Karen Ravn wrote an informative review called Obesity: ‘Like the new smoking’ and published it in the Los Angeles Times. Ravn got her title from a quote by Anne McTiernan, a medical doctor with a Ph.D. in Public Health. Dr. McTiernan focuses on prevention of new and recurrent breast and other cancer through physical activity, diet and chemoprevention. I’ve never met Dr. McTiernan, who is the director of the Prevention Center at the Fred Hutchinson Cancer Research Center in Seattle, but she is a self-proclaimed pragmatist and that practical aspect wins respect from me. I believe that she is right; people want to know exactly what they have to do – and how little they need to do – to reap healthy rewards. Her research is specifically answering these questions. She says, “Nothing is guaranteed, but exercise and weight control are like wearing a seat belt. It reduces your risk.”

According to a 2009 survey conducted by the American Institute for Cancer Research (AICR), there is a significant disconnect in risk awareness of obesity as related to cancer. (Note: See the link for Awareness of Obesity-Cancer Link Called “Alarmingly Low” in a little box on the right side of the AICR link above.) Only about 51% of those surveyed by the AICR realize that obesity is linked to at least 6 different cancers: colorectal, post-menopausal breast, endometrial, pancreatic, kidney and esophageal. It’s marvelous that 94% of the public know that tobacco use causes cancer and 87% know that sun exposure increases risk of cancer, but about half of Americans don’t realize that obesity is linked with cancer.

Because obesity is now at epidemic proportions this issue has a wide-reaching impact in our country. Related awareness numbers are: that only 52% are aware that diets low in vegetables and fruit increase cancer risk; 46% realize that lack of physical activity increases cancer risk; and only 38% realize that diets high in red meat increase risk. Ninety percent of Americans blame cancer on genes, in spite of the fact that the genetic mutations occur in only a small proportion of the population.  Lifestyle choices (diet and physical activity) that impact our weight can have a real impact on the prevention of many common cancers. Every year about 100,000 Americans get a cancer that they wouldn’t have gotten if they had kept their weight in the normal range.

Researchers don’t know exactly how excess weight increases cancer risk, but they seem to be guessing that it does so in multiple ways, including: higher levels of estrogen, insulin and inflammatory compounds. Inflammation – the same measures that have been linked to an increased risk of type 2 diabetes, cardiovascular disease, and Alzheimer’s disease – is one of the factors in metabolic syndrome and is already linked to an increased risk of various cancers.

In 2003 it was reported by Eugenia E. Calle, et al in the New England Journal of Medicine that the more overweight we are, the more deadly is the trend in increased death rates from cancer. Karen Ravn has done a terrific job reporting the increased rates; some as high as 350% - 535% increase in deaths from cancer in the obese. Ouch!!!

A preemptive dietary strike against cancer

William Li M.D., the president and medical director of the Angiogenesis Foundation, gave an innovative TED talk (a little redundant, since all TED talks are innovative). First let’s be clear about the term angiogenesis. Angiogenesis is a big word for a simple concept: it’s the process through which our bodies create new blood vessels to supply growing tissues.  Dr. Li (and before him, his mentor Dr. Judah Folkman) has researched how blood vessels are a necessary component of a growing cancer. Dr. Li makes the issue really clear in his TED talk (link above – note, I think it’s worth watching.) The bottom line is that tiny dormant cancers often sit throughout our bodies and never grow – never become harmful because they are not able to convince the body to grow the necessary blood vessels to bring them nourishment. But a microscopic tumor can grow up to 16,000 times its original size in as little as two weeks, if it has the angiogenesis stimulators – the way of tricking to body to answer the tumor’s call “feed me, feed me”. The cancer with the blood vessel mechanism is “the turnkey step that converts a harmless cancer into a deadly one,” says Li.  Note: gaining weight requires new blood vessels to feed the growing tissue. An obese body has become quite good at growing a lot of new blood vessels – a lot of angiogenesis.

