By Susan Blumenthal, M.D. and Rachel Gardner, B.A.
As many as forty percent of all cancers in the United States (630,000 cases) are linked to excess weight according to a recent report issued by the U.S. Centers for Disease Control and Prevention (CDC).
Overweight has been linked to 13 separate types of malignant tumors, including of the esophagus, stomach, colon, rectum, liver, gallbladder, pancreas, breast (post-menopausal), uterus, ovaries, kidney, and thyroid, as well as to multiple myeloma and meningioma. The rate of these obesity-related cancers has increased since the 1990s with a 7 percent rise in occurrence during the 9-year-period from 2005 to 2014. Meanwhile, non-obesity related cancer rates declined by 13 percent during this same time period. The only exception to this alarming rise in obesity-related cancer rates was colorectal cancer, which declined by 23 percent during this time frame due in large part to early detection of the disease related to increased screenings.
Approximately two-thirds of the overweight-associated cancers diagnosed in 2014 occurred in people aged 50 to 74. Disproportionately, these weight-associated cancers affected women: 55 percent were diagnosed in females as compared to 24 percent in males. Non-Hispanic blacks and non-Hispanic whites had higher incidence rates compared with other racial and ethnic groups. Furthermore, Black males and American Indian/Alaska Native males had higher incidence rates of weight related cancers compared to white males.
These trends are of great concern given that 71 percent of adults and almost one third of children in America are either overweight or obese. Currently, 32.8 percent of Americans are overweight and 37.9 percent are obese. The CDC defines being overweight as having a body mass index (BMI) of 25-29.9 kg/m2 and being obese as having a BMI equal to or exceeding 30 kg/m2. BMI is calculated by dividing a person’s weight in kilograms by the square of the person’s height in meters.
The release of this CDC report adds to an abundance of evidence pointing to the health damaging effects of excess weight and the need for effective interventions to prevent and treat this public health epidemic in America. Unfortunately, efforts to reduce the obesity crisis in recent years have been difficult. Obesity is a highly stigmatized condition; many physicians feel uncomfortable discussing this health condition with their patients. There is minimal training on nutrition and the prevention and treatment of obesity in medical education and residency programs. Furthermore, behavioral counseling sessions for overweight patients have been underutilized. Medicare is the only insurance program that has comprehensive coverage for these counseling sessions for obese patients with a BMI of 30 or more, which represents one third of the program’s beneficiaries. Since the implementation of the Affordable Care Act in 2010, certain states’ participating private insurance plans cover some weight-related behavioral counseling sessions. A select group of states also provides these counseling sessions in their Medicaid programs.
As of 2016, 16 states now include behavioral counseling and weight loss programs. An additional seven states cover nutritional counseling or therapy, but only for diabetes-related obesity. In combination, some coverage is required in 23 states. To more effectively address the growing obesity related chronic disease epidemic, these services should be available in all states.
Comprehensive multi-sector efforts are needed to reverse the enormous toll of obesity related health problems in America. This means increasing public awareness and health care provider training as well as mobilizing the resources of the public and private sector. The US Preventive Services Task Force (USPSTF) recommends that primary care physicians routinely screen for obesity, track patients’ weights over time, and refer overweight patients for intensive behavioral interventions to lose weight. The USPSTF recommends 12 to 16 visits of intensive behavioral interventions for adults and 26 contact hours or more for children.
In order for these clinical interventions to be effective for patients, however, these services must be aligned with community programs, such as physical activity interventions, healthy nutrition options, school and workplace wellness programs, and other home and community resources and supports. Our mission must be to prevent obesity from occurring in the first place. It is only through a “health in policies” approach, mobilizing all sectors of society, that we can tip the scales on obesity. And in so doing, these efforts will help to prevent cancer, diabetes, heart disease, and other illnesses in the United States associated with overweight as well as more effectively promote a culture of health in America.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of the Huffington Post. She is a Senior Fellow in Health Policy at New America and a Clinical Professor at Tufts and Georgetown University Schools of Medicine. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four U.S. Presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women’s Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also served as a White House Advisor on health. Prior to these positions, Dr. Blumenthal served as Chief of the Behavioral Medicine and Basic Prevention Research Branch and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health (NIH). She has chaired numerous national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Been Foundation. She is a recipient of the Rosalind Franklin Centennial Life in Discovery Award.
Rachel Gardner currently serves as a Health Policy Fellow at New America in Washington D.C. She graduated from Cornell University in 2017 with a degree in government and aims to attend medical school in the future.