View Full Version : New US Obesity Numbers
08-18-2010, 12:19 PM
This is obesity only (does not include overweight).
08-31-2010, 11:00 AM
Tanya, I have a breast cancer specific question related to obesity.
My problem continues to be the one problem that no one acknowledges for those like me who are over 55, some years out from treatment and gradually becoming more and more postmenopausal -- the problem of how to successfully deal with completely unavoidable interruptions in diet and exercise.
My 1,000 calorie a day diet and my full hour a day of exercise now are not producing actual weight loss. Those things are what I have to do just to avoid gaining more weight.
Today is an especially good example of this problem. On rare occasion I have significant vertigo, which is what I have today. There is no way I can do a 3-miler today, nor can I do resistance exercises. Since diet and exercise is only resulting in weight maintenance for me and not weight loss, what am I supposed to do today? Not eat at all and wait to feel better so that I won't gain weight? Or eat something today, and gain weight that I then am unable to lose? Or do I reschedule everything whenever these things happen and "double" my amount of exercise (but not double what I eat) for several days everytime this happens on a completely unpredictable basis?
What would you do?
This is why I question whether doing chemotherapy is helpful in a group of patients who are almost entirely unlikely to recur in the first 10 or so years. Doing the chemo makes a little more sense for those who are under age 50 and still premenopausal. For older women (who clearly are the majority of breast cancer patients), the chemotherapy "stalls out" metabolism for those who are older, and then results in more intractable weight gain that then increases the risk of recurrence. What is the point of doing the chemotherapy in that group of women if it puts them back at high risk?
That is why I would like to see if drugs like trastuzumab used alone in that group would result in a lower recurrence rate, or not.
I feel sorry for those who are under 50 and premenopausal because it would seem logical that if the chemotherapy plus trastuzumab does work and they do not recur, it seems logical that they will eventually have the same problem with weight management that I am having despite consistent diet and exercise.
08-31-2010, 04:26 PM
Sorry to cut in before Tanya gets a chance to answer your question.
Have you checked on your heart function? Please be sure there's no 'fluid retention' issue because it could be the cause that you haven't been able to lose weight (on the scale).
My weight has been steadily dropping again - always a sign of some kind of illness for me. Saw my oncologist yesterday and he was 'totally not concerned' - probably because my blood test result (CBC, etc) was so good and I seemed to be 'happy' (showed him my picture on the article I wrote for an Alumni Assocation in Southern California.)
I know I need to eat more so I can maintain a healthy weight. But what was the cause for me not to have much of an appetite? The heat? My brain tumor? Lack of activity? In your case, is your bowel movement normal? Are you eating enough fiber? Among my friends and family, we have a saying that 'some people can gain weight by just drinking water'.
It's certainly a puzzle that garners interest.
09-01-2010, 11:38 AM
One reason I think I am a "good example of a breast cancer patient" (but who has done some treatment in the past) is because I have no other chronic conditions of any kind and take no medications (other than the Estring, and occasional testosterone). When I was at one time considering doing a lapatinib trial after having completed my original therapy, my PCP did an echocardiogram on me because of the Adriamycin x 6 I'd had, and my results were completely normal. My BP is nice and low, and all of my labs are completely normal except for one LFT that is just barely over the top end of normal, showing that I do probably have a fatty liver.
So what I mean when I say I am a good example of a breast cancer patient is that I am pretty much a "pure" lab rat, other than having done chemotherapy and some tamoxifen. My situation can't be blamed on other, "man"-made causes. I've never smoked or drank or done illicit drugs, for example. There is no thyroid disease or diabetes involved for me.
One reason I am so concerned about the application of diet and exercise is because if someone like me, who has no complications, has problems making it "work", then how realistic are we being in expecting patients who have other complications like arthritis, etc. to be successful in the application of diet and exercise to avoid recurrence?
My diet is made up primarily of vegetables, fish, some chicken, fruit, and the only starch I eat is very very limited amounts of whole grains or legumes (no sugars, just Stevia).
