Diet and exercise advice to reduce your cancer risk

MD Anderson Cancer Center
Date: 08-12-2013

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Lisa Garvin: Welcome to Cancer Newsline, a podcast series from the University of Texas, MD Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention providing the latest information on reducing your family's cancer risk. I'm your host, Lisa Garvin. Today our guest is Dr. Karen Basen-Engquist, she is a Professor of Behavioral Science here at MD Anderson and also Director of the new Center for Energy Balance. Welcome Dr. Basen-Engquist.

Dr. Karen Basen-Engquist: Thank you Lisa.

Lisa Garvin:  First of all what is the Center for Energy Balance?

Dr. Karen Basen-Engquist:  Well the Center for Energy Balance in cancer prevention and survivorship is an effort to bring together researchers at MD Anderson and at external institutions who are working on the field of energy balance in cancer to try to increase collaboration and really determine what are the best kinds of interventions and diet and physical activity for our patients and for the community.

Lisa Garvin: And I think anyone who isn't living under a rock knows that there is obviously a link between physical activity and obesity. So given that fact the hard part is getting people to commit to physical activity. Is that correct?

Dr. Karen Basen-Engquist:  That is correct. Making behavioral changes is incredibly difficult and people often underestimate the amount of effort it takes. So it's the physical activity and it's also what we're eating. In our society we've sort of grown more and more sedentary. Many of us have jobs where we sit all day long. And we exercise less. And so if we can get people to exercise more, the recommendations are that people exercise at a moderate intensity for at least 30 minutes a day or up to 60 minutes a day if you are, especially if you're trying to manage your weight. That they reduce their sitting time because sometimes even just sitting all day long can help, can have negative health impacts and that we eat a diet that helps us maintain a healthy weight. And that's increasingly difficult given those super-size portions that we often eat and the really high availability of high fat, high sugar foods.

Lisa Garvin: When you're talking about the recommended exercise we've seen that change quite a bit in recent years. And I think at one point it was a very daunting, like I think they were saying several hours a week. And I was thinking a busy mom is never going to be able to do that. So have they settled on these guidelines for good or?

Dr. Karen Basen-Engquist:  Well, you know, the research as we learn more we do tend to change guidelines and that's really just so that the public can have the most up-to-date information about what's helpful to them. But they, you're right. They have changed over the years and at one time we were really emphasizing that people do kind of vigorous intensity exercise like running and aerobics and that that was very important and it was important to do it all at once, you know, in a single session. But what we've learned is that it's not necessary to do that vigorous intensity exercise. You can still get health benefits from moderate intensity exercise. So doing things like taking a brisk walk and you're talking the stairs once in a while and doing exercise that's a little lower intensity but can still have benefits especially if you do for at least ten minutes. And that's the other thing that we've learned is it doesn't have to be done all at once. So you don't have to go to the gym for an hour and work out. If you can work into your day three ten minutes periods where you go for a brisk walk or do some other kind of moderate intensity activity, that can have benefits for your health as well. And that's usually a lot easier type of routine for people to adopt.

Lisa Garvin:  And a friend of mine a few years ago gave me a book, a little book called Office Yoga. And it actually has little stretching routines and things that you can do at your desk. And I'm victim of hey I've been sitting for three hours all of a sudden. So I've built a walk into my day. But there are things you can actually do without the equipment, without having to shower or change clothes correct?

Dr. Karen Basen-Engquist:   Absolutely, absolutely. So stretches you can do at your desk can help especially with some of the, you know, muscular skeletal problems that we sometimes have when we've been sitting too long. But even just getting up and moving around a little bit. Like I said going for a walk, maybe going up a few flights of stairs and getting your heart pumping a bit. But you don't need to take a shower, you don't need to work so hard that you have to shower. And, you know, you don't have to go to the gym. Obviously if you can that's a good thing too. But yes, brief bouts of exercise spread throughout the day can be very helpful.

Lisa Garvin:  And for women, and I've heard this, I don't know if this is common knowledge or not, that the larger you are the more calories you burn. Is that true?

