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Cancer Society declares war on obesity
By WES ALLISON © St. Petersburg Times, published January 6, 2001 Everyone knows that Americans are too fat and that obesity can lead to heart disease and other ills. Now, citing mounting evidence that it also boosts your risk of cancer, the American Cancer Society is calling for an all-out assault on fat through social and policy changes, akin to the war on smoking. For the first time, the cancer society's annual report on cancer trends and prevention targets obesity, which may increase your risk of dying from several common cancers by up to 50 percent. The 1980s and '90s were the "biggie-sized" decades: 27 percent of U.S. adults were obese in 1999, compared with 15 percent in 1980. With smoking rates flat since 1990, the American Cancer Society sees obesity as the biggest threat to declining cancer death rates. "What we've learned from smoking is that individual measures are important, but social and policy measures are far more effective," said Dr. Michael Thun, director of epidemiological research at the society's headquarters in Atlanta. "Tobacco smoking was the norm in the '50s. Nobody perceived it as being more than moderately obnoxious," he said. "The way that society sort of recognizes and deals with things that cause disease is gradual over time, and this draws attention to a really important problem." The American Cancer Society is one of the nation's most influential private, non-profit health organizations and has published Cancer Facts & Figures every year since 1952. It is distributed each spring to hundreds of thousands of doctors, hospitals, legislators and journalists and will be available on the Internet at www.cancer.org by March. The decision to target the link between obesity and cancer, which many Americans may be unaware of, was heralded by other cancer researchers, who said proof of weight's role has been building in recent years. "It's very significant," said Dr. Nagi B. Kumar, director of nutrition at Moffitt Cancer Center in Tampa, whose own research into diet, obesity and cancer is nationally known. "It's a very aggressive recommendation here, a position statement." As in past issues, Cancer Facts & Figures 2001 urges plenty of exercise and a diet rich in fruits and vegetables and low in fat. But this year's issue also recommends policy changes that mirror the nation's aggressive anti-smoking campaign, including raising taxes on high-calorie food and drink, increasing education and exercise in schools and developing a government program for preventing obesity. "We have no federal program to deal with this," said Joann Schullenbach, national director of media affairs, whose office publishes Cancer Facts & Figures 2001. "And the health impact of this problem is of such proportions that it ought to have the sort of attention that we give to drugs and alcohol and tobacco." According to the report, "accumulating evidence suggests that obesity increases" risks in three of the most common types of cancer -- breast, prostate and colorectal -- as well as endometrium and gallbladder cancers. Other groups have found links to kidney cancer, too. Overall, obese men are 30 to 40 percent more likely to die of cancer than their lean counterparts, while obese women are 40 to 50 percent more likely, the society says. The findings are based largely on a study of 1.2-million adults published last fall. For post-menopausal women, obesity increases the relative risk of breast cancer by 1.5 times, although it doesn't seem to affect the risk for younger women. Among obese men, the risk of developing colon cancer increases by 40 percent. Obesity's role in cancer is not entirely clear. But researchers know that excess fat changes the way the body uses glucose, forcing the pancreas to produce extra insulin. That extra insulin appears to encourage tumor growth, Thun said. Fat also changes the way estrogen acts in the body, which may stimulate some cancers, such as those of the breast, prostate and uterus. Being significantly overweight also makes it difficult for doctors to find tumors before they grow dangerously large. Doctors note that an obese person is still more likely to develop heart disease, high blood pressure or diabetes because of extra weight than cancer. And obesity is not nearly as serious a cancer risk factor as smoking, which is blamed for 80 percent of all cases of lung cancer, the most prevalent type. "But because obesity is so common, the contribution to cancer in the general population is large," Thun said. "Obesity is the one major risk factor that is going in the wrong direction." But some worry that comparing obesity with smoking, which has become virtually unacceptable in some quarters of society, will further stigmatize overweight people. "So, comedians should tell more fat jokes?" said Dr. Paul Ernsberger, a member of the medical advisory board for the National Association for the Advancement of Fat Acceptance. Ernsberger, an associate professor of nutrition at Case Western Reserve School of Medicine in Cleveland, said the cancer society should stick to harping about diet, not weight. He also questioned some of the society's research and said the new recommendations will scare people into trying unrealistic or unhealthful fad diets, such as the Atkins diet. Americans, already bombarded by bad news about their eating habits, can expect to hear more about this in the coming months. The National Cancer Institute is preparing a report on obesity and cancer, and the American Institute for Cancer Research recently launched Our New American Plate, a program that emphasizes smaller portions and more fruits and vegetables. It has taken three decades of concerted public health campaigns to change attitudes about smoking. As anyone who has ever tried to shed a few pounds knows, eating less and working out more isn't easy, either. Kumar said she thinks the cancer society's goals are reasonable, but she knows firsthand the opposition they may face. As overseer of Moffitt's food service, she once raised the prices of burgers and fries in the cafeteria in hopes of persuading patrons to choose less expensive, healthier items. "It was chaos," she said. "People totally objected to it. We had a lot of customers really mad at me." Recent coverageDrug tried in mice gives dieters hope (June 30, 2000) Obesity is growing on us (November 1, 1999) Where he's been, where he's going (May 26, 1999) Checking the mileage (May 25, 1999)
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