Even though the effects of overweight and obesity on diabetes, cardiovascular disease, all-cause mortality, and other health outcomes are widely known, there is less awareness that overweight, obesity, and weight gain are associated with an increased risk of certain cancers. A recent review of more than 1000 studies concluded that sufficient evidence existed to link weight gain, overweight, and obesity with 13 cancers, including adenocarcinoma of the esophagus; cancers of the gastric cardia, colon and rectum, liver, gallbladder, pancreas, corpus uteri, ovary, kidney, and thyroid; postmenopausal female breast cancer; meningioma; and multiple myeloma.1�An 18-year follow-up of almost 93?000 women in the Nurses� Health Study revealed a dose-response association of weight gain and obesity with several cancers.2
Obesity Increase
The prevalence of obesity in the United States has been increasing for almost 50 years. Currently, more than two-thirds of adults and almost one-third of children and adolescents are overweight or obese. Youths who are obese are more likely to be obese as adults, compounding their risk for health consequences such as cardiovascular disease, diabetes, and cancer. Trends in many of the health consequences of overweight and obesity (such as type 2 diabetes and coronary heart disease) also are increasing, coinciding with prior trends in rates of obesity. Furthermore, the sequelae of these diseases are related to the severity of obesity in a dose-response fashion.2�It is therefore not surprising that obesity accounts for a significant portion of health care costs.
Cancers
A report released on October 3, 2017, by the US Centers for Disease Control and Prevention assessed the incidence of the 13 cancers associated with overweight and obesity in 2014 and the trends in these cancers over the 10-year period from 2005 to 2014.3�In 2014, more than 630?000 people were diagnosed as having a cancer associated with overweight and obesity, comprising more than 55% of all cancers diagnosed among women and 24% of cancers among men. Most notable was the finding that cancers related to overweight and obesity were increasingly diagnosed among younger people.
From 2005 to 2014, there was a 1.4% annual increase in cancers related to overweight and obesity among individuals aged 20 to 49 years and a 0.4% increase in these cancers among individuals aged 50 to 64 years. For example, if cancer rates had stayed the same in 2014 as they were in 2005, there would have been 43?000 fewer cases of colorectal cancer but 33?000 more cases of other cancers related to overweight and obesity. Nearly half of all cancers in people younger than 65 years were associated with overweight and obesity. Overweight and obesity among younger people may exact a toll on individuals� health earlier in their lifetimes.2�Given the time lag between exposure to cancer risk factors and cancer diagnosis, the high prevalence of overweight and obesity among adults, children, and adolescents may forecast additional increases in the incidence of cancers related to overweight and obesity.
Clinical Intervention
Since the release of the landmark 1964 surgeon general�s report on the health consequences of smoking, clinicians have counseled their patients to avoid tobacco and on methods to quit and provided referrals to effective programs to reduce their risk of chronic diseases including cancer. These efforts, coupled with comprehensive public health and policy approaches to reduce tobacco use, have been effective�cigarette smoking is at an all-time low. Similar efforts are warranted to prevent excessive weight gain and treat children, adolescents, and adults who are overweight or obese. Clinician referral to intense, multicomponent behavioral intervention programs to help patients with obesity lose weight can be an important starting point in improving a patient�s health and preventing diseases associatedwith obesity. The benefits of maintaining a healthy weight throughout life include improvements in a wide variety of health outcomes, including cancer. There is emerging but very preliminary data that some of these cancer benefits may be achieved following weight loss among people with overweight or obesity.4
The US Preventive Services Task Force (USPSTF)
The US Preventive Services Task Force (USPSTF) recommends screening for obesity and intensive behavioral interventions delivered over 12 to 16 visits for adults and 26 or more visits for children and adolescents with obesity.5,6�Measuring patients� weight, height, and body mass index (BMI), consistent with USPSTF recommendations, and counseling patients about maintaining a healthy weight can establish a foundation for preventive care in clinical care settings. Scientific data continue to emerge about the negative health effects of weight gain, including an increased risk of cancer.1�Tracking patients� weight over time can identify those who could benefit from counseling and referral early and help them avoid additional weight gain. Yet less than half of primary care physicians regularly assess the BMI of their adult, child, and adolescent patients. Encouraging discussions about weight management in multiple health care settings, including physicians� offices, clinics, emergency departments, and hospitals, can provide multiple opportunities for patients and reinforce messages across contexts and care environments.
