Coffee with Komen – Weight, What?

By Kristen Trukova, MS, RD, LDN, CNSC, CSO

When most people think about cancer and weight, they think about rapid weight loss, or loss of strength and fitness.  However, many people are surprised to learn that weight gain is also a common occurrence in patients with breast cancer.

In fact, research has shown that 50 to 96 percent of patients with breast cancer gain weight at some point during treatment or as survivors.[i] The Nurses’ Health Study (20) of 5,204 women found that the average gain was six to 17 pounds[ii]. In the Women’s Healthy Eating and Living (WHEL) cohort of 3,088 breast cancer survivors, only 10 percent of women who gained weight were able to return to their pre-diagnosis weight after four years[iii].

These weight changes were first documented in the late 1970s and studies have shown that women who were treated with chemotherapy were more likely to gain weight compared to women who had surgery, radiation or hormonal therapies.

So why is weight gain so common for breast cancer patients?

  • Researchers have found that one of the largest causes was a decrease in physical activity during chemotherapy. Chemotherapy can cause fatigue and numerous digestive side effects, making maintaining activity levels challenging.  Active breast cancer survivors have frequently reported that they had to move from intense gym workouts and running to walking. Others reduced workout time, breaking it into smaller, more manageable sessions.
  • Chemotherapy can cause taste bud changes, making patients avoid foods they used to love and choose foods they never enjoyed before. In fact, at times, patients may not be able to taste foods at all during treatment. This can cause a rebound effect once taste returns to normal.  Patients may feel that it’s time to celebrate and actually enjoy food again.  Also, during chemotherapy, excess carbohydrates may be consumed in an effort to combat fatigue and digestive side effects, which could lead to weight gain, particularly when combined with a decline in physical activity. However, much of the research in this area has not shown that women consumed more calories than before diagnosis.
  • Studies have also shown that women who entered menopause as an effect of chemotherapy also experienced a higher weight gain than women who had no change in menopausal status. That’s likely because metabolism slows down after menopause, which could lead to weight gain without an adjustment in pre-diagnosis calorie intake.

Maintaining a healthy weight is important for breast cancer survivors since obesity is found to increase the risk of cancer recurrence, as well as other health conditions. Breast cancer survivors with a higher body weight have been found to have higher incidence of heart disease, diabetes and arthritis compared to leaner women.

While this can be frustrating news to both women newly diagnosed with breast cancer as well as long-term survivors, there are still several aspects that remain in our control. It’s important to take time to review your habits in both what you’re eating and how active you are.  First, look to the nutrition guidelines and recipes for cancer survivors from the American Institute for Cancer Research.  These guidelines encourage eating more poultry, fish and beans than red meat, choosing two to five cups of fruits and vegetables every day, and eating more whole grains and nuts. Research has also shown that keeping a food log, even just for three days, can help patients see what needs to change.  Lifestyle intervention studies in breast cancer survivors are also beginning to demonstrate positive effects on weight.

Specifically, in one study of 338 breast cancer survivors, patients were able to lose 5.3 percent of their body weight over six months with a telephone counseling intervention. This intervention encouraged women to make healthy diet changes and increase physical activity[iv] (LISA). In the ENERGY research trial, 346 women attended in-person visits, then personalized telephone counseling over two years. Women were encouraged to engage in 60 minutes of physical activity, and to eat 500-1000 calories fewer per day than usual. After two years, women had lost 6 percent of their body weight. Women who did not participate in the intervention lost 1.5 percent of body weight[v]. (ENERGY)

These studies show that weight loss after breast cancer can be more successful with counseling from dietitians, physical therapists, and other health professionals. .

Another tool is a concept called mindful eating. The basics of mindful eating encourage you to take time to savor each bite of food and note not just the flavor, but the color, shape and texture. Eating more slowly also helps you prevent overeating, as it takes around 20 minutes for your stomach to realize you have eaten.

Planning ahead for meals is more critical than most people realize. It’s important to eat before you are ravenously hungry, as that’s when most people make less healthy choices. Ideally, planning meals for the whole week is best.  But, even planning one day ahead, or prepping veggies, meats or sauces the night before, can be a big help. If you’re not able to fully control meals, one idea might be to bring two fruits and two veggies with you during the day, so you always have healthful snacks or sides to add to your meal.

Even the best nutrition regimen is not complete without physical activity.  Keep in mind, activity does not have to be intense exercise. Some of the most successful weight loss programs involve simply walking. Aim for 150 minutes of activity per week, which has been shown by many studies to reduce recurrence of cancer. Grab a walking partner or gym buddy to help you keep the habit.

Overall, while a cancer diagnosis can be extremely difficult and life-changing, I have often heard patients mention that for them, it was a time to reflect and think about how they wanted their life to improve going forward. Now is a great time to become a healthier you!

As always, check with your physician before starting any diet and exercise program.

Resources: 

  • CTCA Nutrition Resources  Offers background in nutrition basics, tips for healthy eating, information about managing side effects with nutrition, recipes and more
  • Local Farmers’ Markets – Provides and online database of farmers’ markets around the country so you can find fresh, whole foods and learn what’s in season
  • Susan G. Komen – Provides support to survivors in their own communities and funds critical research

[i] Vance V, Mourtzakis M, McCargar L, Hanning R. Weight Gain in Breast Cancer Survivors: Prevalence, Pattern and Health Consequences. Obesity Reviews. 2011 Apr;12(4):282-94.

[ii] Kroenke CH1, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol. 2005;23:1370-8.

[iii] Saquib N, Flatt SW, Natarajan L, Thomson CA, Bardwell WA, Caan B, et al. Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women’s healthy eating and living (WHEL) study. Breast Cancer Res Treat. 2007;105(2):177-86.

[iv] Goodwin PJ, Segal RJ, Vallis M, Ligibel JA, Pond GR, Robidoux A, et al. Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol. 2014 Jul 20;32(21):2231-9.

[v] Rock CL, Flatt SW, Byers TE, Colditz GA, Demark-Wahnefried W, Ganz PA, et a.l Results of the Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) Trial: A Behavioral Weight Loss Intervention in Overweight or Obese Breast Cancer Survivors. J Clin Oncol. 2015;33(28):3169-76.

 

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