Fighting Cancer with a Healthy Weight

What is Your Healthy WeightChristine Zoumas, MS, RD

Dept. of Family and Preventive MedicineCancer Prevention and Control Program

In the American Association for Cancer Research's new cancer report lies the sad fact

that about half of the 585,720 cancer deaths expected to occur in the United States this year

are related to preventable behaviors

A combination of weight problems, poor diet, and exercise account for another third of all

preventable cancers

Top Preventable Causes of Cancer

American Association for Cancer Research

American Cancer Research Institute, aicr.org

Body Weight and Cancer Risk

AICR's expert report, Food, Nutrition, Physical Activity and the Prevention of Cancer and its continuous updates found a strong link between excess body fat and increased risk for the following cancers:

Esophagus Pancreas*Colon* and RectumEndometrium*Kidney

Postmenopausal breast*GallbladderOvarian* Prostate* (aggressive)Liver*

Evidence also indicates that being overweight and obesity may also be associated with an increased risk of non-Hodgkin lymphoma, multiple myeloma and cervical cancer

• produces proteins called cytokines, which cause inflammation, a factor for increased cancer risk

• produces more estrogen, a sex hormone linked to higher risk of some cancers

• leads to insulin resistance, which causes the body to produce more insulin and related growth factors, increasing risk for cancer

How Does Body Fat Affect Your Risk for Cancer?

Excess Fat

Be as lean as possible throughout life without being underweight

Whether or not your own weight is healthy for you depends on several factors:

· How much of your weight is fat

· Where your body fat is located

· If you have weight related health problems

Aim to Be a Healthy Weight

How Much of Your Weight is Fat?

· Height and weight, body mass index (BMI)

· Waist circumferences

· Body composition measures (dual energy x-ray absorptiometry, electrical conductance or impedance, skinfold measures)

Body Mass Index (BMI)

BMI = weight (lbs) X 703height squared (in2)

On-line BMI Calculator

Underweight = BMI < 18.5Healthy weight = BMI 18.5-24.9Overweight = BMI 25-29.9Obese = BMI 30-39.9Severely obese = BMI >40

BMI and Weight

Where is Your Body Fat Located?

Classification of Overweight and Obesity by BMI, Waist Circumference and Associated Disease Risk*

Disease Risk* Relative to Normal Weight and Waist Circumference

Men ≤40 in >40 in

Women ≤35 in >35 in

BMI (kg/m2)

Underweight <18.5 — —

Normal+ 18.5 – 24.9 — —

Overweight 25.0 – 29.9 Increased High

Obesity 30.0 – 34.9 High Very High

35.0 – 39.9 Very High Very High

Extreme Obesity

≥40 Extremely High Extremely High* Disease risk for type 2 diabetes, hypertension, and CVD.+ Increased waist circumference can also be a marker for increased risk even in persons

of normal weight.

Source (adapted from): Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organization Consultation of Obesity. WHO, Geneva, June 1997

Goals of Weight Loss to Achieve a Healthy Weight

• Reduce body weight and maintain a lower body weight for the long term

• An initial weight loss of 5 to 10 percent of body weight is recommended

Condition Health Benefits of Modest (10%) Weight Loss

Mortality • 20-25% fall in overall mortality

• 30-40% fall in diabetes-related deaths

• 40-50% fall in obesity-related cancer deaths

Diabetes • Up to a 50% fall in fasting glucose

• Over 50% reduction in risk of developing diabetes

Lipids • 10% fall in total cholesterol

• 15% fall in LDL cholesterol

• 30% fall in triglycerides

• 8% increase in HDL cholesterol

Blood pressure • 10 mmHg fall in diastolic and systolic pressures

Benefits of a 10% Weight Loss

Aim to move your weight in this direction

BMI and Weight

Energy Balance

Energy In = Energy Out

Energy In

CHO 4 kcals/gram

Fat 9 kcals/gram

Protein 4 kcals/gram

Alcohol 7 kcals/gram

Energy Out

Basal Metabolic Rate (BMR)• Minimum energy needed to keep you alive

(meet basic physiological needs)• ~50 to 60% of total energy needs

Physical Activity (Calorie burning activity)• Cardio• Lifestyle• ~25 to 50% of total energy needs

