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Is obesity a cancer risk?

October 13, 2014

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Is Obesity a Cancer Risk? is rather difficult to take at face value, especially when most of the co-authors have ties to pharmaceutical and diet/exercise companies. However, even without those ties and the resulting conflicts of interest, there’s a lot to deconstruct in this article.

Obesity represents “a central challenge” to cancer prevention and care and requires immediate action to reduce the toll, the American Society of Clinical Oncology (ASCO) asserts in its first-ever position statement on obesity.

Immediate action? I can think of several “immediate actions” that could be taken today that would reduce the toll of cancer on fat people.

#1: Quit fat-shaming people. That will put an immediate stop to fat people avoiding doctors until their illness is so advanced that little can be done to treat the illness.

#2: Start looking at fat people as people to be diagnosed and treated instead of seeing someone whose every ailment is caused by their size and can be cured by reducing that size (you wouldn’t tell that to a thin patient with the same ailment).

#3: Remember that a lot of medications have dosages that must be changed (titrated upwards) for heavier people. Undertreatment is as bad as no treatment in some cases.

Published in the Journal of Clinical Oncology, the statement calls for increased efforts to address the critical priorities of education and awareness about the links between obesity and cancer, development of new resources for clinicians, intensified and coordinated research, and policy changes to improve access to obesity screening, diagnosis, and treatment.

History suggests that a lot of hard work lies ahead, with no guarantees of success.

Dudes, before you can address the “critical priorities of education and awareness about the links between obesity and cancer,” it Cancerwould be a good idea to find out exactly what those links are, or if they even exist. For a skeptical viewpoint, check out Dr. Linda Bacon’s debate on the link between weight and cancer on the BBC.

Until you find out what the links are between obesity and cancer, it doesn’t matter what new resources you develop for clinicians, and those policy changes to improve access to obesity screening (like fat people don’t know they’re fat, or haven’t been told by their doctors what their BMI is), diagnosis, and treatment aren’t going to do much good. You can “improve access” all you want, but if fat people are going to continue to be shamed for their weight, and told that weight loss will be their miraculous “cure,” fat people are not going to use that “improved access” (which throws its usefulness right out the window).

“Obviously, nobody is so simplistic as to suggest that we simply counsel patients to lose weight,” ASCO immediate past president Clifford Hudis, MD, of Memorial Sloan Kettering Cancer Center in New York City, told MedPage Today. “Our sister societies in many areas of medicine have been highlighting the risks of obesity with regard to diabetes, heart disease, and other problems for decades.”

Really? You’re really saying that simply counseling patients to lose weight isn’t the answer? Your “sister societies” in different areas of medicine have been doing that for decades and it hasn’t worked for them? Well, maybe that’s because who gets any sort of disease is quite a bit more complicated than just how much they weigh.

Could it be that the medical and research community needs to take into account all the other factors that affect who gets a disease? And realize that even then, not everyone will get a disease just because they meet all the “criteria” you’ve decided are relevant. Race, education, socioeconomic status, stress, where they live, what kind of job they have, gender, genetics, and more all influence weight, as well as our risk for disease (any disease).

If that “highlighting the risks of obesity with regard to diabetes, heart disease, and other problems” hasn’t been successful in turning fat people into thinner people, maybe the problem isn’t with the fat people, maybe it’s with the counseling itself — the diets, exercise, and weight loss surgery that are recommended don’t work, not to make fat people permanently thin, anyway. You’d think that decades of failure would tell all of you in the medical community that you need to come up with a better plan to improve the health of fat people — weight loss alone just doesn’t do it.

“The truth is, the obesity problem, despite their careful counsel, has simply gotten worse,” said Hudis, one of the co-authors of the position statement. “I don’t think that anybody harbors the illusion that by drawing attention to this that we will immediately control weight in the U.S.”

Could it be that there are reasons this so-called “obesity problem” is getting “worse”? Reasons like changing the definitions for overweight and obese back in 1998? Could it be that we have problems with more additives in our food: antibiotics/growth hormones in our meat, pesticides on our fruits/veggies, over-processing of our grain products, and a whole host of other problems with food supply? Maybe those are issues that the medical community needs to tell our government to address, along with all the other issues that influence weight and disease risk, instead of calling for a “war on obesity.”

The magnitude of the problem was illustrated by a study published more than a decade ago. At that point in time, the results suggested that as many as 20% of cancer deaths could be attributed to obesity.

So 20% of cancer deaths can be attributed to “obesity”? Does this mean that “obesity” actually caused the cancer that killed the patient, or does it mean that the patient with cancer “died while fat”? If you can’t see the difference in those two scenarios, then you need to take off your blinders and get a reality check.

Developed by ASCO’s Energy Balance Working Group, the policy statement emphasizes the growing cancer threat posed by obesity, which is predicted to overtake tobacco as the leading preventable cause of cancer. Almost three-fourths of Americans meet criteria for overweight or obesity, which underscores the health threat and its potential to “undo decades of prevention, early diagnosis, and treatment of cancer,” Hudis said.

All I have to say to the above quote is “Scaremongering much?” How many times have we heard that “obesity” is going to overtake tobacco as the next leading preventable cause of “________________________” (pick your disease of the day)?

