Cancer and Weight Loss

Weight loss can feel overwhelming. Cancer survivorship may make it feel even more complex. Fortunately, finding support during weight loss doesn't have to be an added challenge.

That's where Your Health is Calling, a new telehealth program for cancer survivors, comes in. This free, evidence-based telehealth curriculum combines expertise from dietitians, cancer survivors and an exercise physiologist.

Ahead, researcher Karen Basen-Engquist, Ph.D., and senior health education specialist Giselle Garza share program-approved weight loss tips for cancer survivors.

Know why it’s important

Excess body weight is a risk factor for developing 12 types of cancer, as well as chronic diseases including diabetes, heart disease and arthritis. For cancer survivors, weight is also tied to a greater risk of developing a second cancer, Basen-Engquist notes.

Researchers are exploring why excess body weight may increase cancer risk. One explanation? When cells rapidly divide, there is a greater chance of a mistake leading to uncontrolled cell growth and cancer. Excess body weight can cause inflammation, insulin resistance and increased estrogen levels, three factors that can each cause cells to multiply more rapidly.

Consult with your cancer care team

Whether or not you are a cancer survivor, the equation for weight loss is largely the same, Basen-Engquist says: using more calories than you consume. This is also called a calorie deficit.

However, she adds that cancer may change the way you approach weight loss. For example, weight loss can be a side effect of some cancers and cancer treatments, which might mean patients and their families associate weight loss with being sick.

Conversely, with some types of cancer, people tend to gain weight during or after treatment. This leaves them to navigate life after cancer and weight loss at the same time.

“I think there's a little bit of an extra frustration that they might have, although certainly weight loss is frustrating for a lot of people,” Basen-Engquist says.

You’ve probably heard the advice, “Consult with your care team,” countless times during your cancer treatment. But this advice is repeated for good reasons: your care team can provide guidance tailored to your medical history and unique needs. They can also answer questions about whether weight-loss injection drugs, or GLP-1s, or other weight loss medications might be right for you.

Find out what a healthy weight is for you

One of the first steps in weight loss? Figuring out whether you need to lose weight, and, if so, how much.

There are many ways you can determine if you are at a healthy body weight. Your Health is Calling uses Body Mass Index (BMI), and is open to people with a BMI of 25 or higher, meaning they fall into overweight or obese BMI classifications. However, BMI isn’t the only way — or necessarily even the best way — to determine whether you are a healthy weight.

“BMI is really controversial right now as far as whether it's a good measure of body fatness and a good measure of health risk,” Basen-Engquist says. This is because BMI doesn’t account for some factors that may impact weight, such as muscle mass, gender, age, ethnicity and body fat distribution.

Instead of BMI, you can also use other at-home tools such as waist circumference, waist-to-hip ratio, waist-to-height ratio and body roundness index. These options can be especially helpful in determining abdominal obesity, which Basen-Engquist says may indicate greater health risks than fat in other parts of the body.

“Abdominal obesity, the fat on your organs, does seem to increase health risks more than, say, fat in your legs, buttocks, arms and other areas,” she says.

RELATED: Is BMI the best body weight calculator?

Determine your calorie needs

Next, determine how many calories you should eat in a day.

To do so, our dietitians recommend using online calculators such as the National Institutes of Health Body Weight Planner. First, enter your current weight, sex, age, height and physical activity level. Next, enter your goal weight and the timeline you’d like to reach it in. Then, select if you plan on increasing your physical activity levels. The planner will then tell you the number of calories to eat in a day to maintain your current weight, reach your goal weight and maintain your goal weight.

“As a weight loss strategy, it's very important, especially initially, to reduce the amount of food you're eating,” Basen-Engquist says.

This means portion control is an important focus in weight loss. Some people find it helpful to keep a record of what they eat, while others use tools like food scales and portion plates, Garza notes.

Eat healthy foods

When it comes to diet, it can be easy to fixate on how much you eat. But it’s also important to consider what you eat.

The foods you choose can help impact how you feel, keep you feeling full and even impact your disease risk.

“You need to maintain adequate nutrition while losing weight,” says Basen-Engquist. This means eating a balance of protein, fats and carbohydrates, plenty of fruits and vegetables and vitamin-rich options.

MD Anderson dietitians recommend eating meals rich in whole grains, vegetables, fruits, beans, nuts and seeds. Come mealtime, this looks like filling two-thirds of your plate with whole grains, vegetables, fruits, beans, nuts and seeds. The remaining one-third can be lean animal protein or plant-based protein.