Weight Loss Programs
Implementation of clinical interventions, including screening, counseling, and referral, has major challenges. Since 2011, Medicare has covered behavioral counseling sessions for weight loss in primary care settings. However, the benefit has not been widely utilized.7�Whether the lack of utilization is a consequence of lack of clinician or patient knowledge or for other reasons remains uncertain. Few medical schools and residency programs provide adequate training in prevention and management of obesity or in understanding how to make referrals to such services. Obesity is a highly stigmatized condition; many clinicians find it difficult to initiate a conversation about obesity with patients, and some may inadvertently use alienating language when they do. Studies indicate that patients with obesity prefer the use of terms such as�unhealthy weight�or�increased BMI�rather than�overweight�or�obesity�and�improved nutrition and physical activity�rather than�diet and exercise.8�However, it is unknown if switching to these terms will lead to more effective behavioral counseling. Effective clinical decision support tools to measure BMI and guide physicians through referral and counseling interventions can provide clinicians needed support within the patient-clinician encounter. Inclusion of recently developed competencies for prevention and management of obesity into the curricula of health care professionals may improve their ability to deliver effective care. Because few primary care clinicians are trained in behavior change strategies like cognitive behavioral therapy or motivational interviewing, other trained health care professionals, such as nurses, pharmacists, psychologists, and dietitians could assist by providing counseling and appropriate referrals and help people manage their own health.
Achieving sustainable weight loss requires comprehensive strategies that support patients� efforts to make significant lifestyle changes. The availability of clinical and community programs and services to which to refer patients is critically important. Although such programs are available in some communities, there are gaps in availability. Furthermore, even when these programs are available, enhancing linkages between clinical and community care could improve patients� access. Linking community obesity prevention, weight management, and physical activity programs with clinical services can connect people to valuable prevention and intervention resources in the communities where they live, work, and play. Such linkages can give individuals the encouragement they need for the lifestyle changes that maintain or improve their health.
The high prevalence of overweight and obesity in the United States will continue to contribute to increases in health consequences related to obesity, including cancer. Nonetheless, cancer is not inevitable; it is possible that many cancers related to overweight and obesity could be prevented, and physicians have an important responsibility in educating patients and supporting patients� efforts to lead healthy lifestyles. It is important for all health care professionals to emphasize that along with quitting or avoiding tobacco, achieving and maintaining a healthy weight are also important for reducing the risk of cancer.
Corresponding Author:�Greta M. Massetti, PhD, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341 (gmassetti@cdc.gov).
Conflict of Interest Disclosures:�All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflict of Interest. Dr Dietz reports receipt of scientific advisory board fees from Weight Watchers and consulting fees from RTI. No other disclosures were reported.
Disclaimer:�The findings and conclusions in this report are those of the authors and not necessarily the official position of the Centers for Disease Control and Prevention.
References
1. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K; International Agency for Research on Cancer Handbook Working Group. Body fatness and cancer�viewpoint of the IARC Working Group. N Engl J Med. 2016;375(8):794-798. PubMedArticle
2. Zheng Y, Manson JE, Yuan C, et al. Associations of weight gain from early to middle adulthood with major health outcomes later in life. JAMA. 2017;318(3):255-269. PubMedArticle
4. Byers T, Sedjo RL. Does intentional weight loss reduce cancer risk? Diabetes Obes Metab. 2011;13(12):1063-1072. PubMedArticle
5. Grossman DC, Bibbins-Domingo K, Curry SJ, et al; US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426. PubMedArticle
7. Batsis JA, Bynum JPW. Uptake of the centers for Medicare and Medicaid obesity benefit: 2012-2013. Obesity (Silver Spring). 2016;24(9):1983-1988. PubMedArticle
8. Puhl R, Peterson JL, Luedicke J. Motivating or stigmatizing? public perceptions of weight-related language used by health providers. Int J Obes (Lond). 2013;37(4):612-619. PubMedArticle
Degenerative disk disease (DDD), which could affect any one of us as we age, may be particularly problematic for people who are overweight. To understand why, take a step back and consider the construction and function of your spine.
