body Composition With Ketogenic Diet in Ovarian/Endometrial Cancer Patients’, concluded that “In women with ovarian or endometrial cancer, a ketogenic diet may reduce total and visceral fat mass, perhaps by reducing in

sulin concentration,” the researchers concluded.
“A metabolic environment characterized by low insulin and IGF-I may impair the ability of cancer cells to multiply.”

In a 2nd paper, ‘Bariatric Surgery and the Risk of Cancer in a Multisite Cohort of 88,625 Adults With Severe Obesity’, researchers from the University of Cincinnati sought to determine whether bariatric surgery is associated with a lower risk of cancer.

They concluded that “In this large, multisite cohort of patients with severe obesity, bariatric surgery was associated with a lower risk of incident cancer, particularly obesityassociated cancers, such as post-menopausal breast, endometrial, and colon cancer,” the authors concluded In conclusion, obesity is a known risk factor some cancers and has negative outcome in the treatment response as well and early treatment of obesity can ameliorate the incidence and outcome of this cancer.

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