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Breaking the Link

African Americans, obesity and cancer

Focused on Health - April 2009

By Rachel Winters

Even with the presence of healthier items on fast food menus and an increase in memberships to fitness clubs over the past five years, 66% of the U.S. population is overweight or obese, according to the Centers for Disease Control and Prevention.

While obesity trends are prevalent across the country, they are even more pronounced among African Americans, 76% of whom are considered overweight or obese. The African American population may be heavier than the general population for a variety of reasons, but the sunny side to this growing problem is that obesity is reversible. Making little changes can have a huge impact—on individuals and on communities.

The Connection Between Cancer and Obesity
Encouraging African Americans to adopt a healthier lifestyle can help lower obesity rates and also may contribute to cancer prevention.

“I think that rates for certain cancers, such as breast, colon and endometrial cancers, would decrease if obesity rates decrease,” says Danielle Baham, M.S., R.D., L.D., a senior clinical dietitian in M. D. Anderson’s Clinical Nutrition Department. “People need to know that there are simple things they can do to lose weight and fight cancer.”

Obesity can lead to cancer because fat cells convert circulating androgens to the hormone estrogen, in both men and women. Certain forms of estrogen can increase the chance of cell mutations throughout the body, and cell mutation leads to cancer.

While obesity statistics, especially for African Americans, might sound scary, each individual can usually control their own risks because weight is generally controllable through modifications in diet and exercise. No fancy gym equipment or shots of wheat grass required.

Cancer in the African American Community
According to the U.S. Department of Health and Human Service’s Office of Minority Health, African Americans are 33% more likely to die from all types of cancer than whites, which means that African Americans have the highest cancer death rates of any racial or ethnic group.

“African American women have a higher incidence of pre-menopausal breast cancer, and African American men’s onset of prostate cancer is often much earlier than in other populations,” says Richard Hajek, Ph.D., senior research scientist at        M. D. Anderson’s Center for Research on Minority Health. “Both of these cancers are linked with obesity, making it very important to educate this community about weight control.”

A “Nu” Study Sheds Light on the Issue
Encouraging news for African Americans has surfaced recently. Preliminary research from M. D. Anderson’s A Nu-Life study indicates that adopting a healthier lifestyle can, in fact, help the body fight cancer.

The A Nu-Life study looked at breast cancer risk among pre-menopausal African American women ages 25 to 45 and sought to determine if a low-fat, high-fiber diet would lower levels of estrogen hormones that lead to cancer.

“A Nu-Life was a study of what happens to your body when you modify your eating habits,” says Beverly Gor, Ed.D., postdoctoral fellow in M. D. Anderson’s Center for Research on Minority Health and one of the study’s principal investigators. “Initial analysis shows that changes in diet can decrease hormone levels.”

What A Nu-Life Means for Men
Another M. D. Anderson study, called The WHEL Study (Women’s Healthy Eating and Living Study), looked at diet and cancer recurrence in breast cancer survivors, and found that being active and eating healthy reduced female participants’ estrogen levels and thus reduced their risk for breast cancer recurrence. So what do these studies mean for men?

“The WHEL Study findings, and those from A Nu-Life, lead us to believe that the same would be true for estrogen levels in men, which would reduce their risk for prostate cancer,” says Hajek, a co-investigator for both the WHEL Study and A Nu-Life study. “We hope to conduct that research in the future.”  

Barriers to Reaching Diet and Exercise Goals
Focus groups with A Nu-Life participants, held before the study began, captured interesting information about some of the cultural differences that might account for the variation in obesity rates in African Americans and other ethnicities.

“The focus groups showed us, for starters, that part of the issue is that African Americans consider a larger body image to be acceptable,” Gor says.

“It’s a cultural thing,” Baham says. “And because having a heavier weight isn’t seen as a problem, there is less of a tendency to engage in exercise or healthy eating.”

The A Nu-Life study focus groups also pointed out other more specific barriers to healthy eating.

“We found that time is a big issue,” Gor says. “We heard that while participants understood the message that they should eat better, they were concerned about how to do so when they had limited time to prepare a meal. We heard that they didn’t always have time to go to the grocery store. Running through a drive-through was more convenient. Many participants also were concerned that healthy eating would mean a larger grocery bill.”