The spine is made to help support the weight of your body. It’s designed to keep your weight balanced and evenly spread. For example, the vertebrae are positioned from smallest to largest: small in your neck (cervical spine) and greatest in your low back (lumbar spine). They grow in size because the lower parts of the back must support the most weight.
Your intervertebral discs�the cushions between your vertebrae�increase in size, also. Only because they need to absorb and adjust to the most weight, they are thickest in the lumbar spine.
The back must be functioning accordingly in order to ensure all of its structures are healthy. Nonetheless, in degenerative disc disease, their capability to properly operate are altered and often lost. Intervertebral discs gradually become less effective at absorbing and cushioning your motions. Joints, including the facet joints, may subsequently transform as they readjust to changes in the disc; and they may not move as easily, making it harder for your own body to take and distribute weight.
Extra weight puts additional stress on the back. In the event that you are overweight and have DDD, then you’re stressing and straining your vertebrae and discs much more. The excess weight might even accelerate the degenerative processes because the elements of your spine will need to work more to carry the additional weight�and the harder they work, the quicker they may wear out or degenerate.
A diagnosis of degenerative disc disorder might be the motivation you need to become more physically active to get rid of extra weight, stop smoking or make other lifestyle changes to benefit your back and overall health and wellness. Your doctor or alternative healthcare provider can offer helpful suggestions about lowering your body weight and enhancing your general well-being.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Weight Loss Eases Back Pain
Back pain and symptoms of sciatica can affect a majority of the population throughout their lifetime. Research studies have demonstrated that people who are overweight or obese experience more back complications than people with a healthy weight. A proper nutrition along with regular physical fitness can help with weight loss as well as help maintain a healthy weight to eliminate symptoms of back pain and sciatica. Chiropractic care is also another natural form of treatment which treats back pain and sciatica utilizing manual spinal adjustments and manipulations.
Many people in the United States will experience back pain at some point in their lifetime, whether it’s a temporary or chronic issue. However, a great percentage of individuals with this debilitating complication are overweight or obese.
Fortunately, research has demonstrated that weight loss can have a considerable effect towards relieving symptoms of back pain. Weight loss programs can be very helpful for patients with weight problems and back pain. While there are a variety of programs available, not every program is the same and it may be difficult to find the best one for each individual. Some are commercialized and others are managed by a physician. Some weight loss programs recommend the use of supplements while others prescribe medications. Others may or may not be covered by insurance companies.
What to Look for in a Weight Loss Program
Considering all the differences in weight loss programs, it’s ultimately essential for Americans to first do some research in order to find the most appropriate program for them before signing up and spending any amount of money. Several weight loss programs may even provide practices that your healthcare professional may have advised you to avoid participating in if they would have been consulted first.
A recent study evaluated 191 different weight loss programs in the Maryland, Washington, DC and Virginia region of the country. From the wide array of programs, their websites provided little to no relevant information regarding they type of weight loss program. Important details, such as the type of diet, the amount of exercise and physical activity, types of behavioral therapies, and the use of medications, were all missing online, factors which were heavily considered for the study. Most websites had not been designed to offer details of each program, but rather offer contact information for clients.
Several of the weight loss programs also incorporated weight loss supplements and medications, an important piece of information which they also failed to mention on their websites. Individuals must be cautious of taking products which have not been approved by the FDA. There are U.S. Food and Drug Administration approved medications and supplements available to help treat excess weight and obesity, however, these must be prescribed by a licensed and qualified healthcare professional.
Three essential factors to an effective weight loss program, as recommended by the American Heart Association, American College of Cardiology and the Obesity Society, which should be featured include:
a moderately reduced caloric meal plan;
a regimen for increased physical activity;
and a behavioral therapy strategy.
