In 2001, scientists concluded that cancers of the colon,
endometrium (the lining of the uterus), kidney and esophagus
were associated
with obesity. In fact, excess weight, obesity and physical inactivity may
account for as many as 25-30% of these cancers. Some studies have also reported
links between obesity and cancers of the gallbladder, ovaries and pancreas
(1).
Preventing weight gain can reduce the risk of many cancers.
Experts recommend that people establish habits of healthy eating and physical
activity early in life to prevent becoming overweight and obese. Those who are
already overweight or obese are advised to avoid additional weight
gain and to lose weight through a low-carbohydrate diet and exercise. Even a
weight loss of only 5-10% of total weight can provide health benefits.
How many people get cancer by being overweight or obese? How
many die?
"Overweight and obesity in the U.S. occur at higher rates in racial / ethnic minority populations such as African American and Hispanic Americans, compared with White Americans. Asian-Americans have a relatively low prevalence for obesity. Women and persons of low socioeconomic status within minority populations appear to particularly be affected by overweight and obesity. Cultural factors that influence dietary and exercise behaviors are reported to play a major role in the development of excess weight in minority groups."
In 2002, about 41,000 new cases of cancer in the United States
were estimated to be due to obesity. This means that about 3.2% of all new
cancers are linked to obesity (2). A recent report estimated that, in the
United States, 14% of deaths from cancer in men and 20% of deaths in women
were due to them being overweight or obese (8).
Does obesity increase the risk of cancer of the uterus?
Obesity has been consistently associated with uterine
(endometrial) cancer. Obese women have two to four times greater risk of developing
the disease than do women of a healthy weight, regardless of menopausal
status (1 - 7). Increased risk has also been demonstrated among
overweight women (5 - 7). Obesity has been estimated to account for about 40% of
endometrial cancer cases in affluent societies (8).
It is unclear why obesity is a risk factor for endometrial
cancer. However, it has been suggested that lifetime exposure to hormones and
high levels of estrogen and insulin in obese women may be contributing
factors (1, 4 - 6, 9).
Does obesity increase the risk of colon cancer?
"Being overweight hurts men's chances of having successful radiation treatment for prostate cancer. Researchers found that moderately and severely obese men had a 70 percent higher risk of having a tumor recur after radiation treatment than thinner men did."
Colon cancer occurs more frequently in people who are obese
than in those of a healthy weight (1, 10 - 14). An increased risk of colon
cancer has been consistently reported for men but not women with a
high Body Mass Index (11, 14, 15).
Body Mass Index, or BMI, is the standard measure of the
relationship or ratio of weight-to-height. It is a formula in which body weight in
kilograms is divided by the square of a person's height in meters.
To determine your BMI using pounds and inches, multiply your weight
in pounds by 704.5, then divide the result by your height in inches, and
divide that result by your height in inches a second time. The multiplier
704.5 is used by the National Institutes of Health. Other organizations may
use a slightly different multiplier; for example, the American Dietetic
Association suggests multiplying by 700. The variation in outcome - a few tenths -
is insignificant. (See the section in this website entitled How
is Excess Weight and Obesity Diagnosed? for an easy-to-use set of BMI tables.) The relationship between BMI and risk in women has been found
to be weaker (1, 11, 15) or absent (16).
Unlike for breast and endometrial cancer, estrogen appears to
be protective for colon cancer in women overall (17). However, obesity and
estrogen status also interact in influencing colon cancer risk. Women with a
high BMI, who are either pre-menopausal or postmenopausal and taking
estrogens, have an increased risk of colon cancer similar to that found for men
with a high BMI. In contrast, women with a high BMI who are postmenopausal and
not taking estrogens do not have an increased risk of colon cancer (18).
There is some evidence that abdominal obesity may be more
important in colon cancer risk (14, 15). In men, a high BMI tends to be
associated with abdominal fat. In women, fat is more likely to be distributed
in the hips, thighs and buttocks.
Thus, abdominal fat, waist-to-hip ratio or waist circumference
may be better predictors of colon cancer risk. Few studies have yet
to compare
waist-to-hip ratios to colon cancer risk in women, however.
One study that did find an increased risk of colon cancer
among women with high waist-to-hip ratios found that the association was
present only among inactive women, suggesting that high levels of physical
activity may counteract the effects of increased abdominal fat (19).
A number of mechanisms have been proposed for the adverse
effect of obesity on colon cancer risk. One of the major hypotheses is that high
levels of insulin, such as those caused by the condition called Insulin
Resistance, or insulin-related growth factors in obese people may promote
tumor development (1, 20, 21).
Does obesity increase the risk of kidney cancer?
Studies have consistently found a link between a type of
kidney cancer (renal cell carcinoma) and obesity in women (1, 7, 22 - 25), with
some studies finding the risk among obese women to be two to four
times greater than the risk to women of a healthy weight.
Results of studies including men have been more variable,
ranging from an association similar to that seen in women (7, 23, 26), to a
weak association (25, 27, 28), to no association at all (22). A meta-analysis
(where several studies are combined into a single report), which found an
equal association of risk among men and women, estimated the kidney cancer risk
to be 36% higher for an overweight person and 84% higher for an obese
person, compared to those of a healthy weight (29).
The mechanisms by which obesity may increase renal cell cancer
risk are not well understood. An increased exposure to sex steroids,
estrogen and androgen is one possible explanation (1).
Does obesity increase the risk of cancer of the esophagus or
stomach?