With regard to closing gaps in health insurance coverage, ASCO calls for the Centers for Medicare and Medicaid Services to add obesity to the list of conditions eligible for the proposed Complex Chronic Care Management Services payments, and for the Department of Health and Human Services to develop clear definitions of access to obesity treatment services in state healthcare exchange plans that have emerged from the Affordable Care Act.

Right, add “obesity” to the list of conditions to be covered by Medicare, Medicaid, and state healthcare exchanges, then listen to fat-phobic taxpayers howl about how “teh fatties” are bankrupting our nation with all of their oh-so-preventable diseases. All because you say there’s a “link” between “obesity” and ___________ (again, pick your disease, they’re all “linked” to “obesity” according to researchers and the medical community [/sarcasm]).

The policy statement calls for development of a clearly defined, coordinated, and robust research agenda involving unresolved issues in the association between obesity and cancer. Studies are needed to determine whether weight loss can reduce the risk of developing or dying of cancer, whether obesity should be treated differently in cancer survivors than in the general population, and when and how to initiate weight management interventions for cancer patients.
“Research has clearly established that there is a critical relationships between cancer and obesity, but more work is needed to determine whether weight loss, increased physical activity, and improved dietary quality can lower cancer rates and improve outcomes,” Jennifer Ligibel, MD, chair of ASCO’s cancer survivorship and cancer prevention committees, said in a statement.

Yep, it’s the end of the article, and here’s the kicker to the whole piece that’s going to be ignored by all-too-many people who read it: “The policy statement calls for development of a clearly defined, coordinated, and robust research agenda involving unresolved issues in the association between obesity and cancer.” Unresolved issues in the association between obesity and cancer. How many people (doctors included) are going to read this article and come away with the impression that fat people get cancer more often and that’s the reason they also die from that cancer? How many people are going to remember that there are “unresolved issues in the association between obesity and cancer”?

More work is needed to determine whether weight loss, increased physical activity, and improved dietary quality can lower cancer rates and improve outcomes.” Gee, ya think? How about determining whether the majority of people even have access to safe and affordable physical activity and improved dietary quality? That alone might go a long way toward improving peoples’ health and allowing them to survive cancer if they do get it, no matter what their weight happens to be.

There are so many things wrong with our society, and the systemic problems of poverty and lack of access to just the basics of a decent life for all too many people are just two of them. When you add shaming people for their weight, which is pretty much not something most of us can control, and blaming people because they’re fat for the diseases they get, well, that’s just adding a layer of shit icing to the shit cake that is life for a lot of people.

This kind of reporting just pisses me right-the-fuck off. Devote the majority of the article to stressing your point of view, even if it’s not proven, and then throw in a caveat at the end that admits your point of view needs more research to prove it valid. Careless, lazy, and shoddy work all the way around.


5 Comments leave one →
  1. Twistie permalink
    October 13, 2014 10:31 am

    Other factors in the ‘rise of obesity’ that never get mentioned: during the time (around twenty years ago, at this point) when the actual average weight of Americans did rise a whole fifteen pounds, the average height of Americans also rose by about an inch. Taller people have higher BMIs because it’s a quick and dirty calculation with no real diagnostic value, but height is part of said calculation.

    Also, the higher your muscle mass, the higher your BMI. If you take the same size mass of muscle and of fat and weigh them, the muscle will weigh more. It’s denser. So the people who are keeping extra fit with huge amounts of exercise to build muscle… are raising their BMIs and becoming obese, even if they lose weight and look thin and everyone admires their ‘healthy’ look.

    Tom Cruise is obese. Johnny Depp is overweight. Nobody is going to point to either of them and scream about their cost to the healthcare system with their hideous, hideous fatness. Nobody is going to point fingers at them and scream about diabetes and cancer.

    When someone gets a disease, treat the freaking disease. My body is not a disease.

  2. Len permalink
    October 13, 2014 4:10 pm

    I can think of one link between cancer and obesity they forgot to mention.

    My father is alive today because he is fat. His cancer treatment would have killed him otherwise, the doctors were quite upfront about it.

    Fat can keep people alive under extreme circumstances. It also allowed me to recover much faster from bowel surgery.

    Just saying …

    • vesta44 permalink
      October 16, 2014 2:17 pm

      Len, being fat allowed my mother to survive for 10 years after her diagnosis of ovarian cancer. She had surgery to remove it, but a year later, they found colon cancer, then they found bladder cancer, and last of all, they found stomach cancer. The last three months of her life, she couldn’t eat or drink anything. If she hadn’t been fat to begin with, I really doubt that she would have lived as long as she did (but I’m not so sure I would have wanted to live, not with all of the surgeries, chemo, and recurring cancers).

  3. Harriet permalink
    October 13, 2014 7:19 pm

    And the article is complete with a nice headless fatty picture.

  4. October 14, 2014 4:47 am

    Here’s the most “telling” line: “There are so many things wrong with our society, and the systemic problems of poverty and lack of access to just the basics of a decent life for all too many people are just two of them.” And, BTW, “studies” such as this are inevitably both indicators and symptoms of fragile thinking. It’s that Soviet/Harvard belief that a) the authors are intelligent, and b) their work commands attention. In Truth, they know nothing at all. They’re just taking up space and engaging in unwarranted judgments against others. When your car is broken down by the side of the road, the person most likely to stop and help is driving a modest vehicle. Those who drive swanky, late-model thangs will glance at your distress as they continue to their very important destination.

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