Seeking Professional Advice
Because many weight loss programs are commercialized products or services, these can most commonly offer practices which may not meet professional standards. According to Dr. J Michael Gonzalez Campoy, MD, PhD, FACE, a specialist in obesity medicine, people seeking a weight loss program to participate in should primarily seek advice and guidance from a healthcare professional who specialized in treating weight issues and obesity.
�With the epidemic of overweight and obesity in this country, two-thirds of Americans will seek help managing their weight. The point is well taken that there is too much commercialism, or selling products with a promise of unrealistic achievements. It is best for each patient to address weight management with their personal healthcare professional first,” stated Dr. Gonzalez Campoy.
When it comes to finding the best weight loss program for your own needs, speaking to a licensed and qualified expert can be the most suitable alternative, as this option can often be safer and more effective than other weight loss programs. Patients can find obesity medicine doctors through the website of The American Board of Obesity Medicine, abbreviated as ABOM.
When Back Pain is an Issue for Weight Loss
Although many people with excess weight and obesity seek weight loss program alternatives to lose weight, it can often be difficult for them to engage in the practices due to back pain. Studies have shown that back pain is most prevalent on individuals with weight issues and that can play a huge role on their inability to engage in a proper weight loss program. However, inactivity can also ultimately lead to muscle weakness and stiffness, particularly affecting core strength, which is necessary for supporting the spine and its surrounding structures.
Aquatic therapy, or physical activity in a pool, is a low-impact form of exercise that can be a good choice for people with back pain, helping them reduce weight and strengthen the muscles. Additionally, people with obesity and excess are more likely to experience muscle weakness and stiffness along their lower back, making it difficult for them to walk on a treatmill or step mill. Although overweight or obesity complications can contribute to back pain, consulting a healthcare professional is a good approach to learning the best possible way for them to stay active and avoid further injury.
If symptoms of back pain worsen and/or they are accompanied by tingling sensations, numbness and/or weakness, it may be advised to obtain a proper diagnosis to determine the source of the symptoms and adjust or stop physical activity and exercise immediately. Furthermore, regular physical activity and exercise can help prevent aggravating back pain during intense or prolonged workouts. Over time, regular exercise and physical activity will help increase the individual’s strength, flexibility and endurance, improving their overall health and wellness.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Weight Loss Eases Back Pain
Back pain and symptoms of sciatica can affect a majority of the population throughout their lifetime. Research studies have demonstrated that people who are overweight or obese experience more back complications than people with a healthy weight. A proper nutrition along with regular physical fitness can help with weight loss as well as help maintain a healthy weight to eliminate symptoms of back pain and sciatica. Chiropractic care is also another natural form of treatment which treats back pain and sciatica utilizing manual spinal adjustments and manipulations.
A good attitude about weight loss will go a long way in helping you to achieve success. Whether your weight problem has resulted from eating the wrong foods, lack of routine physical exercise, using food to resist anxiety, age, or genetics �you can help defeat that by setting reasonable goals and expectations that are realistic.
The initial step to take would be to discuss your set for weight loss and general health by means of your physician. Your physician can assist you to make informed choices about treatments that contain weight loss plans and exercise suitable to your needs.
Therapies include dietary, behavioral, drug, and for some patients, surgical alteration of the digestive system to reduce the quantity of food consumed. A safe and realistic weight reduction plan may result in success.
Evaluating your body weight is more involved than stepping on the scale. This info is assessed to find out your risks due to extra weight (eg, high blood pressure).
Nutrition Means To Feed Your Body
In the event you haven’t detected, the ‘D’ word (Diet) hasn’t been used in this post as it relates to weight reduction. Granted, caloric reduction will be required by a weight loss program. Yet, for many overweight or obese folks, a weight loss program means exercising, handling anxiety, and making lifestyle changes, which might comprise relearning how to eat.
It’s vitally crucial that you feed your body the nutrients it needs to be healthy and live. No one food contains all the essential nutrients �it takes combining a wide variety of foods to help meet your body’s needs. If you have been heavy or obese for a long time, your body may really be starving for necessary nutrients!
Nutrients Their Food Sources & Activities In The Human Body
*Fats are essential in taking the fat-soluble vitamins A, D, E, and K. There are just three types of fats:
Saturated Fat will raise blood cholesterol levels. These fats are found mostly in meat and diary products.
