Physical Activity Lowers Cancer Risk - More People Should Probably Know That

A new study has found that a large majority of the public may be unaware that lack of physical activity can increase the risk of cancer.

The study, out of Washington University in St. Louis and published Wednesday in the Journal of Health Communication, included a diverse sample of participants who were asked to list three diseases caused by physical inactivity. Just three percent of 351 respondents listed cancer, while over 60 percent listed diseases such as heart disease or diabetes.

These findings add to those of other studies and surveys that have shown that: while many people know that a healthy lifestyle overall can help prevent cancer, many are often unsure about the exact types of behaviors that can lower cancer risk.

A 2017 American Institute for Cancer Research (AICR) survey, for example, found that the vast majority of respondents knew that smoking and sun exposure increased cancer risk, yet well under half identified physical inactivity as a risk factor.

There is a large amount evidence, however, showing the benefit of regular physical activity in relation to cancer.  It can lower the risk of breast cancer, colon cancer, and endometrial cancer. It can help with weight control - a key cancer risk factor. And in cancer survivors, it can improve mood, boost energy level, and possibly lower the chance of recurrence.

Physical activity has been an integral part of the Siteman Cancer Center's Your Disease Risk tool since its launch in 2000, and regular physical activity is recommended throughout Siteman's 8IGHT WAYS cancer series (see below).

Erika Waters, lead author of the Washington University study and Associate Professor of Surgery at the School of Medicine, commented: "People might be more likely to exercise if they understand just how important physical activity is to their overall health - not just their heart health."

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Large-Scale Problem: Obesity Rates Still Increasing in Certain Groups

by Hank Dart

The course of the obesity epidemic in the United States has been so bad for so many years that even minor victories have been cause for celebration. But despite some bright spots in the most recent Centers for Disease Control and Prevention reports on national rates of obesity (on adults, on youth), there's little celebrating going on.  The reason?  Some striking milestones in the rates of obesity in both women and teenagers.

The rate of obesity in US women -- which for most of the past decade rested around 35 percent -- has now surpassed 40 percent -- rising from 35.7 percent in 2005/6 to 40.5 percent in 2013/14, the most recent years for which there are data. And this overall number doesn't tell the complete picture, as the burden of obesity isn't shared equally across all groups.  The rate of obesity is around 38.2 percent in white women, 46.9 percent in Hispanic women, and 57.2 percent in black women.  Asian women have the lowest rate, at around 12.4 percent.

While the numbers in men are concerning as well, they've stabilized somewhat over the past decade, bouncing around the mid-30s, with the most recent report finding that 35 percent of men in the United States are obese. As with women, the numbers for men vary by age, with Asians having the lowest rate (12.6%) and blacks the highest (38%).

The new numbers for youth are not quite as striking - but remain concerning as well.  They show that over the past 25 years the rate of obesity in adolescents and teenagers has nearly doubled -- from 10.5 percent to 20.6 percent -- with the overall rate of obesity in youth ages 2 - 19 years old now at 17 percent, up from 10 percent in 1988.

There are, however, two positive trends in younger kids, with rates of obesity dropping since 2004 in 2 - 5 year olds and leveling off since 2008 in 6 - 11 year olds.

The overall picture of obesity in America, however, can be quite discouraging, even for the optimists who tend to work in public health. The epidemic began over two decades ago, and no efforts so far have been able to make real strides in reversing it. And the health, quality of life, and fiscal implications are enormous.

In a recent Viewpoint in the Journal of the American Medical Association, David Ludwig, MD of Harvard Medical School and the New Balance Foundation Obesity Prevention Center writes that the latest evidence may support predictions that the obesity epidemic and its health consequences may begin to shorten life expectancy in coming generations. While advances in the treatment of obesity-related chronic diseases like heart disease, diabetes, stroke, and cancer have kept mortality rates of these disease relatively stable or on the decline, a new provisional report on death rates suggests that mortality rates may now be increasing for some diseases.  The obesity epidemic could be creating more disease, and more serious disease, that advances in treatment can no longer keep up with.

Making progress against the epidemic is going to be essential if we are to help prevent growing rates of disease in the years and decades ahead.

In addition to bolstering research on the causes and prevention of weight gain, we need to support efforts that help people make and maintain healthy food and activity choices.  As with the fight against tobacco, this means multi-pronged, multi-layered approaches - such as improved food and activity offerings in schools and workplaces, taxes on unhealthy foods, subsides for healthy foods, widespread communication campaigns, and infrastructure that allows people to easily and safely fit activity into their days.  The social, financial, and structural environment that surrounds us is key to making and sustaining healthy behaviors.

