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Pati, S.;  Irfan, W.;  Jameel, A.;  Ahmed, S.;  Shahid, R.K. Management of Obesity in Cancer Survivors. Encyclopedia. Available online: https://encyclopedia.pub/entry/40746 (accessed on 19 December 2025).
Pati S,  Irfan W,  Jameel A,  Ahmed S,  Shahid RK. Management of Obesity in Cancer Survivors. Encyclopedia. Available at: https://encyclopedia.pub/entry/40746. Accessed December 19, 2025.
Pati, Sukanya, Wadeed Irfan, Ahmad Jameel, Shahid Ahmed, Rabia K. Shahid. "Management of Obesity in Cancer Survivors" Encyclopedia, https://encyclopedia.pub/entry/40746 (accessed December 19, 2025).
Pati, S.,  Irfan, W.,  Jameel, A.,  Ahmed, S., & Shahid, R.K. (2023, February 02). Management of Obesity in Cancer Survivors. In Encyclopedia. https://encyclopedia.pub/entry/40746
Pati, Sukanya, et al. "Management of Obesity in Cancer Survivors." Encyclopedia. Web. 02 February, 2023.
Management of Obesity in Cancer Survivors
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This entry is adapted from the peer-reviewed paper 10.3390/cancers15020485

Many cancer survivors experience weight gain following the diagnosis of cancer and its treatment. As described above, obesity not only increases the risk of recurrence in some cancers but also increases the risk of diabetes mellitus, cardiovascular disease, and poor quality of life.

obesity cancer malignancy overweight

1. Introduction

Evidence demonstrates that structured exercise combined with dietary support for weight loss results in greater weight loss than exercise or diet alone and has the greatest impact on blood-borne biomarkers linked to common cancers, such as insulin resistance and circulating levels of sex hormones, leptin, and inflammatory markers [1][2][3][4][5]. Many cancer guidelines recommend that survivors maintain a healthy weight, but there is a lack of evidence regarding which weight loss method to recommend [6][7][8]. Lifestyle interventions that include diet, exercise, and behavior therapy are the mainstay of interventions related to lifestyle modification (Figure 1). Pharmacological and surgical interventions are not well studied in cancer survivors. A Cochrane meta-analysis of 20 studies involving 2028 breast cancer survivors evaluated the effect of different body weight loss approaches in overweight or obese breast cancer survivors and found that weight loss interventions, especially multimodal interventions that include diet, exercise, and psychosocial interventions resulted in a reduction in body weight, body mass index, waist circumference, and better overall quality of life [9].
Figure 1. Structured exercise in combination with dietary support and behavior therapy are effective interventions for all cancer survivors. Treatment with glucagon-like peptide-1 analogues and bariatric surgery can be considered in selected cancer survivors.

2. Diet

A consistent caloric deficit regardless of the type of diet results in weight loss [10][11]. The 2-year POUNDS LOST (Preventing Overweight Using Novel Dietary Strategies) trial randomized study participants into four diets groups with a deficit of 750 kcal per day and showed that there was no difference in the short- and long-term weight loss among the four groups [10]. However, macronutrient components of a low caloric diet can contribute to cardiometabolic outcomes [12]. The Diet and Androgen-5 (DIANA-5) trial examined whether a dietary adjustment based on macrobiotic and Mediterranean diet principles can lower the incidence of events associated with breast cancer. The early results showed that the DIANA-5 dietary intervention is effective in reducing body weight and metabolic syndrome parameters [13]. According to the Obesity Guidelines, an energy deficit of 500–750 kcal per day can result an average weight loss of 0.5–0.75 kg per week, which is 1200–1500 kcal per day for women and 1500–1800 kcal per day for men [14].

3. Exercise

Aerobic exercise on a regular basis improves physical fitness and endurance and in conjunction with diet not only has a positive effect on weight reduction but also reduces the risk of metabolic syndrome and cardiovascular complications by reducing visceral fat, blood pressure, and lipid levels and improving glycemic control [15][16]. As most of the published literature on weight reduction programs lacks long-term follow-ups, it is not known whether weight changes are sustained beyond the intervention periods.
The SUCCESS C (Docetaxel Based Anthracycline Free Adjuvant Treatment Evaluation, as Well as Lifestyle Intervention) phase 3 randomized trial assessed whether physical activity and healthy diets following adjuvant chemotherapy in 3643 women with early-stage breast cancer reduce disease-free survival [17]. Women in the intervention arm had a significant reduction in baseline weight compared with the non-intervention arm. Overall, 1477 women completed the 2-year lifestyle intervention program. An interim analysis showed that women who completed the 2-year lifestyle intervention program had a significantly better disease-free survival than those who did not complete (hazard ratio 0.35) [18]. Several trials are examining whether exercise with or without dietary intervention in obese or healthy weight cancer survivors could improve oncology outcomes (Table 1).