Polyunsaturated Fat tends to lower blood cholesterol levels. It’s mainly found in plant sources such as safflower, sunflower, soybean, corn, and cottonseed.
Monounsaturated Fat tends to lower the bad cholesterol or LDL (low density cholesterol). Examples include canola oil, olive oil, peanut oil, and avocados.
Although this amount is exceeded by most Americans, dietary ingestion of fat shouldn’t exceed 30% per day.
Remove the skin from poultry, trim visible fat from meat, an easy method to cut back fat consumption is to choose lean cuts of meat, choose water-packed tuna, and pick dairy products made from skim or low-fat milk.
Getting overweight adults to adopt new heart-healthy eating habits is an uphill battle. But giving them a handout about nutrition may be better than nothing, new research suggests.
“There’s an urgent need for innovative approaches to support the implementation of current dietary advice,” said Dr. David Jenkins, lead author of the new study from the University of Toronto. To prevent chronic disease, U.S. nutrition guidelines recommend diets rich in fruits, vegetables and whole grains, plus foods that lower cholesterol such as oats, barley, nuts and soy.
Jenkins, who is chair of nutrition and metabolism at the university, and his team tried three ways of encouraging these healthy habits. The researchers randomly assigned more than 900 overweight adults to one of four groups.
Encouraging Healthy Eating Habits
One group received advice about diet through phone calls. Another got a weekly food basket but no advice about diet. The third group got both advice and food baskets. A fourth group, used as “controls,” did not receive advice or food baskets. Everybody in each group got a “food guide” handout about diet.
Six months later, participants overall had only slightly increased their consumption of healthier foods like fruits and vegetables, regardless of group. The researchers said the only consistent increases were seen in the group that received both food and advice. And by 18 months, that slight increase in healthy eating was dwindling, the investigators found. Still, weight and blood pressure dipped a bit in all the groups, including the control group, according to the study.
The results were published Feb. 27 in the Journal of the American College of Cardiology.
“These data demonstrate the difficulty in effectively promoting fruit, vegetable and whole grain cereals to the general population using recommendations that, when followed, decrease risk factors for chronic disease,” Jenkins said in a journal news release.
But the author of an accompanying journal editorial suggested looking at the results as a “glass half-full.”
“Each country and scientific society must prioritize the strategies best adapted to local customs and regulations,” wrote Dr. Ramon Estruch, an internist at the Hospital Clinic of Barcelona, in Spain.
“However, it appears that simply giving a copy of healthy dietary guidelines causes small changes in the right direction. Perhaps we should start with this extremely simple, no-cost procedure at schools, workplaces, clinics or sports centers, while the other strategies are slowly developed and implemented,” Estruch suggested. Jenkins disclosed grant funding from several food-related companies.
SOURCE: Journal of the American College of Cardiology, news release, Feb. 27, 2017
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Weight Loss Eases Back Pain
Back pain and symptoms of sciatica can affect a majority of the population throughout their lifetime. Research studies have demonstrated that people who are overweight or obese experience more back complications than people with a healthy weight. A proper nutrition along with regular physical fitness can help with weight loss as well as help maintain a healthy weight to eliminate symptoms of back pain and sciatica. Chiropractic care is also another natural form of treatment which treats back pain and sciatica utilizing manual spinal adjustments and manipulations.
Peripheral neuropathy may be more common in patients with pre-diabetes than previously thought, and early interventions may be warranted in this patient population, according to researchers from the University of Utah.
