Obesity and cancer- moving beyond the epidemiology to focus on intervention research Annie S. Anderson, University of Dundee

Obesity and cancer can be an emotive topic laden with guilt and a feeling of being overburdened. It has been described as the “elephant in the room” but the bottom line is that it is time to move beyond epidemiology and mechanisms to open the door on interventional research.

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Our paper on obesity and primary prevention of cancer1 and the accompanying paper on obesity and cancer survivorship2 was initiated, developed and supported through the NIHR Cancer and Nutrition Collaboration. This unique collaboration was formed in 2014 in response to patients’ unmet need for trustworthy nutritional care based on high quality evidence, supported by the NIHR Southampton Biomedical Research Centre, World Cancer Research Fund and the NIHR Office for Clinical Research Infrastructure.  

The Collaboration created a ‘Public Health and Cancer Prevention’ research work stream with strong multidisciplinary expertise and close links with the collaboration’s Molecular Mechanisms and Living With and Beyond Cancer groups. Multidisciplinary debate on cancer and obesity sure has the potential for lengthy dialogues. All of us agree that a healthy public policy that can produce an equitable approach to obesity prevention is top of the agenda but whilst we wait for our politicians there is a research agenda that has now become  increasingly important . Topics abound- does  exercise offer a greater opportunity for cancer risk reduction than caloric reduction? What are the key mechanisms for study? How practically useful is Mendelian Randomisation?  What about the Obesity paradox (where high body fat appears to be protective)? Add in behavioural scientists, trialists and nutritionists and we have the potential for the perfect storm or, in our case, the perfect multi-disciplinary team for exploring a complex problem.

Importantly, we also sought patient and public representation to ensure that what we are debating is also a priority for the people who will be affected by the results. For them, it was clear that although excess body fat is a risk factor in cancer to individuals it is a very personal issue that is not simply about ill-informed lifestyle choices. A thriving weight loss industry has not stemmed the increase in obesity, suggesting that a broader, tailored approach is needed if people are to reduce their risk of cancer.

So, we took our debate to Dundee in the form of a satellite meeting to the European Congress on Obesity. Through this wider, international lens we were able to identify agreement and common ground. Lessons from other intervention areas (notably diabetes), lessons from ongoing US studies of weight loss and post-menopausal breast cancer, new techniques for promotion and maintenance of weight control regimens, what should be measured and what might be measured supply many good reasons for taking interventional response forward. The bottom line is that there needs to be an international commitment to decreasing the cancer burden and this includes demonstrating the clinical effectiveness of body fat reduction in appropriately designed weight management trials.

The Collaboration is very happy to share its review and perspectives on the role of weight control in primary and secondary cancer prevention, and welcomes new collaborators to work with us to address the research gaps identified in translational cancer prevention research.

www.cancerandnutrition.nihr.ac.uk

Cancer_nutrition@nihr.ac.uk

  1. https://www.nature.com/articles/s41416-020-01154-3.
  2. https://www.nature.com/articles/s41416-020-01155-2.

Annie Anderson

Professor of Public Health Nutrition, The University of Dundee

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