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Cancer survivorship, excess body fatness and weight-loss intervention—where are we in 2020?


Earlier diagnosis and more effective treatments mean that the estimated number of cancer survivors in the United Kingdom is expected to reach 4 million by 2030. However, there is an increasing realisation that excess body fatness (EBF) is likely to influence the quality of cancer survivorship and disease-free survival. For decades, the discussion of weight management in patients with cancer has been dominated by concerns about unintentional weight loss, low body weight and interventions to increase weight, often re-enforced by the existence of the obesity paradox, which indicates that high body weight is associated with survival benefits for some types of cancer. However, observational evidence provides strong grounds for testing the hypothesis that interventions for promoting intentional loss of body fat and maintaining skeletal muscle in overweight and obese cancer survivors would bring important health benefits in terms of survival outcomes and long-term impact on treatment-related side effects. In this paper, we outline the need for studies to improve our understanding of the health benefits of weight-loss interventions, such as hypocaloric healthy-eating plans combined with physical activity. In particular, complex intervention trials that are pragmatically designed are urgently needed to develop effective, clinically practical, evidence-based strategies for reducing EBF and optimising body composition in people living with and beyond common cancers.

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Fig. 1: Possible explanations for the obesity paradox.
Fig. 2: Two-step Mendelian Randomisation procedure: integration of feasibility randomised controlled trial (RCT) results with MR to predict the long-term effect of interventions.


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The authors thank Ms Jill Hampton, Mrs Mary Burke for the paper coordination and preparation and Ms Fiona Davies for organisation of meetings and discussion sessions.

the UK NIHR Cancer and Nutrition Collaboration (Population Health Stream)

Annie Anderson14, Rebecca Beeken15, Janet Cade16, Amanda Cross17, Angela King18, Richard Martin19, Giota Mitrou20, Elio Riboli21, John Saxton22, Andrew Renehan23

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A.S.A. led the paper drafting, original concept, paper structure and drafting, while R.M.M., A.G.R., J.C., E.R.C., A.J.C., C.G., L.K., A.K., E.R., C.S. and J.M.S. were involved in the original concept, paper structure and drafting. All authors approved the final version of the paper.

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Correspondence to Annie S. Anderson.

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Competing interests

R.M.M. reports grants from CRUK, during the conduct of the study. J.C. reports that she is the director of Dietary Assessment Ltd. E.R.C. reports other from SECA, personal fees from Roche, personal fees from Lilly, personal fees from Pfizer, personal fees from Novartis, personal fees from Astra-Zeneca and personal fees from Nanostring, outside the submitted work. C.S. reports personal fees from Boehringer Ingelheim, personal fees from Eli Lilley and Company and personal fees from Chugai, outside the submitted work. The remaining authors declare no competing interests.

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This work was supported by the NIHR Cancer and Nutrition Collaboration. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care Funding. R.M.M. is supported by a Cancer Research UK programme grant (C18281/A19169) and by the National Institute for Health Research (NIHR) Bristol Biomedical Research Centre. The National Institute for Health Research (NIHR) Bristol Biomedical Research Centre is funded by the National Institute for Health Research and is a partnership between University Hospitals Bristol NHS Trust and the University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. A.G.R. is supported by the Manchester NIHR Biomedical Research Centre (IS-BRC-1215-20007). C.S. is partly funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London.

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The Population Health Stream exists to promote research on key nutrition-related factors in the primary and secondary prevention of cancer. These are; diet and nutrition, alcohol, physical activity and obesity. In calling for more research, the group is addressing an urgent need for more effective cancer prevention strategies and interventions. We do not assign any judgement or stigma to any groups or individuals on the basis of their lifestyle.

Members of the UK NIHR Cancer and Nutrition Collaboration (Population Health Stream) are listed above Acknowledgements.

These members were involved in work stream discussions but were not involved with the drafting of the publication: Rebecca Beeken, Giota Mitrou.

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Anderson, A.S., Martin, R.M., Renehan, A.G. et al. Cancer survivorship, excess body fatness and weight-loss intervention—where are we in 2020?. Br J Cancer 124, 1057–1065 (2021).

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