4. Behavior Therapy

Behavior therapy involves the use of various techniques and strategies to replace existing eating and activity behavior with a healthy eating and active lifestyle. It includes tracking eating, calorie intake, and physical activity, modifications of the environment to avoid overeating, the creation of exercise plans, and setting realistic goals, among others [19][20].

5. Drug Therapy

Currently, few drugs are approved for weight loss [21]. The most important of these are glucagon-like peptide-1 (GLP-1) analogue liraglutide and semaglutide. In a randomized phase 3 trial, when liraglutide was injected subcutaneously at a dose of 3.0 mg once-daily to 3731 patients as an adjunct to diet and exercise, it was associated with significant weight reduction. For example, after 56 weeks of treatment, 63.2% of treated patients vs. 27.1% with placebo lost at least 5% of their body weight and 33.1% of treated patients vs. 10.6% of the control group lost more than 10% of their body weight [22]. Semaglutide is available as a weekly injection [23]. A handful of preclinical studies suggest their association with thyroid and pancreatic cancer [24][25]. Other suggest that GLP-1 may have a protective effect on a reduction in the growth of certain cancers such as prostate and breast cancer [26][27][28]. Although there is paucity of research of the long-term safety of GLP-1 analogues in cancer survivors, it is a reasonable option in diabetic cancer survivors with excess body weight or those who are normoglycemic but failed other weight reduction measures. Other drugs that have shown efficacy in weight reduction include orlistat, the phentermine–topiramine combination, the bupropion–naltrexone combination, benzphetamine, phendimetrazine, and diethylpropion [21] (Table 1). However, unlike GLP-q analogues, they have more side effects, drug interactions, and several contraindications [21][29].
Table 1. Drugs with US Food Drug Administration (FDA) approved indication for obesity.
Drug [21][29] Mechanism of Action Dose Weight Change Relative to Placebo Side Effects
Semaglutide glucagon-like peptide 1 receptor (GLP1R) agonists, decreases appetite and delays gastric emptying and gut motility 2.4 mg once per week subcutaneous injection 2.4% to 14.9% abdominal pain, constipation, diarrhea, nausea, vomiting, and pancreatitis (rare)
Liraglutide GLP1R agonists, decreases appetite and delays gastric emptying and gut motility 3.0 mg per day subcutaneous injection 2.6% to 8% diarrhea, nausea, vomiting, constipation, dyspepsia, abdominal pain, pancreatitis, and gallstones
Naltrexone SR/bupropion SR Opioid receptor antagonist/dopamine and noradrenaline reuptake inhibitor causing appetite suppression 32 mg/360 mg oral twice daily dose dependent
1.3% to 6.1%		 headaches, hypertension, sleep disorders, nausea, constipation, vomiting, diarrhea, palpitation, dizziness, tremor, and others
Orlistat Pancreatic lipase inhibitor causing excretion of 30% of ingested trigylcerides in stool 120 mg 3 times daily 6.1% to 10.2% nausea, diarrhea, steatorrhea, abdominal bloating, and hepatitis
Phentermine/
topiramate		 Sympathomimetics/anticonvulsant causing appetite suppression 15 mg/92 mg once daily oral dose depending
1.2% to 7.8%		 tachycardia, xerostomia, constipation, headache, sleep disorder, anxiety, depression, suicidal ideation, and cardiovascular event
Phendimetrazine Sympathomimetics causing appetite suppression Short-term (≤12 weeks) 17.5 to 35 mg 2 or 3 times daily Not available hypertension, ischemic events, palpitations, tachycardia, headache, insomnia, overstimulation, psychosis, and others

6. Weight Reduction Surgery

Weight reduction surgery or bariatric surgery, such as sleeve gastrectomy or adjustable gastric banding, is typically considered in patients with a BMI > 40 kg/m2 or with a BMI of 35–40 kg/m2 with associated comorbid conditions such as obstructive sleep apnea [30]. Ongoing research has deemed that bariatric and related surgeries continue to be safe and will likely be used in the future [31]. The most common and considered to be highly effective forms of surgery used are the sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) [32]. Scant evidence suggests that the benefit of bariatric surgery as a weight reduction intervention is similar in cancer survivors compared with those with no history of cancer [33][34]. A systemic review and meta-analysis of six observational studies involving 51,740 patients demonstrated that bariatric surgery was associated with a 55% reduction in cancer risk. Patients who underwent bariatric surgery for obesity have a 27–59% lower risk of developing cancer than weight- and age-matched controls [35]. The advantages of bariatric surgery might only apply to malignancies linked to obesity, such as those of the breast and endometrium, where the average risk reduction is 38% (p = 0.0001). In contrast, the benefits of bariatric surgery are significantly more moderate (9%) among malignancies unrelated to obesity, such as those of the lung and bladder; this level of risk reduction is comparable to that of individuals who do not undergo bariatric surgery (p = 0.37) [36].

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Subjects: Oncology
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register : Sukanya Pati ,
Wadeed Irfan
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Ahmad Jameel
, Shahid Ahmed , Rabia K. Shahid
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Update Date: 07 Feb 2023
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