Boy, it has been awhile. Even though I have the intention to write something on the blog every single day, it was impossible for the past two to three weeks or so since I only have 3 hours to sleep and the rest of them were committed for my research and academic stuff. Now I'm back so today we are going to start off easy. Let's talk about obesity and its mortality rate from cancer. The trigger to this discussion is from an article that I read on LiveScience regarding a topic of the same title which was written by Rachael Rettner, one of the senior writer on that particular site.
Obesity
I know sometimes we used the word "obese" and "obesity" rather loosely but people do understand that obesity is related to an unhealthy weight gain which could cause dire systemic complications such as diabetes mellitus, renal complications, hypertension and cardiac illnesses. In fact, when people were talking about obesity, the most frequent topic that could have conjured up in their mind would be either diabetes or heart diseases; those two are quite popular and can be seen frequently among obese people who attended GP clinic or any healthcare services. Some might be thinking of other complications such as chronic lower back pain, atherosclerosis and stroke but rarely people consider malignancies as one of the complications that could have arisen from obesity. The root of this kind of deficiency could have been caused by low effort to disseminate knowledge through public education and thus people just don't know.
Preventing obesity can be the most effective primary prevention from other sorts of chronic illnesses but as whether or not you are obese can be influenced by multiple factors that include genetics and environment, people need to be extra careful with what they are putting in and how much they were using their own energy every single day. Although we know that obesity can be caused by certain type of genes, the extent of weight or fat gain are not that significant that could have contributed to chronic diseases; in other words, they aren't doomed to such terrible fates. An article which was written by Kelly K in 2008 estimated that if the current obesity trend were to keep on going, by 2030 we would have seen 38% of the adult population all over the world would be overweight and 20% would be obese. Now, what's the difference between overweight and obese? Does it matter?
It would not matter if it is in the context of your everyday conversation, for example referring people who are overweight as obese, but if it is in the clinical setting, mode and urgency of management would differ between those two. Overweight carries a relatively lower risk compared to people who are obese but both are predisposed to get a variety of chronic illnesses which could affect their quality of life over a long period of time. Therefore, people who were obese could benefit greatly from weight management programs while people who are overweight, they could benefit from a specific type of changes that need to be implemented for them to lose weight. For example, while people who are obese need to watch out for what they were eating, how they spend their day and how long they were sleeping at night, people who were overweight can be assessed and advised for a change of either one of those domains. It would be best for them to manage their lifestyle the same way as people who were obese, but we can give some degrees of leniency for them to manage their own weight provided they were just overweight.
According to the World Health Organisation, people who have a BMI of more than 25 kg/m2 would be considered overweight while people who have a BMI of more than 30 kg/m2 would be considered as obese. However, it is worth noting that, in Asia, the guideline which is published by a certain Medical Endocrine society used a different value of BMI to classify people into either of the body habitus. In Malaysia for example, people who have a BMI of more than 27.9 kg/m2 would be considered as obese. This is concurrent with the finding of some research that indicate diabetes mellitus is more common among Asian than the rest of the world. It's better to start intensive weight management before they start developing chronic diseases with regards to obesity.
Obesity And Cancer
Cancer is not an easy topic for public education even though the incidence of a certain type of cancers were on the rise these days. From the perspective of a primary care physician, it is important for people to know that certain risk factors such as smoking and obesity can lead to malignancies so that proper measures could be taken to prevent such thing from happening. Just ask people who were diagnosed with lung cancers, how much they were smoking every single day prior to the diagnosis. Although smoking could prevent ulcerative colitis, a type of inflammatory process in the colon, it carries a far more risk which could have caused a variety of complications thus prescribing cigarette as a treatment for ulcerative colitis is not relevant to the risk that patients would face in the future.
Obesity increased the risk of getting gastrointestinal related cancer by two-fold and this finding is supported by a few studies conducted in the past by Arslan et al, Xu et al and Pischon et al. Although some research might have been quite outdated, in a paper written by Calle et al in 2003, they have written regarding the mortality rate of obese people from cancer being 14.2% and 19.8% for men and women respectively. It's not a new thing and people have recognised malignancies related to obesity for a few decades now but still, when we were educating people regarding obesity, we failed to mention their chances of getting malignancies if they were obese. As the primary contributory factor of obesity is the way we eat, we are not only exposed to developing cancer while being obese but also what we ate to cause obesity. People who love to eat red and processed meat, for example, are associated with a high risk of getting colon cancer and people who love to eat high in salt-cured fish and meat, especially in Asia, are predisposed to nasopharyngeal carcinoma.
From 1995 to 2014 there were 14 672 409 incident cases for 30 types of cancer. Incidence significantly increased for six of 12 obesity-related cancers (multiple myeloma, colorectal, uterine corpus, gallbladder, kidney, and pancreatic cancer) in young adults (25–49 years) with steeper rises in successively younger generations.
Even though most of the cancers risk for the young adult population were low, we are now in the midst of ageing society. The number of elderly people is greater than the number of people aged below 18 years old. If obesity is prevalent among our current elderly population, then the incidence of cancers could have risen. This can cause significant changes to the biological, psychological and social aspect of the affected elderly people and the cost of treatment for certain types of cancers would rise. It's better for us to practice caution now then feel sorry later so as usual, education remains as the most important tools for public engagement. Lifestyle modification should be prioritised and people should be encouraged to participate in any social activities to improve motivation, social skill and at the same time, prevent mental illnesses that could have contributed to obesity.
References and further reading materials
- Obesity-Related Cancer Rates Are Rising Among Millennials. Retrieved on 9th February 2019.
- Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. Retrieved on 9th February 2019.
- The Epidemiology of Obesity: A Big Picture. Retrieved on 9th February 2019.
- Overweight versus Obese: Different Risk and Different Management. Retrieved on 9th February 2019.
- Obesity (WHO). Retrieved on 9th February 2019.
- Obesity as a Major Risk Factor for Cancer. Retrieved on 9th February 2019.
- Obesity and Cancer: Existing and New Hypotheses for a Causal Connection. Retrieved on 9th February 2019.
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