RELATED: 36 foods that can help lower your cancer risk

Stay active

The other half of the weight loss equation? Movement.

Aim for at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week. To tell the difference between moderate and vigorous exercise, try the talk test. During moderate exercise — think a brisk walk — you should still be able to hold a conversation, but you won't be able to sing. During vigorous exercise, like running, you might only be able to say a few words without feeling out of breath.

The basic formula for weight loss is no secret: burn more calories than you consume. But actually doing that can feel like cracking an impossible code. Add cancer into the equation, and weight loss feels infinitely more complicated.

We know that excess body weight is a risk factor for more than 10 types of cancer. For some, this knowledge makes weight loss feel especially urgent after being diagnosed with cancer. Others struggle to keep weight on due to cancer itself or treatment-related side effects. For others still, the stress of cancer means weight loss is the furthest thing from their mind.

To put it mildly, there’s a lot to unpack on the topic of weight loss during cancer treatment. To help clear up the confusion, we spoke with clinical dietitian Reeve Reinsborough. Read on for some do's and don’ts to help you decide if losing weight during cancer treatment is right for you and, if so, how to do so safely.

Don’t approach weight loss alone

Trying to lose weight on your own can be especially tricky during cancer treatment. There are so many variables to consider. That’s why Reinsborough stresses the importance of working with your care team to determine if you need to lose weight.

“First, talk with your primary physician or a dietitian to determine if weight loss would benefit you and your health goals,” she says.

While you may want to lose weight, you don’t want to lose your strength and muscle mass in the process. If your care team recommends losing weight, Reinsborough recommends partnering with a dietitian throughout the process.

“Patients undergoing cancer treatment need individualized care both before, during and after their treatments to healthily lose weight,” she says.

Each MD Anderson patient has a registered dietitian on their care team who can help answer questions related to nutrition and weight.

Do know that weight loss looks different during cancer treatment

Life can look and feel a lot different after a cancer diagnosis. Even weight loss during cancer seems to go by different rules.

“The cancer population is completely different than the general public as far as a healthy weight loss journey goes. Although the general idea for weight loss is ‘less calories in, more calories exerted,’ it is important to remember the increased stress that patients go through during treatment even if they are less active than they were previously,” Reinsborough says.

So, if you have cancer, how do you know how many calories to eat a day?  Factors like age, gender, weight and height are used to help predict daily calorie intake. But, for cancer patients, additional factors like the type of treatment you are on can change your nutritional needs. For example, she notes that people receiving radiation therapy may have higher calorie or protein needs. That’s why it can help to talk to a dietitian or doctor about losing weight during treatment.

Don’t use only BMI or the scale to determine if you should lose weight

Body Mass Index (BMI) calculators are a popular way to get an idea of if you are underweight, overweight or at a healthy weight; all you need to do is plug in your height and weight. But the simplicity of BMI calculators can also be a weakness as they fail to consider other factors that might impact weight. The same goes for the number on your scale.

“Your BMI or weight should not be the only indicator that weight loss would be beneficial,” Reinsborough says.

Instead, she recommends speaking to your care team about your health goals. A few reasons she says weight loss may be recommended during cancer treatment include the following:

• Reduce the risk of complications due to health conditions such as:
  • Hypertension
  • Type 2 diabetes
  • High cholesterol
  • Arthritis
  • Joint pain
• Reduce complications during surgery

Do focus on maintaining your weight

Cancer and cancer treatment can take a lot out of you, both mentally and physically. That’s why it’s so important to eat healthy foods that provide a variety of nutrients.

MD Anderson dietitians recommend eating meals rich in whole grains, vegetables, fruits, beans, nuts and seeds. Aim to fill two-thirds of your plate with whole grains, vegetables, fruits, beans, nuts and seeds. The remaining one-third can be lean animal protein or plant-based protein.

RELATED: Healthy foods to eat during cancer treatment

While the idea of your scale being stuck in one place is a common concern among people trying to lose weight, this consistency isn’t a bad thing during cancer treatment. In fact, many people in cancer treatment focus on maintaining their weight.

This doesn’t mean that the scale shows the exact same number every time you weigh yourself. Rather, it means that fluctuations are minor: think 2 or 3 pounds in each direction, Reinsborough says. For example, a 140-pound woman might notice her weight varying from 137 to 143 pounds depending on the day.