Overweight and obese individuals are twice as likely than
healthy weight people to develop a type of esophageal cancer called
esophageal adenocarcinoma (1, 30 - 33). A smaller increase in risk
has been found for gastric cardia cancer, a type of stomach cancer that
begins in the area of the stomach next to the esophagus (31 - 34).
Most studies have not observed increases in risk with obesity
in another type of esophageal cancer, called squamous cell cancer. An
increased risk of esophageal adenocarcinoma has also been associated with weight
gain, smoking and being younger than age 59 (31, 34).
The mechanisms by which obesity increases the risk of adenocarcinoma of the esophagus and gastric cardia are not well understood. One of
the leading mechanisms proposed has been that increases in gastric reflux
due to obesity may heighten risk. However, in the few studies that have
examined this issue, risk associated with BMI was similar for those with and
without gastric reflux (33).
Does obesity increase the risk of prostate cancer?
Of the more than 35 studies on prostate cancer risk, most
conclude that there is no association with obesity (1, 21, 35 - 37). But
some report that obese men are at higher risk than men of healthy weight,
particularly for more aggressive tumors (38 - 40). One study found an
increased risk among men with high waist-to-hip ratios, suggesting that abdominal
fat may be a more appropriate measure of body size in relation to prostate
cancer (41).
Studies examining BMI and prostate cancer mortality have had
conflicting results (3, 42, 43).
Despite the lack of association between obesity and prostate
cancer incidence, a number of studies have examined potential
biological factors that are related to obesity, such as insulin-related growth
factors, leptin and other hormones. Results of these studies are inconsistent.
But, generally, greater risk has been linked to men with higher
levels of leptin (44), insulin (45) and IGF-1 (insulin-like growth factor-1)
(46).
Is there any evidence that obesity is linked to cancer of the
gallbladder, ovaries or pancreas?
An increased risk of gallbladder cancer has been found to be
associated with obesity, particularly among women (47 - 49). This may be due to
the higher frequency of gallstones in obese individuals, as gallstones
are considered a strong risk factor for gallbladder cancer. However, there is
not enough evidence to draw firm conclusions.
It is unclear whether obesity affects ovarian cancer risk.
Some studies report an increased risk among obese women (50 - 52), whereas
others have found no association (53, 54). A recent report found an
increased risk in women who were overweight or obese in adolescence or young
adulthood. No increased risk was found in older obese women (55).
Studies evaluating the relationship between obesity and
pancreatic cancer have been inconsistent (56 - 59). One recent study found that
obesity increases the risk of pancreatic cancer only among those who
are not physically active (57). A recent meta-analysis reported that
obese people may have a 19% higher risk of pancreatic cancer than those with a
healthy BMI. The results, however, were not conclusive (60).
Does regular physical activity lower the risk of cancer?
There have been no controlled clinical trials on the effect of
regular physical activity on the risk of developing cancer. However,
observational studies have examined the possible association between
physical activity and a lower risk of developing colon or breast cancer:
In 2002, a major review of observational trials found that physical activity reduced colon cancer risk by 50%. This
risk reduction occurred even with moderate levels of physical activity (1).
For example, one study showed that even moderate exercise, such as brisk
walking for 3-4 hours per week, can lower colon cancer risk (19).
A limited number of studies have examined the effect of
physical activity on colon cancer risk for both lean and obese people. Most of
these studies have found a protective effect of physical activity across all
levels of BMI (1).
What biological mechanisms are thought to be involved in the
link between obesity and cancer?
The biological mechanism that explains how obesity increases
cancer risk may vary for different cancers. The exact mechanisms
are not known for any of the cancers. However, possible
mechanisms include alterations in sex hormones (e.g. estrogen,
progesterone and androgens), and insulin and IGF-1 in obese
people that may account for their increased risk for cancers of
the breast, endometrium, and colon. Sex-hormone binding
globulin, the major carrier protein for certain sex hormones in
the plasma, may also be involved in the altered risk for these
cancers in obese people (1, 9, 35, 61).
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In 2001, scientists concluded that cancers of the colon,
endometrium (the lining of the uterus), kidney and esophagus
were associated
with obesity. In fact, excess weight, obesity and physical inactivity may
account for as many as 25-30% of these cancers. Some studies have also reported
links between obesity and cancers of the gallbladder, ovaries and pancreas
(1).
Thus, abdominal fat, waist-to-hip ratio or waist circumference
may be better predictors of colon cancer risk. Few studies have yet
to compare
waist-to-hip ratios to colon cancer risk in women, however.
Studies have consistently found a link between a type of
kidney cancer (renal cell carcinoma) and obesity in women (1, 7, 22 - 25), with
some studies finding the risk among obese women to be two to four
times greater than the risk to women of a healthy weight.
The mechanisms by which obesity increases the risk of adenocarcinoma of the esophagus and gastric cardia are not well understood. One of
the leading mechanisms proposed has been that increases in gastric reflux
due to obesity may heighten risk. However, in the few studies that have
examined this issue, risk associated with BMI was similar for those with and
without gastric reflux (33).
Despite the lack of association between obesity and prostate
cancer incidence, a number of studies have examined potential
biological factors that are related to obesity, such as insulin-related growth
factors, leptin and other hormones. Results of these studies are inconsistent.
But, generally, greater risk has been linked to men with higher
levels of leptin (44), insulin (45) and IGF-1 (insulin-like growth factor-1)
(46).
It is unclear whether obesity affects ovarian cancer risk.
Some studies report an increased risk among obese women (50 - 52), whereas
others have found no association (53, 54). A recent report found an
increased risk in women who were overweight or obese in adolescence or young
adulthood. No increased risk was found in older obese women (55).