Being a public health nutritionist and focused on prevention, I really celebrate Li’s perspective and where he is concentrating much of his effort. Because Li knows that the patient is more likely to survive cancer, the sooner it is treated; he does not want to wait for the tumor to get past the microscopic phase. Li says that we are treating cancer too late in the game; he wants to beat cancer at it’s own game. His foundation spends a great deal of attention on prevention – music to the ears of this public health nutritionist. He has discovered that, “Mother Nature has laced many foods and beverages with naturally occurring inhibitors.” Li and his colleagues are doing research to discover which of the foods; varieties of foods; and combinations of foods are most potent in inhibiting angiogenesis. But meanwhile, we can derive comfort from the fact that berries, tomato, cinnamon, bok choy and pumpkin, are among the list of already identified anti-angiogenic foods and are delicious and available. Li’s foundation is working to shift how we think about food; that is, learning how to eat to starve cancer by preventing its blood supply from being constructed by the body.

The Angiogenesis Foundation is also working on using anti-angiogenesis on obesity. The foundation has already made some discoveries, but again, why wait? While Li and his colleagues work on the synergy of different foods, you can begin adding fruits, vegetables and spices to your regular fare – lots of vegetables; they will eventually replace some of the processed grains, sugar, fats and red meats in your diet. It’s a great place to start – in the beginning you’re not changing much, just adding. If you study his list, you will notice that the foods are all plant-based foods that are encouraged in the Mediterranean-style of eating that we so frequently write about. And unlike, unhealthy fad diets, you are learning how to nourish yourself for the long term while you’re attaining a healthy weight. Maintaining a healthy weight is not the only goal; maintaining a healthy weight and having a well-nourished body (one that has the ability to fight cancer) for the long haul – that is the goal. We don’t need to wait until Li’s research is complete; we can begin now – while making our shopping list; while at the market; while cooking and using our own spice cabinet. Li says that Mother Nature is providing clues; what we eat is chemotherapy three times per day – and without the terrible side effects.

It seems as though, we as a nation, are up against a difficult situation; cheap tasty fattening fudes are ubiquitous in our society. Getting us to move more and eat less fudes and more whole, plant-based foods seems almost insurmountable – it would be an enormous life-style change for millions. Shall we sit around waiting for a pill that will fix this problem? (See: Stopping the Pendulum) My guess is that there may never be a pill, or any combination of them, that will do the job. My suggestion is to begin making the changes; changes that are within our reach; begin moving, and learning how to include more fruit, vegetables, whole grains, legumes, seeds, nuts, and fish in our diet. While not an instant fix, it is doable and has the actual benefit of sustainability – the kind of weight management and protection from diseases that can last.

Meanwhile, you may want to consider reading about the Masters of Weight Management – those are the people who have made the big decision to change their life-styles permanently and have maintained weight loss for a long time. Thin for Life: 10 Keys to Success from People Who Have Lost Weight and Kept It Off, by Anne M. Fletcher, M.S., R.D. is not a new book (published in 2003), but what I like about it is that it helps motivate the reader to first ‘get their thinking straight.’ Ms. Fletcher, who had maintained a 35-pound weight loss for over 25 years, as of 2003, tells the stories of those that kept lost weight off (some who have kept off tremendous weigh loss); she calls them masters. The book can encourage you in the knowledge that you can, not only take it off, but you can keep it off like the masters. I celebrate all those who have succeeded at this feat; it’s not easy as most of us know, but the rewards are vast. What’s the point of going to all the work of losing the weight if you can’t maintain the weight loss? Why not make the decision to be healthier, to reduce your risk of serious disease?

Cancer is at the top of the list of feared diseases, yet Americans don’t seem to realize that they can actually Do Something to reduce their risk of getting it. Increase the amount of exercise and the amount of fruits and vegetables in your diet! Start now! It will not only increase your intake of anti-angiogenesis containing foods; but at the very same time you will be decreasing the caloric density of your diet, which has the potential of helping you manage overweight/obesity – a risk for cancer all by itself. If you’re not at a healthy weight, begin thinking about the first steps that you can take to reduce your weight and your risk.