Don’t ignore it if you are losing weight without trying

While the idea of weight simply melting off without any effort may be exciting for some, effortless weight loss during cancer treatment should raise a red flag.

“Unintentional weight loss during cancer treatments is very common and can lead to increased risk for several complications or inability to continue with the treatment itself,” Reinsborough says, adding that if you unintentionally lost weight before treatment, it isn’t recommended for you to keep losing weight.

Curious as to why weight maintenance or even gaining weight may be recommended for some cancer patients? It all comes down to safety. Reinsborough explains that maintaining or gaining weight during treatment can help reduce the risk of negative outcomes such as muscle loss, serious falls and prolonged hospital stays.

Tell your care team if you find yourself losing weight without trying so you can make a plan to ensure you get the nutrition your body needs during treatment.

“Focus on providing your body with enough energy and the strength it will need,” she says.

Do tell your care team if you are on weight loss medication 

Be sure to tell your care team if you are using a type of injectable weight-loss medication called GLP-1 agonists. This is because these drugs may impact certain cancer treatments and side effects. 

For example, endocrine neoplasia and hormonal disorders specialist Sonali Thosani, M.D., notes GLP-1 products may make treatment side effects like nausea and vomiting harder to manage. Additionally, GLP-1 drugs can lead to significant weight loss and muscle loss which may make chemotherapy tougher to tolerate.

RELATED: Weight loss injections and cancer: 6 questions, answered

So, if you do use weight loss drugs, tell your care team so they can advise you on the safest path forward. 

Request an appointment at MD Anderson online or call 1-877-632-6789.

Losing weight when you’re not trying to can be frustrating. But it may also be cause for concern.

Cachexia, sometimes called wasting syndrome, is a syndrome characterized by unintentional weight loss and a significant loss of muscle. It could be a sign of cancer or a side effect of cancer treatment. Or, it could be caused by other health conditions. The sooner cachexia in cancer patients is diagnosed and treated, the better their chance to maintain or gain weight and improve their physical function and quality of life.

Here, I’ll explain more about cachexia, including who it affects, how it’s treated and why early intervention is important.

What is cachexia?

Cachexia is more than just unintentional weight loss. It also includes severe skeletal muscle wasting, which is the progressive breakdown of your muscle tissue that controls movement and strength. As cachexia progresses, it causes your body to become extremely weak and decline in function.

What health conditions cause cachexia?

Cachexia can be caused by several health conditions, including:

• Cancer
• Congestive heart failure
• Chronic kidney disease
• Infectious diseases, such as AIDS

What causes cancer cachexia?

The term “cancer cachexia” refers to cachexia that is associated with cancer. It is typically characterized by unintentional weight loss as well as a significant loss of muscle and fat.

Cancer patients often take in fewer calories, either due to treatment side effects or the disease itself. For example, radiation to the head and neck can cause mucositis, which makes swallowing food painful. Chemotherapy can often cause nausea or appetite changes. Depression and anxiety can also play a part because when you have emotional and psychological distress, the gut tends to shut down. And sometimes when you’re fatigued, you just don’t feel like eating.

In addition, cancer increases your metabolism because your body requires more energy to fight off cancer. So, your body’s need for more energy when you’re taking in fewer nutrients can lead to a loss of weight, muscle and fat.

Cachexia is fairly common in cancer patients, most often in those with advanced-stage disease. Patients who are cachectic tend to have worse treatment outcomes.

In a survey of cancer patients in UT MD Anderson’s Supportive Care Clinic, about 50% to 60% were classified as cachectic. For patients with pancreatic cancer, colorectal cancer and lung cancer, that number is close to 80%. We tend to see varying degrees of cachexia, depending on the underlying cancer type.

For example, sarcopenia, the gradual loss of strength and muscle mass without fat loss, is seen more often in patients with breast cancer and prostate cancer.

What are the stages of cachexia?

Clinicians classify cachexia into three stages.

Pre-cachexia

In this stage, you have unintentional weight loss that is less than 5% of your body weight. Your symptoms may include a loss of appetite and metabolic changes like inflammation.

It’s best to catch cachexia in this stage before it progresses. It may be easier to intervene and prevent weight loss.

Cachexia

In this stage, you have either lost:

• More than 5% of your body weight over the past 6 to 12 months, or
• More than 2% of your body weight with a Body Mass Index (BMI) less than 20

Symptoms include loss of muscle, strength and appetite.