I am sorry that it is hard for you to maintain a stable weight, and it sounds like you have had some complications over time but it is hard to identify what ones are factors in the weight maintenance. Here is where we desperately need REAL answers through endocrinology, not oncology.
Thanks for asking and mentioning some ideas to consider,
09-01-2010, 03:50 PM
What about the genes?
I noticed that you have an extensive family bc history. Are the other members of your family/relatives able to maintain an ideal weight easier than you?
My Mother went on a vegetable diet (more related to the Buddhist belief) when she turned 65 and lost about 20 lbs in a 10 year span (she's only about 5'1'' and had been chubby all her life) She went back to 'normal' diet at 75 after she was diagnosed with Non-Hodgkins Lymphoma. She's a healthy 87-year-old right now.
09-01-2010, 08:10 PM
I am sorry it has taken me a couple of days to respond. To be honest, I find your question difficult to answer because there is no straight forward, easy answer. Unfortunately, the causes of overweight and obesity remain mysterious in some people. I know from past conversations that you have tried higher caloric diets (I normally wouldn't recommend 1000 or less due to decreased metabolism) and they have produced weight gain despite exercise. Post-chemotherapy for breast cancer happens to be one of the "mysterious" groups struggling with weight issues. The reason remains unknown at this point and I can't even say I see an answer in the near future. As we have discussed before survivorship care for breast cancer survivors will remain incomplete without the input of endocrinology which clearly plays a significant role in hormone sensitive breast cancers.
Getting to your questions regarding exercise interruptions...you can't stop them. Interruptions happen to everyone-both diet and exercise. If you are able to do a little extra when you feel better I believe it will benefit you, however, if it ends up making you too sore to exercise the next day then you are behind the eight ball again. A couple of questions come to mind in reading you scenario. One is regarding the vertigo--it is not a blood sugar/hypoglycemia issue vs vertigo? Following a very low calorie/low-mod low carbohydrate diet places you at increased risk for hypoglycemia so just want to be sure that is not the case (difficult to assess over the internet so please don't be offended if it is clearly not hypoglycemia). Secondly, how often do you change up your diet/exercise routine? I question whether there would be benefit to trying some interval training and increasing calories for a short period of time to see if that helps to jump-start weight loss.
09-02-2010, 02:01 PM
Hi Jackie and Tanya,
To Jackie - Up to age 50 I was at mid-range of BMI and mostly looked like my mum. My older sister was short and overweight and looked like our paternal Gran. After treatment it took 6 years but I did lose the 25 pounds I had gained -- BUT -- am having more trouble now losing weight by doing exactly the same diet and techniques that worked in the first 5 years after treatment. The metabolism is slowing down.
To Tanya - I've had the vertigo once a year or so ever since completing chemotherapy, and it doesn't fluctuate with eating so I would guess it isn't hypoglycemia. My blood sugars stay in normal range for labs. The only thing I do that is sort of like interval training is that I do my daily 3 miles mixing walking backward with walking forward so that it exercises different muscles and improves balance. (The pavement is clear and very smooth, with some uphill and downhill sections.) It looks weird I'm sure to passersby but so be it. I have been avoiding jumping rope but may throw bits of that in to try interval training. Thank you for the reminder and suggestion for that. As the weather gets colder and wetter I am doing more resistance exercise indoors, too. I will be seeing the endocrinologist later this fall to see if I can get a more accurate idea of what my true metabolism actually is, so that I know better what calorie level/exercise level I have to aim for. I definitely think that we need some post-treatment support by endocrinologists to know where we should work to go with it all if we are to avoid recurrence through weight management.