Calculating Your BMR

The Harris-Benedict Equation

Man: 66.5 + 13.8 x (weight in kg) + 5 x (height in cm) - 6.8 x (age) = 1745 kcal/day

Woman: 655.1 + 9.6 x (weight in kg) + 1.8 x (height in cm) - 4.7 x (age) = 1536 kcal/day

• Lean body mass • Hormones

• Age • Caffeine

• Gender • Drugs

• Body size • Starvation

• Stress

Factors that Affect Your BMR

Physical Activity

Your daily activity will determine will affect energy needs

• Sedentary people expend less than ½ energy of BMR in physical activity

• Very active athletes can expend twice BMR

Activity LevelActivity Factor

Resting: Sleeping, reclining

1.0

Sedentary: Bedridden Minimal movement, largely Activities include: watching television, reading, etc.

1.3

Light: Office work, sitting, day consists of sleeping 8 hrs with 16 hrs of walking or

standing Activities include: walking, laundry, golf, ping pong, walking on level ground at

2.5-3 mph Usually includes 1 hr of moderate activity

1.5 - 1.6

Moderate:• Light manual labor• Activities include: walking 3.5-4 mph, cycling, tennis, dancing

1.6- 1.7

Very Active: Full-time athletes, agricultural laborers, active military duty, hard laborers (mine

and steel workers) Activities include: team sports, climbing

1.9 - 2.0

Activity Factors

Estimating Your Energy Needs

Total Energy Expenditure* (TEE) 1. Calculate Basal Metabolism

2. Find appropriate activity factors

3. Multiply 1 and 2

* Energy needs change (increase) during the following life cycle periods: Pregnancy Lactating Women Infants Children and Adolescents

http://www.health-calc.com/diet/energy-expenditure-advanced

http://www.scymed.com/en/smnxdg/health101/srcalx/sr35350.htm

Weight Loss Basics

Increase Energy Out:Increase Muscle Mass (exercise & activity) &

increase BMRIncrease physical activity (exercise & activity)

Decrease Energy In:Decrease Calories (energy) consumed

One pound of body fat = 3500 calories

Eat SmarterAnd

Move More

• A diet that is individually planned to help create a deficit of 500 to 1,000 kcal/day should be an integral part of any program aimed at achieving a weight loss of 1 to 2 lb/week.

• The diet should fit the patient’s lifestyle and food preferences.

• Dietary education is a necessary to achieve adjustment to a reduction in Calories.

Balance Calories in with Calories Out

• Food composition

• Reading nutrition labels

• Food purchasing

• Food preparation

• Reducing portion sizes

• Limiting alcohol consumption

Food Education

http://www.calorieking.com

http://www.myfitnesspal.com

http://www.fda.gov/Food/ResourcesForYou/Consumers/NFLPM/default.htm

All Food are Not Created Equal

• Nutrient density: A measure of nutrients (vitamins & minerals) provided per kcals of food

• Vegetables, Fruits, whole grains, lean proteins and low-fat dairy

• Empty calories: Provides kcals with few to none other nutrients

• Foods with lots of added sugar and fat such as sodas

Energy Density

Energy Density = Calories/volume

Choose low energy-dense foods that increase volume without increasing Calories (volumizing):

• Water• Air • Fiber

Limit high-energy dense foods that contain high amounts of added fats and sugars

Volumize

Volumize

Move More

Physical Activity

Aerobic Exercise = Exercise that increases your heart rate and breathing rate for a sustained amount of time to improve how your heart and lungs work together. Aerobic exercise burns calories

Strength Training Exercise = Exercise that improves the strength of muscles and bones, and increases the body’s ability to use energy (metabolism).

Lifestyle Activity = Physical activity that is unstructured and incorporated into daily tasks.

Physical ActivityGoal: 150 minutes a week of moderate-intensity or 75 minutes of vigorous activity is recommended for healthy weight control.

Dietary Change Should… Meets nutritional needs

Slow & steady weight loss

Adapted to individuals’ habits and tastes

Contains enough kcal to minimize hunger and fatigue

Contains common foods

Fit into any social situation

Change eating problems/habits

Improves overall health

Includes exercise

Includes behavior change

Questions?