Refractory cachexia

This is the most severe stage of cachexia, with a loss of more than 15% of your body weight. At this stage, skeletal muscle wasting is severe and often irreversible, particularly in patients whose cancers are no longer responding to treatment.

Symptoms include extreme loss of weight and muscle mass, as well as functional decline.   

How is cachexia diagnosed?

Diagnosing cachexia is important, specifically in its earliest stage, when treatment is most effective.

That’s why it’s so important for clinicians to document patients’ weight, changes in weight and body composition.

When someone is diagnosed with cancer, these things are documented regularly. With cancer patients, I recommend monitoring their weight at least every three months. In the research setting, clinicians are studying the use of body composition assessment tools to calculate muscle mass. There is research that shows these assessments are better predictors of survival.

At UT MD Anderson, we’ve also started initiatives to document malnutrition risk, which is broader than just cachexia. Malnutrition risk describes a person who may be getting enough nutrients but doesn’t get enough of certain vitamins or essential minerals. This can also play a part in overall health.

How is cachexia treated?

At UT MD Anderson, we focus on treating and managing the symptoms of cachexia. Treatment usually includes a combination of the following:

• Medication: Doctors can prescribe medicine to help with appetite stimulation and weight gain.
• Healthy diet: Everybody should aim for a healthy diet that includes plenty of fruits, vegetables, whole grains and protein. It’s crucial for cancer patients to get enough protein because protein helps build muscle mass. If you’re a UT MD Anderson patient, ask for a referral to one of our dietitians, who can share tips to help you get more protein during treatment.
• Exercise: Exercise – particularly resistance-based activity – can help slow muscle wasting and preserve skeletal muscle mass during treatment. Try activities like strength training using resistance bands, water aerobics or tai chi. Aim for 30 minutes of light exercise per day, three times a week. If 30 minutes is too difficult, break it down into three 10-minute sessions. Any exercise done regularly can be beneficial. It also helps with other cancer treatment side effects like fatigue and neuropathy.
• Supportive care: Our Supportive Care Center can offer physical and emotional support to patients and caregivers. If you’re a patient at UT MD Anderson, ask your care team for a referral.

What is the prognosis of someone with cachexia?

Early intervention is key when it comes to cachexia. If your cancer treatment is working to control the cancer, we will work with you to start increasing your weight and muscle mass. Our goal is for you to at least maintain your weight and function.

Once cachexia reaches the refractory stage, it usually signals that you are very sick. If you are not responding to treatment, we can provide psychosocial support and counseling to you and your caregiver.

What research is being done to help treat cancer cachexia?

New research shows promise for some patients with refractory cachexia. A Phase 2 clinical trial studied the efficacy of the monoclonal antibody ponsegromab in patients with advanced cancer, cachexia and elevated levels of GDF15, a protein that helps regulate food intake, body weight and stress responses.

Results showed that patients who received ponsegromab had improvements in their weight, appetite and physical activity. A Phase 3 clinical trial is currently underway to study the efficacy of ponsegromab in patients who have cachexia and metastatic pancreatic cancer.

The vagus nerve sends signals between the brain and gut, and it helps regulate appetite. At UT MD Anderson, gastrointestinal medical oncologist Xiling Shen, Ph.D., and colleagues conducted research that suggests that targeting the vagus nerve with a non-invasive device could delay the onset of cachexia or prevent it altogether.  

What else should patients and caregivers know about cachexia?

The timeframes associated with cachexia stages don’t always tell the whole story. What happens a lot, unfortunately, is that people are diagnosed with cancer two years or so after unintentionally losing weight. We see this the most with colorectal cancer and pancreatic cancer, where people have unintentional weight loss two years before they are diagnosed. Unintentional weight loss should always be a red flag that something may be going on in your body. So, see your doctor if you experience this. This may allow them to catch a potentially serious health condition sooner.

Caring for a cachectic loved one can be distressing. It’s natural to want to feed and provide nourishment to your loved one with cancer, and you may become frustrated when the patient doesn’t want to – or simply cannot – eat.

If your loved one has cachexia, I encourage you to reach out to their care team. They can help provide support to you both.

Rony Dev, D.O., is an internal medicine and palliative care specialist at UT MD Anderson.

Request an appointment at UT MD Anderson online or call 1-877-632-6789.