Nutrition, Physical Activityand Cancer: What’s the Connection? Colleen Doyle, MS, RD Director, Nutrition and Physical Activity American Cancer Society
758,757 CDC, US Census
453,146 CDC, US Census
674,450 CDC, US Census
0 5 10 15 20 25 30 35 Causes of Cancer Estimate percentage of total cancer deaths attributable to established causes of cancer Tobacco Adult diet/obesity Sedentary lifestyle Occupational factors Family history of cancer Viruses/other biologic agents Perinatal factors/growth Reproductive factors Alcohol Socioeconomic status Environmental pollution Ionizing/ultra-violet radiation Prescription drugs Medical procedures Salt/other food additives/contaminants Source: Harvard Report on Cancer Prevention, Cancer Causes and Control, November/December, 1996
2012 Recommendations for Individuals: 1) Maintain a healthy weight throughout life. 2) Adopt a physically active lifestyle. 3) Consume a healthy diet, with an emphasis on plant sources. 4) If you drink alcoholic beverages, limit consumption. Communities: Work together to make it easier for people to eat better and be more active.
Society Recommendations for Individual Choices Maintain a healthy weight throughout life. • Be as lean as possible throughout life without being underweight. • Avoid excess weight gain at all ages. If currently overweight or obese, losing even a small amount of weight has health benefits and is a good place to start. • Engage in regular physical activity and limit high calorie foods and beverages as key strategies for maintaining a healthy weight.
BMI and Specific Cancers Established Men Women Colon/rectum Breast (postmenopausal) Kidney Colon/rectum Esophagus Endometrium Pancreas Kidney Esophagus Pancreas Kushi, et al. CA Cancer J Clin. 2012
BMI and Specific Cancers Probable Men Women Gall bladder Gall bladder Liver Liver Multiple myeloma Multiple myeloma Non-Hodgkin Lymphoma Non-Hodgkin Lymphoma Prostate Cervix Ovary Kushi, et al. CA Cancer J Clin. 2012
Why the obesity connection is so important • In the United States, overweight and obesity accounts for about 14% to 20% of all cancer deaths. • About 2 out of 3 Americans are overweight or obese. Calle, et al. NEJM. 2003; CDC
ObesityAmong U.S. Adults, 2011 15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35% Source: Behavioral Risk Factor Surveillance System, CDC. Prevalence reflects BRFSS methodological changes in 2011, and these estimates should not be compared to previous years.
Childhood Obesity • Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years. • The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. • The percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period. • In 2010, more than one third of children and adolescents were overweight or obese. CDC
Adopt a Physically Active Lifestyle • Adults: Engage in at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity each week, preferably spread throughout the week. • Children and adolescents: Engage in at least 1 hour of moderate- or vigorous- intensity activity each day, with vigorous-intensity activity at least three days each week. • Limit sedentary behaviors such as sitting, laying down, and watching television and other forms of screen-based entertainment.
Consume a Healthy Diet, With an Emphasis on Plant Sources • Choose foods and beverages in amounts that help maintain a healthy weight. • Limit consumption of processed meat and red meat. • Eat at least 2.5 cups of vegetables and fruits each day. • Choose whole grains in preference to refined grain products
If You Drink Alcoholic Beverages, Limit Consumption. • Drink no more than one drink per day for women or two per day for men. • One drink of alcohol = • 12 oz. beer • 5 oz. wine • 1.5 oz. of 80-proof liquor
Alcohol and Cancer Risk • Heavy drinking – esp combined with tobacco use - increases risk of cancers of: • Mouth & pharynx • Larynx • Esophagus • Liver • Even moderate drinking increases risk of breast cancer in women
“I thought a glass of wine was good for me!” • Moderate intake of alcohol appears to decrease risk of heart disease • Other approaches to reduce heart disease risk • Not recommended that non-drinkers begin drinking • Consider risk of both heart disease and cancer to make an informed decision
Conclusion: Adherence to cancer prevention guidelines for obesity, diet, physical activity and alcohol consumption is associated with a lower risk of death from cancer, CVD and all causes in non-smokers.
Maine Overweight and Obesity (BMI) (Adults 18 and older, 2012) Source:Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,, 2011.
Participated in 150 minutes or more of Aerobic Physical Activity per week.(Adults 18 and older, 2011) Source:Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,, 2011.
Adults who have consumed fruits and vegetables five or more times per day.(Adults 18 and older, 2009) Source:Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,, 2009.
Maine High School Students, 2011 • 16% overweight • 13% obese • Only 38% report attending PE one or more times per week (down from 47% in 1997) • 24% report watching at least 3 hrs tv/day • 31% report playing video games or using a computer for something other than school work for 3 hours or more per day. 2011 ME Integrated Youth Health Survey
High Calorie Foods Available at Low Cost….Whenever You Want Them! CALORIES Double Cheese Burger = 690 Super Size Coke = 280 Biggie Fries = 570 TOTAL = 1,540 Ad in Sports Illustrated 6/15/02
Marketing and Advertising to Kids Food and Drink Packages Computers and TV Mobile Devices Games and Toys Schools
From: Healthy People 2010, Understanding and Improving Health, Volume 1
ACS Recommendation for Community Action Public, private and community organizations should work collaboratively at national, state and local levels to implement policy and environmental changes that: • Increase access to affordable, healthy foods in communities, worksites and schools, and decrease access to and marketing of foods and beverages of low nutritional value, particularly to youth. • Provide safe, enjoyable and accessible environments for physical activity in schools and worksites, and for transportation and recreation in communities.
What’s It Going To Take? Multi-strategy, coordinated and comprehensive approach at national, state and local levels Policies that make it easier for people to eat better and be more active Policy and environmental changes in priority systems
A New Shift In Communications Messaging that increases awareness of key issues that influence eating and exercise habits From “Eat More Fruits and Vegetables” to: What’s being served at your child’s school? Got a salad bar at work? We need better quality produce at this store. From “Be More Active” to: No sidewalks? Speak up. What’s the school policy on PE? Hey – can we get some bike racks at the office?
Strategic, Sustainable and Effective Collaborations Traditional Health Organizations Government Media Industry Non-Traditional City Planning and Architecture Transportation Planners Parks and Recreation Legal and Policy Experts
Calls to Action • Recommended Community Strategies and Measurements to Prevent Obesity in the United States (2009) • IOM Reports • Cancer Prevention and Control (2003) • Childhood Obesity (2004) • Food Marketing and Advertising (2005) • Local Government Actions to Prevent Childhood Obesity (2009) • Policy and Action for Cancer Prevention: Food, Nutrition and Physical Activity, World Cancer Research Fund (2008) • Guide to Community Preventive Services (2001/2010)
General Population Smoking In The US Annual Adult Per Capita Cigarette Consumption and Major Smoking and Health Events – United States 1900 – 1998.