According to the American Cancer Society, one-third of African American adults do no physical activity, with African American women more likely than men to be physically inactive.

Breaking the Link’s experts work hard to help people live healthier lives. 
(Left to right): William Baun, Beverly Gor, Ed.D., Danielle Baham, R.D., Richard Hajek, Ph.D.

“Based on what we’ve observed, some barriers preventing African Americans from being physically active may be the unavailability of affordable gym memberships and safe walking trails in urban communities,” Baham says.

Quick and Inexpensive Ways to Improve Diet
“You don’t need to start a fad diet that can lead to failure,” Baham says. “It’s all about small steps that will help you break your habits. Don't look at healthy eating as a diet. Just make small adjustments for a healthier you.”

Baham suggests:

  • Drink water! By replacing one can of soda, sweetened tea or sugary juice with water daily, you could save 1,000 calories a week.
  • Choose more whole grains. Try mixing white rice with brown rice or try whole wheat pasta. Top rice with beans, or toss pasta with steamed veggies and olive oil for a quick low fat, high fiber meal!
  • Cook vegetables or rice in low sodium chicken broth to give more flavor without adding extra fat. Also, experiment with your favorite herbs and spices.
  • Do simple substitutions that are lower in fat when making your favorite recipes. For example, use 2% or 1% milk instead of whole milk; applesauce or other fruit purees instead of oil in baked goods; and egg whites instead of whole eggs.
  • Limit alcoholic drinks to two for men and one for women each day.
  • Always read the nutrition facts when shopping for food. Make sure that foods are low in total fat, saturated fat and sodium.
  • Choose fresh fruits and vegetables instead of snacking on cookies or chips between meals when those “sweet or crunchy” cravings hit.
  • Portion control! Use smaller plates, or share an entrée with a friend when dining out. It is gentle on your waistline, diet and wallet.
  • Avoid foods high in saturated fats, such as whole milk, high fat meats, butter and chicken skin.
  • Choose lean cuts of meat such as round or loin, poultry without skin and fish. Use low-fat cooking methods such as grilling, baking or broiling.

Fitness: The Cheapest Health Insurance
“You don’t have to use the word ‘exercise’ when thinking about decreasing your body fat,” says William Baun, M. D. Anderson’s wellness coach and fitness guru. “Think about increasing your physical activity, even without access to a gym."

According to Baun, physical activity means burning calories and building muscle to speed up your metabolism. What matters is the length of your activity, which should be 30 to 40 minutes. As for the actual activity, be sure to find something you enjoy and someone who will support your efforts.

“Expect to feel awkward and uncomfortable during the first days of exercise,” Baun says. “It will get easier.”

Baun suggests:

  • Aerobic DVDs can provide great workouts in the comfort of your living room. Buy a variety of them to keep your interest and momentum going.
  • House cleaning is great exercise when done for at least 30 to 40 minutes! Vacuum, mop the floor, lift baskets of wet laundry or wash the dishes. It’s an instant workout.
  • Go out dancing, or have friends over and shake it! It doesn’t matter what movements you do, as long as you get into it and dance for at least 30 to 40 minutes.
  • Pay a visit to your local church. Many have health ministries that can help you find resources in your community.
  • Try “Wii Fit,” and invite your friends. It’s fun, engaging and gets you moving.
  • Wash your car. Don’t forget to do a detailed cleaning of the interior as well for an extra workout.
  • Walk up the stairs in your building or anyplace with stairs (going up is easier on your joints than going down). Add to your workout by carrying weights or something heavy.
  • Stretch every day to keep yourself flexible and decrease any soreness you might feel from your workout. It will enable you to keep going!
  • Build muscle to burn fat. Without a gym, lift weights with cans of food or jugs of water. Pushups are great as well.
  • Walk! If it’s difficult to walk in your neighborhood or during your lunch break, try a nearby mall, or the track/fitness facility of your local elementary school. Even walk to see coworkers instead of making phone calls or sending emails. Park at the end of the parking lot, and do a lap around the lot or building. Walk or bike to work.

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© 2014 The University of Texas MD Anderson Cancer Center