Stemming the tied of weight gain in the US will not be easy, but it's essential that as a society we garner the will to put in place a concerted effort that will benefit current and future generations.

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See also:

Other Cancer News in Context posts addressing cancer, chronic disease, and weight.

Unwrapping Holiday Weight Gain - and Ways to Prevent It

by Hank Dart

We’re in the middle of it now. The holiday season – that wonderful and stressful five-week stretch from Thanksgiving to New Year’s where at every turn, there seems to be food. And not just everyday food, but food of such amounts and enticing types that it can feel nearly impossible at times to refuse them.

Add the long nights, cold weather, and busy schedules that throw us off our normal exercise routines, and the stage can be set for entering 2016 with our clothes fitting just a bit tighter than they did earlier in the fall.

If this scenario feels all too familiar from holidays past, you can find some comfort in knowing you’re not alone. Studies have found that holiday weight gain is a very real thing that many people struggle with.

How much weight gain are we talking about?
Though it can vary greatly from person to person, typical weight gain over the holidays is around 1 to 1.5 pounds. But, many people gain considerably more, on the order of 5 pounds or more, says Dr. Samuel Klein, William H. Danforth Professor of Medicine and Nutritional Science at Washington University School of Medicine.

And the weight put on over the holidays makes up a large proportion of the weight that most people gain every year. A study in the New England Journal of Medicine found that of the weight that participants on average gained over the course of a year, just over half was put on during the holidays (1).

It’s like the party guest that never leaves. And that’s what makes holiday gains problematic, according to Klein: “People usually do not lose the weight they gain during the holidays and it is a major cause of yearly weight gain and increasing body weight in the United States.”

Of course, the amounts don’t sound like anything that’s really worth worrying about. A pound here. A pound there. But weight gain has a way of silently creeping up on people. And over the years, it can turn into noticeable amounts that can have a negative impact on both health and quality of life.

Assuming a gain of just one pound per year, for example, someone who is 5’9”, weighs 165 pounds, and has a “healthy” BMI of 24 would be well into the middle of the “overweight” category after 20 years (BMI of 27) and then crest into “obesity” after 40 years (BMI of 30). With the large majority of people in the United States already overweight or obese, these movements can happen even faster, not only because the starting BMI is higher but also because holiday weight gain is often larger in those who are already overweight.

“In general, [holiday] weight gain is proportional to BMI. People with higher BMI tend to gain more weight,” says Klein.

And findings from the New England Journal of Medicine study provide a good example of this. Of those participants who were overweight, 11 percent experienced “major holiday weight gain” of 5 pounds or more. In obese, participants, the proportion rose to 17 percent. In healthy weight participants, only 5 percent experienced a major gain.

How many extra calories does it take?
So, how much overeating does it take from Thanksgiving through New Year’s to cause the typical holiday weight gain? Surprisingly little it turns out.

In a paper in Physiology & Behavior, Dale Schoeller of the University of Wisconsin ran some numbers and concluded that it took just 55 extra calories a day to build up to the average holiday gain of about a pound (2). That’s around the amount in that cookie you grabbed on the way out the door at your work party or that dollop of whip cream you put on your pie.

What can we do about it?
Keeping weight in check is hard any time of year, let alone over the holidays when we’re thrown off our regular routines. But it’s far from impossible. A lot of people come through the holidays without gaining any weight, and some even harness the change in schedule to their advantage and are able to lose a few needed pounds.

Looking at all the meals, parties, and other holiday-themed gatherings that are part of the Thanksgiving to New Year’s season, there are some practical approaches that can help us keep excess calories, and weight gain, at bay.

Klein offers these practical tips for holiday events:

“Portion control”
One of the best ways to keep calories in check is to cut back on portion size. We’ve gotten really used to huge meals, huge snacks, and huge drinks. Put smaller amounts of food on your plate, or try simply choosing a smaller plate. Most of the time you’ll find that smaller amount is all you really wanted.

“Eat before going to parties so that you are less hungry”
Coming to a party when you’re feeling ravenous can lead to overeating. The better approach is to have a healthy meal or snack at home and then head to the festivities. This way, all those alluring high-calorie choices won’t hold quite as much sway.

“Stay as far away as possible from the food tables at parties”
This falls into the “out-of-sight., out-of-mind (and stomach)” category. Just giving yourself some distance from the food at an event can make it less likely that you’ll grab food mindlessly, even when you’re not hungry.