Currently, 86 million adults � more than one in three U.S. adults � have prediabetes, according to CDC estimates. Without weight loss and moderate physical activity, 15% to 30% of these people will develop full-blowntype 2 diabetes within 5 years.1
�We know now a lot more than we did 3 or 5 years ago about neuropathic pain in patients with prediabetes. Neuropathy affects patients with prediabetes in a continuum,� said J. Rob Singleton, MD, who is a professor of neurology at the University of Utah in Salt Lake City. �We think it is more obesity and dysfunction of lipids (fats) that is causing the problem.�
Research Shows the Link between Obesity, Pre-diabetes and Neuropathy
In another study conducted by researchers from the University of Michigan, peripheral neuropathy was also common in obese patients, even if they had normal blood sugar levels, when compared with lean control participants. This same study also confirmed that rates of neuropathy were increased in participants with prediabetes and diabetes, leading the researchers to conclude that diabetes, prediabetes, and obesity are likely metabolic drivers of peripheral neuropathy. The findings were published in JAMA Neurology.1
Dr. Singleton and his team have been studying peripheral neuropathy associated with prediabetes and metabolic syndrome as well as what treatments may work best. Metabolic syndrome is the name for a group of risk factors that raise the risk for heart disease, diabetes and stroke. Risk factors include high blood pressure, elevated blood glucose, elevated cholesterol, and abdominal fat. Through their research, they have found that many patients with metabolic syndrome have pre-diabetes and peripheral neuropathy. Therefore, a multi-pronged approach to managing these patients is essential.
�We have shown that, in pre-diabetics with neuropathic pain, exercise reduces neuropathic pain and increases the intradermal nerve fibers in the thigh and ankle. We are in the process now of replicating that study,� Singleton said in an interview withEndocrinology Advisor. �You need to improve lipid (cholesterol) function and glucose levels. So, lifestyle issues have to be addressed.�
Relationship Between Nerve Damage and Pre-diabetes
New studies evaluating the link between prediabetes and peripheral neuropathy are filling in some of the gaps in knowledge.
In a study recently published in Diabetes Care, C. Christine Lee, PhD, of the University of Toronto, and colleagues reported that prediabetes was associated with similar risks for nerve dysfunction and damage leading to peripheral neuropathy as one develops with �new-onset� diabetes.2
While the exact mechanisms behind these associations are unclear, a growing body of evidence suggests that peripheral neuropathy begins in the early stages of diabetes pathogenesis, the researchers noted.
Lee and colleagues analyzed data on 467 individuals. The researchers found that the prevalence of peripheral neuropathy was 29% in adults with normal glucose levels, as compared with 49% in adults with prediabetes and 50% in adults with new-onset diabetes.
The researchers also found that progression of elevated glucose (pre-diabetes) over 3 years predicted a higher risk for peripheral neuropathy and nerve dysfunction.
Early intervention with lifestyle changes involving diet and exercise may be vital to preventing the severity of nerve damage, Dr. Lee stated. This had previously been backed up by another study published in 2006 in Diabetes Care, by Dr. Singleton. Singleton and his colleagues found that dietary changes and exercise can result in cutaneous reinnervation and improved pain in patients with prediabetes.3
Nerve Damage Occurs Long Before Diabetes
It is imperative to realize that the nerve damage seen in peripheral neuropathy can actually occur long before diabetes sets in. In fact the most current research has shown that obesity, even with normal glucose (blood sugar) levels has been linked with causing peripheral neuropathy as well as pre-diabetes. Although it is important to strive for maintaining fasting glucose levels between 70 � 80 mg/dL, it is equally important to keep your weight down, lower LDL cholesterol and triglycerides. All of this can be accomplished without the use of medication or bariatric procedures.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Neck Pain and Auto Injury
Neck pain is characterized as the most prevalent symptom after being involved in an automobile accident. During an auto collision, the body is exposed to a sheer amount of force due to the high speed impact, causing the head and neck to jolt abruptly back-and-forth as the rest of the body remains in place. This often results in the damage or injury of the cervical spine and its surrounding tissues, leading to neck pain and other common symptoms associated with whiplash-related disorders.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
The prevalence of obesity in the United States has been increasing for almost 50 years. Currently, more than two-thirds of adults and almost one-third of children and adolescents are overweight or obese. Youths who are obese are more likely to be obese as adults, compounding their risk for health consequences such as cardiovascular disease, diabetes, and cancer. Trends in many of the health consequences of overweight and obesity (such as type 2 diabetes and coronary heart disease) also are increasing, coinciding with prior trends in rates of obesity. Furthermore, the sequelae of these diseases are related to the severity of obesity in a dose-response fashion.2�It is therefore not surprising that obesity accounts for a significant portion of health care costs.