09-03-2010, 04:33 AM
I don't know how rural your area is but if you happen to be near a larger medical center it might be interesting to see if their dietitians have a indirect calorimeter (MedGem is a common portable brand). We have many calorie/energy equations to estimate nutritional needs but they are really just an educated guess. Indirect calorimetry is the gold standard for evaluating energy expenditure/needs. It is often used in the critical care setting for artificial nutrition support but since portable machines have become available it has been used in other settings. Another thing that would be interesting is Bioelectrical Impedance Analysis (BIA) which evaluates body composition in % lean body mass, fat and fluid. I have a BIA machine at the cancer center where I work and have found it useful from time to time when someone is making a major change in diet/exercise or when we are having trouble with weight management (usually too much wt loss) to evaluate caloric needs in a different way. IC would be better for calorie estimation but either one gives some insight.
It is starting to cool down and become wet here in Northern MI too. Treadmill-here I come =)
09-03-2010, 11:08 AM
Morning, Tanya (or afternoon where you are!)
The Registered Dietitian at the cancer center in Seattle used the MedGem with me in 2008 to calculate the 1440 calories as a basic maintenance diet for me without exercise, and then he and I agreed on 1350 calories with exercise, and it was on that amount that I steadily gained weight. At this point I don't know whether to think that the MedGem is accurate with people who haven't had their metabolism affected by chemotherapy, or whether when it was used for me something was incorrectly done. I am planning an appointment with the RD for October to go over this together, and I will report back here then.
What I want to know is, does chemotherapy affect the metabolism of the breast cancer population differently than the nontreated population, or alternatively, given that the majority of breast cancer patients are over age 55, are the changes in metabolism significantly different than is commonly recognized (simply due to commonalities of aging).
This morning is sunny so doing my morning walk was less difficult than walking in yesterday's steady downpour, and I added 40 paces of light running in-between some of my walking, as a way of incorporating your suggestion. Well, it feels like it might be helping so I am going to hope it is. I do want to add for the benefit of others, though, that wearing a pad might be a good idea since at this age I had some minor leakage that was annoying, that I don't have with just walking.
09-03-2010, 08:00 PM
I was looking for some other subject today and happened to see this one:
09-08-2010, 06:08 AM
The MedGem should account for the changes you have experienced as it is calculated based on your body chemistry specifically, however, there are errors that can occur rendering the test inaccurate. A repeat test would be beneficial. We know that women who have had breast cancer AND chemotherapy gain more weight than those who have had surgery +/- radiation but it is not known why at this point. It is theorized that activity decreases more due to increased frequency of appointments plus increased fatigue from treatment but I don't think anyone is fully convinced by this theory. The interesting thing is that we don't see this trend in other diseases managed with chemotherapy. I haven't had a chance to fully read the article Jackie posted but agree that the use of Metformin in breast cancer/overweight and obesity is very intriguing due to insulin resistance and possible improvement in weight management.
I hope the interval training helps and I look forward to an update after you see your RD.
09-08-2010, 06:31 AM
We know that women who have had breast cancer AND chemotherapy gain more weight than those who have had surgery +/- radiation but it is not known why at this point. It is theorized that activity decreases more due to increased frequency of appointments plus increased fatigue from treatment but I don't think anyone is fully convinced by this theory. The interesting thing is that we don't see this trend in other diseases managed with chemotherapy.
How about the role of steriods given to breast cancer chemotherapy patients? Are steroids given to patients managed with chemotherapy in other diseases?
09-10-2010, 04:42 AM
Yes, steroids are used to prevent drug reactions in many chemotherapy treatments so it doesn't appear that would be the cause for weight gain in breast cancer patients receiving chemo. However, with unique metabolism given wide hormonal fluctuations I wouldn't doubt that the steroids have a bigger impact on this population, especially when coupled with other factors such as decreased activity, changes in eating patterns, etc.
09-10-2010, 02:39 PM
"What I want to know is, does chemotherapy affect the metabolism of the breast cancer population differently than the nontreated population, or alternatively, given that the majority of breast cancer patients are over age 55, are the changes in metabolism significantly different than is commonly recognized (simply due to commonalities of aging). "
It seems to me that the same slowdown of metabolism with chemotherapy is what brings about menopausal weight gain with aging that increases risk for recurrence through inflammation.
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