Dr. Karen Basen-Engquist:   Yeah that's true for both men and women. That the larger you are the more calories you burn just because there's kind of more of you to move around. And so you do burn more calories if you're heavier. But I think that shouldn't dissuade even the smaller people from doing some activity.

Lisa Garvin:  But when people plateau that can be a really tough interlude in the weight loss battle. What sort of advice do and I think the larger you are the quicker you plateau where you hit a moment when you're not losing any weight at all. What advice or encouragement can you give to people who are plateauing?

Dr. Karen Basen-Engquist:   Well that is a very big challenge for people when they are trying to do weight loss. And often that's a critical time point because people get discouraged and then they start to regain their weight. I think it's very important for people to realize that when you're doing weight loss you need to be very vigilant on an ongoing basis, watching what you eat and staying active. Now sometimes what can help people is if you make some changes. So for example if you're in an exercise program sometimes you start to get a little bored with it. So it's okay to change up the exercise. It's, you might take a look at what you're eating. Maybe the foods you're eating are not really satisfying to you so think about other healthful dietary choices that you can make and still maintain your weight. So the plateauing is frustrating but I think the other thing to think about is even if you stay at the, your same weight if you're more active and you're eating more healthy food you're doing your body a lot of good.

Lisa Garvin:  And let's talk about fat versus fit. Because honestly, you know, as a larger woman I, my diabetes is in check, my cholesterol's in check. I was, people always think that while you're big you're naturally going to be unhealthy. Can we dispel that myth?

Dr. Karen Basen-Engquist:   We can absolutely dispel that myth. There is quite a bit of evidence to show that if regardless of somebody's weight if they are exercising, if they're maintaining a good level of fitness, if they're eating well that they are healthier than if they were not doing those things. And so a lot of the issues and the health problems that result from obesity can be overcome with things like exercise and a healthy diet even if the weight isn't lost.

Lisa Garvin:  So as we see into the nutrition part of keeping weight off and staying healthy, what's your feeling on MyPlate? I mean we dealt with the pyramid for so many years and now we actually have a plate that has portions. Do you feel that that was a good move?

Dr. Karen Basen-Engquist:  I think that is a good move. I think that gives people a nice visual representation of how their, how much of each kind of food they should be eating. And of course, you know, vegetables and fruits and whole grains are very important for us to eat. They kind of fill us up with fewer calories. Meat is something that we want to sort of limit our consumption of. It's good to have that protein especially if it's a lean meat but we do want to avoid all the saturated fat that comes with fattier meats and red meats. So I think the plate is nice because it gives you a very visual representation of how you should be distributing your food choices and what we should be eating and what we should be emphasizing in our dietary choices.

Lisa Garvin:  And back in the day and I'm talking about the '60s and '70s when they were talking about portion control and calorie counting. When they say okay at three ounces of meat is the size of a pack of cards or a serving of cheese is like a set of dice. Is portion control still important today?

Dr. Karen Basen-Engquist:   Portion control is really critical. I think more than ever because the environment is rich with examples of bad portion control or, you know, really large portions. Where we're seeing that things like bagels are getting larger and donuts are getting larger and pastries are getting larger. And so the kind of default portion that people are served in restaurants and in other eateries is really more food than you need to eat. You know at one time the Quarter Pounder was sort of the big hamburger at McDonald's. And now it's the small hamburger, right, they don't even have the old small hamburgers. A Quarter Pounder is, you know, four ounces of meat. That's a serving size. Another thing to keep in mind is even our plates or cups that we drink out of are getting bigger. And that if you have a bigger plate you're more likely to fill up that plate with more food. And so even the size of your plate can make a difference and kind of help you manage your portion size.

Lisa Garvin:  There are a lot of diets out there. The South Beach Diet, the new one is the Paleo Diet. Basically they seem to be low carb diets. Is that something that's sustainable in the long run?

Dr. Karen Basen-Engquist:  Well I think different people have probably different preferences in terms of the kind of diet they can stay on for a long time. If we look at the American Cancer Society guidelines they emphasize a diet that is high in plant based foods. So lots of vegetables, lots of fruits, lots of whole grains and even looking at protein sources that are plant based so eating more beans and nuts and a little bit less meat. And also an emphasis on less saturated fat, less red meat, less processed meat. So those are the American Cancer Society recommendations. But I think the, another important thing about a diet is to make sure it's something that you can sustain. That there are foods that are satisfying to you and that you like and you're still, you know, kind of choosing from among those healthful foods.

