Inhabitants of the Western world sometimes forget that though we live in a culture of diverse and abundant food sources, we are only a few generations away from a time of often desperate scarcity. Our brains share wiring with our prehistoric ancestors, who would have had every right and responsibility to take advantage of a bonanza of high caloric and fat rich foods: a rare and welcome treat for them. We live in a very different landscape. A vast offering of rich, fattening food and a decline in physical activity represent a dangerous intersection for the human species. October 11, 2018 was World Obesity Day and in observance of that, let’s delve deeper into the topic of obesity, defined as having a body mass index (BMI), a measure of height to weight, that is 30 kg/m2 or more. It is a serious and prevalent disease.
Approximately 40% of Americans are obese; this makes obesity an epidemic. Roughly a third of Americans are overweight, defined as having a BMI greater than 25 but less than 30. Nearly 10% of women and 5% of men are morbidly obese, that’s when one’s BMI hits 40! The risks are numerous, and often quite lethal. Obese patients have higher rates of coronary artery disease, stroke, diabetes, arthritis, and Alzheimer’s disease. Even more worrisome is the rising prevalence of obesity in younger adults and children.
Recently, extensive data and research have implicated obesity in gastrointestinal cancers, providing us all the more reason to commit to healthy eating and physical activity. Powerful and convincing evidence links obesity to cancers of the esophagus, stomach, colon, and pancreas. More importantly, obesity is increasingly recognized as a preventable cancer risk. Previously, we reported on the alarming rise in incidence of colorectal cancer in younger adults, prompting the American Cancer Society (ACS) to recommend screening for colorectal cancer at the age of 45 instead of 50. The AGA and various cancer advocacy groups have supported this recommendation by the ACS. Taken together, these trends point to the inescapable conclusion that there is a direct correlation between young-onset obesity and the ballooning incidence of colorectal cancer in younger adults. Again, this means the problem is related to Western lifestyle, and preventable. Let’s take a look at the mechanisms of obesity related cancers.
Multiple plausible mechanisms inform the cancer and obesity association. For instance, obesity contributes to chronic inflammation, a well-known mediator of cancer (see our previous article). A cellular mechanism associating obesity with cancer is conceivable, because adipose (fat tissue) is an important endocrine organ, secreting several hormones and chemokines that can regulate tumor behavior, inflammation, and the tumor microenvironment. Therefore, adipose tissue activation might directly promote cancer growth and progression. Another putative hypothesis suggests that obesity causes dysregulated metabolism, which results in insulin resistance, hyperglycemia, and dyslipidemia (an abnormal amount of lipids) and may impact tumor development and growth. By no means are these the only mechanisms by which obesity contributes to cancer development and growth. Numerous and complex cellular mechanisms, beyond the scope of this article, may also influence the development of obesity-related cancers.
This begs the question: How do we combat obesity and live a long, healthy life that is free of cancer and other serious illnesses? With childhood obesity as serious a problem as it is in our culture, it is essential that we initiate child obesity prevention strategies as early as possible for families, childcare and schools. We need a commitment from and careful coordination among legislators, community organizations, schools, childcare and healthcare professionals to create an environment that both teaches and supports a healthy lifestyle. It is remarkable how porous and impressionable young minds and bodies are. When students eat a healthy diet and exercise often they feel better about themselves, experience deeper and more restful sleep, and are more likely to focus and apply themselves in class. Young people should eliminate unhealthy foods (refined grains and sweets, potatoes, red meat, processed meat) and beverages (sugary drinks), increase physical activity, limit idle screen time and reduce stress. For those well into adulthood, the same strategies apply, including a radically healthy diet, and daily exercise to achieve and maintain a healthy body weight. The good news is that when it comes to obesity and its many risks, choices matter. Our health is in our own hands.
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Dr. A-Rahim works with our Medical Advisory Boards, our Medical Directors, and our quality assurance programs to oversee improvement of clinical outcomes for our patients. He also organizes and leads Company efforts to measure and improve clinical outcomes for all centers and the Company as a whole. Dr. A-Rahim earned his medical and doctorate degrees from the Pennsylvania State University and completed a residency in Internal Medicine and fellowship in Gastroenterology at Beth Israel Deaconess Medical Center, Harvard Medical School. As a physician, he is known for his expertise in interventional endoscopy and minimally invasive treatments for gastrointestinal disease. He has authored several articles published in medical journals and has delivered presentations to fellow physicians around the country, including at his alma mater, Harvard Medical School.
Dr. A-Rahim is currently a Lecturer in Medicine at Harvard Medical School and practices gastroenterology at the VA Boston Healthcare System West Roxbury Campus in Massachusetts, and at Pacific Endoscopy Center, an ASC he co-founded in 2008 in Pearl City, Hawaii.