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This section does not replicate the other information in this handbook but provides additional details or context most relevant to professionals.

Supporting lifestyle changes

Addressing your patient’s obesity with compassion, taking time to explore underlying contributors, and with guidance instead of judgment will build trust and cooperation. Most obese people know they are obese (but some do not, so be prepared for that conversation). Many people with obesity desperately want to lose weight but cannot manage it on their own. 

Your active support is likely needed for your patients to make changes, as research shows that adherence is generally low, but interventions combined with support show more success. 

  • Adherence to physical activity, dietary, and multiple lifestyle behaviors recommendations was low among cancer survivors. Recent cancer survivors were relatively more adherent to WCRF/AICR recommendations compared to long-term survivors in a very large meta-analysis of 51 clinical trials.1Tollosa DN, Tavener M, Hure A, James EL. Adherence to multiple health behaviours in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship. 2019 Jun;13(3):327-343. 
  • Physician referral to a weight management group, followed by ensuring the patient made an appointment and was offered follow-up, led to more weight loss at 12 months—2.43 kg (5.35 lb) compared to 1.04 kg (2.3 lb)—than physician advice to the patient that their health would benefit from weight loss.2Aveyard P, Lewis A etal. Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. Lancet. 2016 Nov 19;388(10059):2492-2500. 
  • A group-based behavioral intervention including both exercise and nutrition, supplemented with telephone counseling and tailored newsletters to support weight loss led to greater weight loss after both one and two years among breast cancer survivors compared to a less intensive control intervention.3Rock CL, Flatt SW et al. 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. Journal of Clinical Oncology. 2015 Oct 1;33(28):3169-76.
  • An intervention of three supervised exercise sessions per week and individualized dietary advice, supplemented by weekly nutrition seminars, for women with breast cancer treated 3–18 months previously led to smaller waist circumferences and waist-hip ratios, lower cholesterol and leptin, and a weak trend toward more weight loss compared to controls in a small RCT.4Scott E, Daley AJ et al. Effects of an exercise and hypocaloric healthy eating program on biomarkers associated with long-term prognosis after early-stage breast cancer: a randomized controlled trial. Cancer Causes & Control. 2013 Jan;24(1):181-91. 

Approaching the topic with “we” messages instead of “you” messages can set a supportive tone:

  • We need to work together to address your excess weight.
  • Help me understand your barriers to losing weight.
  • Let’s find a program that works for you.

Involving your patient in setting goals and making changes is both supportive and empowering:

  • How far do you think you can walk each day? Can you increase that by 10% after two weeks?
  • What kind of activity would you look forward to? 
  • What do you think are the biggest problem foods for you? How can you make a small change to start to fix that?

Some physicians have started walking clubs, inviting groups of patients to walk with them on their lunch hour once a week or more. Some offer an incentive of answering medical questions (but not specific to a patient’s condition). We realize that this is “over and above” what you may be able to provide, but perhaps you can be creative in finding small ways to offer support:

  • A weekly email message of support and encouragement. This could be as brief as an inspirational quote, or as long as a newsletter with tips and recipes.
  • Joining an online community with your patients to share successes, find encouragement with challenges, and bolster a sense of support.

For people who are underweight or at risk of unintentional weight loss, dietary counseling is important. “Get more calories, no matter where they come from” is not the best advice. Dietary counseling focused on health-promoting ways to increase calories is important.

See further specific guidance and recommendations for initiating and supporting lifestyle changes that can impact your patients’ body weight on these pages:

Resources for supporting weight loss

Resources for weight loss among people with cancer

Modes of action: obesity and angiogenesis

One study suggests at least one possible way weight loss in obese women may influence cancer behavior. A randomized control trial study compared the effects of dietary weight loss, exercise, or their combination on circulating levels of regulators of angiogenesis (new blood vessel creation to supply cancer cells) in a large sample of healthy, overweight or obese postmenopausal women. Weight loss reduced circulating angiogenic biomarkers. They “suggest that weight loss in overweight or obese postmenopausal women may reduce risk for cancer in part through altering angiogenesis.”5Duggan C, Tapsoba Jde D, Wang CY, McTiernan A. Dietary weight loss and exercise effects on serum biomarkers of angiogenesis in overweight postmenopausal women: a randomized controlled trial. Cancer Research; 76(14); 4226–35.

Preclinical evidence: obesity and immune function

Obesity induced by a high-fat diet impairs CD8+ T cell function in the tumor microenvironment of mice.6Ringel AE, Drijvers JM et al. Obesity shapes metabolism in the tumor microenvironment to suppress anti-tumor immunity. Cell. 2020 Dec 23;183(7):1848-1866.e26. 

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Authors

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Reviewer

Miki Scheidel

Co-Founder and Creative Director
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Miki Scheidel is Co-founder and creative director of CancerChoices. She led the effort to transform Beyond Conventional Cancer Therapies, the prior version of CancerChoices, to its current form. Miki and her family were deeply affected by her father’s transformative experience with integrative approaches to metastatic kidney cancer. That experience inspires her work as president of the Scheidel Foundation and as volunteer staff at CancerChoices. She previously worked with the US Agency for International Development and Family Health International among other roles. She received her graduate degree in international development from Georgetown University, a graduate certificate in nonprofit management from George Mason University, and a Bachelor of Arts from Gettysburg College.

Miki Scheidel Co-Founder and Creative Director

Last update: January 27, 2023

Last full literature review: August 2021

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care, and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies and self carelifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.