Lisa Garvin: But it's okay to build in indulgences in moderation of course.

Dr. Karen Basen-Engquist:  Right I think that a diet where you are constantly denying yourself things that you really like is very hard for people to maintain over the long run. So if you can limit yourself to a moderate portion size of an indulgent food then it's fine to eat that on occasion. Or for, you know, think of them as special occasion foods that you when you're ready to treat yourself. But if it's a food where you think I'm not going to be able to stop eating once I start eating that, that's probably something to stay away from.

Lisa Garvin:  And when we're dealing with cancer patients here, what is your role obviously some of our patients will be obese and come with, you know, comorbidities like diabetes. What is your role in counseling or advising cancer patients?

Dr. Karen Basen-Engquist:  Well we do a number of studies with cancer patients and cancer survivors to look at the benefits of exercise and healthier eating and weight management on outcomes related to their cancer. Looking at the effect on things like fatigue, on their physical functioning and even biomarkers that might be related to cancer prognosis and recurrence. I'm also involved in the integrative health program in our cancer prevention center in the grade of medicine where we're trying to provide more services to our cancer patients and survivors as well as the cancer prevention patients to help them maintain a healthy weight, eat more healthfully and engage in exercise.

Lisa Garvin:  Do you find that cancer might be a teachable moment in this respect?

Dr. Karen Basen-Engquist:  I think it is. I think often times when people have a serious health event like a cancer diagnosis certainly is, that it makes them think about what they could do, what kind of changes they could make to enhance their health, to optimize their health. And so certainly it's something, it's something that gets people to stop and think about what sorts of changes they can make.

Lisa Garvin: And what sort of things can people do now, little incremental things to kind of get them on the road to wellness?

Dr. Karen Basen-Engquist:  Well I'd say as you're listening to this podcast get up out of your chair and walk around would be one of the first things. I like what you said about small changes because I think it's very important to think about small changes. Sometimes it's intimidating to people to think about well I need to lose, you know, 40 pounds, I need to do a wholesale change of my diet, I need to go to the gym for an hour every day. I think making small changes and trying to build on that is very important. So giving up, you know, one thing that I've heard some office workers do is get up and, you know, make sure you're getting up and walking around for a few minutes every hour so that you're not sitting constantly all day long or taking those short walks, maybe ten minutes at your lunch break. One thing we have people do who are just starting to do some more physical activity is get a pedometer and monitor your steps because that's a really nice tool, you look down at any time during the day and see where you are in your step count. The kind of general recommendation is to get 10,000 steps a day but really as long as you're kind of increasing your average steps per day that's wonderful. And you can get that feedback to help you see how much more you need to do that day. As far as eating, you know, maybe making small changes, incorporating an extra serving of vegetables into each meal, reducing your meat portions or your saturated fat. Switching from full fat dairy products to low fat or nonfat dairy products like milk and yogurt. So some of those small changes I think can help get people started on the road to wellness.

Lisa Garvin: And in summary, what sort of behavioral modification research are you doing here at MD Anderson?

Dr. Karen Basen-Engquist:   Well we're testing various interventions to try to see what, what's helpful to people as they make these changes. So we use a lot of behavioral techniques like helping people learn how to do goal setting, how to monitor their behavior, looking at whether kind of prompts during the day are helpful to them. So one of things we're looking at for example is whether Smart Phone intervention, Smart Phone apps can help people adopt an exercise program and maintain it over time through helping them monitor their behavior but also providing some prompts when maybe their behavior is not where they want it to be.

Lisa Garvin: Great, thank you. So it's never too late to get on the road to health.

Dr. Karen Basen-Engquist:   It is never too late to get on that road. And I hope everybody does.

Lisa Garvin:  Thank you. If you have questions about anything you've heard today on Cancer Newsline, contact Ask MD Anderson at 1-877-MDA-6789 or online at mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in for the next podcast in our series.