From 2005 to 2014, there was a 1.4% annual increase in cancers related to overweight and obesity among individuals aged 20 to 49 years and a 0.4% increase in these cancers among individuals aged 50 to 64 years. For example, if cancer rates had stayed the same in 2014 as they were in 2005, there would have been 43?000 fewer cases of colorectal cancer but 33?000 more cases of other cancers related to overweight and obesity. Nearly half of all cancers in people younger than 65 years were associated with overweight and obesity. Overweight and obesity among younger people may exact a toll on individuals� health earlier in their lifetimes.2�Given the time lag between exposure to cancer risk factors and cancer diagnosis, the high prevalence of overweight and obesity among adults, children, and adolescents may forecast additional increases in the incidence of cancers related to overweight and obesity.
The US Preventive Services Task Force (USPSTF) recommends screening for obesity and intensive behavioral interventions delivered over 12 to 16 visits for adults and 26 or more visits for children and adolescents with obesity.5,6�Measuring patients� weight, height, and body mass index (BMI), consistent with USPSTF recommendations, and counseling patients about maintaining a healthy weight can establish a foundation for preventive care in clinical care settings. Scientific data continue to emerge about the negative health effects of weight gain, including an increased risk of cancer.1�Tracking patients� weight over time can identify those who could benefit from counseling and referral early and help them avoid additional weight gain. Yet less than half of primary care physicians regularly assess the BMI of their adult, child, and adolescent patients. Encouraging discussions about weight management in multiple health care settings, including physicians� offices, clinics, emergency departments, and hospitals, can provide multiple opportunities for patients and reinforce messages across contexts and care environments.
Implementation of clinical interventions, including screening, counseling, and referral, has major challenges. Since 2011, Medicare has covered behavioral counseling sessions for weight loss in primary care settings. However, the benefit has not been widely utilized.7�Whether the lack of utilization is a consequence of lack of clinician or patient knowledge or for other reasons remains uncertain. Few medical schools and residency programs provide adequate training in prevention and management of obesity or in understanding how to make referrals to such services. Obesity is a highly stigmatized condition; many clinicians find it difficult to initiate a conversation about obesity with patients, and some may inadvertently use alienating language when they do. Studies indicate that patients with obesity prefer the use of terms such as�unhealthy weight�or�increased BMI�rather than�overweight�or�obesity�and�improved nutrition and physical activity�rather than�diet and exercise.8�However, it is unknown if switching to these terms will lead to more effective behavioral counseling. Effective clinical decision support tools to measure BMI and guide physicians through referral and counseling interventions can provide clinicians needed support within the patient-clinician encounter. Inclusion of recently developed competencies for prevention and management of obesity into the curricula of health care professionals may improve their ability to deliver effective care. Because few primary care clinicians are trained in behavior change strategies like cognitive behavioral therapy or motivational interviewing, other trained health care professionals, such as nurses, pharmacists, psychologists, and dietitians could assist by providing counseling and appropriate referrals and help people manage their own health.
Achieving sustainable weight loss requires comprehensive strategies that support patients� efforts to make significant lifestyle changes. The availability of clinical and community programs and services to which to refer patients is critically important. Although such programs are available in some communities, there are gaps in availability. Furthermore, even when these programs are available, enhancing linkages between clinical and community care could improve patients� access. Linking community obesity prevention, weight management, and physical activity programs with clinical services can connect people to valuable prevention and intervention resources in the communities where they live, work, and play. Such linkages can give individuals the encouragement they need for the lifestyle changes that maintain or improve their health.
The high prevalence of overweight and obesity in the United States will continue to contribute to increases in health consequences related to obesity, including cancer. Nonetheless, cancer is not inevitable; it is possible that many cancers related to overweight and obesity could be prevented, and physicians have an important responsibility in educating patients and supporting patients� efforts to lead healthy lifestyles. It is important for all health care professionals to emphasize that along with quitting or avoiding tobacco, achieving and maintaining a healthy weight are also important for reducing the risk of cancer.
