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Obese patients deserve more straight talking from doctors to reduce cancer risk

Another Christmas of overindulgence and another health warning – it’s hard to know which ones to listen to.

As a bariatric surgeon with Phoenix Health, I specialise – quite literally – in transforming patients’ lives.  The surgery is a way of giving those seemingly beyond help one last chance to get their life – and health –  back.   

Obesity causes cancer development

Links between obesity and problems like high blood pressure and diabetes are well known.  But few doctors and patients are aware that obesity significantly worsens the chance of getting, and surviving, cancer.

Why is this? Obesity triggers pathways that promote cancer development, raising levels of hormones like oestrogen and insulin, but fat cells also produce chemicals called adipokines that can affect cell growth and stimulate inflammation, something that’s been known to cause cancer for over 100 years. 

Treatment of obese patients must change to help cancer treatment

So why aren’t the obese beating down doctors’ doors demanding help to lower their cancer risk?  Part of it is undoubtedly down to embarrassment and concern that the doctor won’t be sympathetic. But we health professionals are also at fault for avoiding difficult conversations – doctors find it hard to raise the topic of obesity with patients and would be wary of scaring them with stories about increased cancer and other health risks.

But the facts about obesity and cancer, particularly women’s cancers, make tough reading. Take breast cancer.  Older obese post-menopausal women are 30 per cent more likely to get breast cancer, but also less likely to respond to treatment. Australian researchers noted that obese breast cancer patients treated with the hormone therapy Arimidex were three times more likely to die of their cancer than leaner women.  And it gets worse.  Obesity is an increasing problem in young women and so it’s a real concern that another large study of younger breast cancer patients receiving chemotherapy found that obesity increased the risk of treatment failure and cancer death by 50 per cent.

Obesity seems to trigger the development of a range of cancers, but one that really stands out is uterine (womb) cancer.  One in three cases are thought to be caused by obesity, and the risk cranks up by another 60 per cent for every five point rise in BMI above normal.

But it’s not just women who are at risk.  Obesity increases the risk of getting colon cancer in men (but not women) by 50 per cent.  If you’re obese you’re also more likely to develop the most aggressive and hard to treat malignancies such as cancer of the oesophagus, pancreas, gallbladder and liver.

Honest conversations will mean effective treatment

Without further research we don’t yet know if the clock can be turned back by dramatically losing weight once cancer has been found, but losing weight can definitely reduce the risk of it being diagnosed in the first place.  Effective and sustained weight loss is key.  For really heavy patients with BMIs over 40 (that’s about a million UK adults) taking a gamble on a diet and exercise programme might work for the determined few, but for most this can only reliably be achieved through bariatric surgery. 

There is little sympathy for the severely obese – a condition conflated with negative personality traits such as laziness and a failure to exercise self-control and individual responsibility – but like it or loathe it, unlike the diet and exercise lottery, bariatric surgery is pretty much guaranteed to work in these people.  It seems crazy to insist that they waste resources and time trying futile alternatives.  

France, a country with a similar population to the UK, carried out 36,000 bariatric operations last year – five times the number funded by the NHS. 

It’s time we took a look in the mirror and realised that if we are to make a meaningful impact on the health of the nation we should concentrate on funding effective treatments for common conditions.  As the Government’s Chief Medical Officer Dame Sally Davies highlighted earlier this month, tackling obesity needs to be at the top of that list.

It’s essential that we start having honest conversations about the links between obesity and a range of cancers. It won’t be easy for patients to hear or for doctors to say – but it must start happening. Treating obesity isn’t just about changing lives but saving them, too

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