“Minimize alcohol intake”
Alcohol is a big part of many holiday gatherings, which is fine in moderation, of course. It’s a time of celebration. But, if you’re watching calories, it’s probably best to keep drinking to a minimum. Alcohol is an appetite stimulant and can quickly disrupt your best-laid plans to avoid eating too much.

“Keep a low-calorie or zero-calorie drink in your hand”
From eggnog to wine to sugary soda, the holidays are filled with high-calorie (and often alcoholic) beverages that can contribute to extra calories. When you get to an event, pick up a low-calorie drink – like fizzy water, coffee, or diet soda – so your host, or best friend, isn’t tempted to give you a high-calorie option.

“Bring a low-calorie dessert or food”
It’s good form to bring a small gift when you’re invited to a dinner party. And most of us default to a bottle of wine or six-pack of beer or sugary soda. If you’re watching calories, try bringing a low-calorie appetizer or dessert option instead – like a platter of vegetables or fresh fruit with a low-calorie yogurt dip. It may feel a little self-serving, but you can bet that others will appreciate it, too.

On top of these special tips for holiday events, it’s also important to keep up with the tried-and-true weight control strategies that apply year-round: exercise every day; keep screen time to a minimum; choose a diet rich in fruits, vegetables, and whole grains; and try to be aware of how much you’re eating. In the end, it’s the calories we burn and the calories we eat that really matter.

Crazy as they can be, the holidays always hold a special place on our calendars. With a little planning, and a few simple steps, we can keep them from making a lasting mark on our waistlines as well.


For more healthy tips - for the holidays and year-round, visit

8IGHT WAYS to Stay Healthy and Prevent Cancer 

Your Disease Risk

Siteman Cancer Center - Healthy Holiday Cookbook 

Photo: Cake cut by Rebecca Siegel (CC License, CC BY 2.0)

References

1. Yanovski JA, Yanovski SZ, Sovik KN, Nguyen TT, O'Neil PM, Sebring NG. A prospective study of holiday weight gain. N Engl J Med. 2000;342(12):861-867.

2. Schoeller DA. The effect of holiday weight gain on body weight. Physiol Behav. 2014;134:66-69.

Photo: Cake cut by Rebecca Siegel (CC License, CC BY 2.0)

8 Ways to Lower Colon Cancer Risk in One Simple Graphic

by Katy Henke

Colon cancer is the third most common cancer in the United States. The good news is that 75 percent of cases could be prevented with healthy lifestyle choices. These eight simple tips can help you lower your colon cancer risk and improve your overall health (PDF). For more information and prevention tips, visit 8ways.wustl.edu.

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Practical Steps to Prevent Breast Cancer: Day 2 - Be Physically Active

It's day two in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.  

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Day 2 - Be Physically Active

Exercise is as close to a silver bullet for overall good health as there is, and those benefits certainly extend to breast cancer. Women who are physically active for at least 30 minutes a day have a significantly lower risk of the disease than those who don’t. Regular exercise is also one of the best ways to help keep weight in check.

Tips and Tricks – Physical Activity

Choose activities you enjoy. When thinking about physical activity, it’s easy to conjure up unpleasant images: pained faces at the end of a marathon or grunting athletes at the gym. It’s no wonder exercise gets a bad rap. But, in reality, exercise can be really enjoyable. It’s just a matter of picking the right activity. Whatever gets you moving at a hard enough effort, counts towards your 30 minutes a day. The talk test is the best way to know if you’re going hard enough. If you can talk while you’re exercising, but can’t sing, that’s perfect. And there are a lot of activities that can put you right in that sweet spot - walking, cycling, dancing, playing tennis, even certain types of gardening and housework.

Make exercise a habit. There are good habits and bad habits. And if you’re like most folks, you have a mix of both. One thing that all types of habits share, though, is power. No matter how busy we get, or how crazy life is, we can almost always fit in our habits day in and day out. Making an effort to turn exercise into a habit can be a powerful tool in the fight against breast cancer and other serious diseases. So how do you do that? The best way is through consistency. Try going to the gym each day at lunchtime or taking a walk regularly after dinner. You may not always feel like doing it, but by doing it nevertheless, it’ll become ingrained into your day. Before you know it, a day won’t feel normal if you didn’t get in your walk, run, or trip to the gym.

Stay motivated by exercising with someone. Friends, family, and workout partners keep you honest. So one of the best ways to make sure you fit in your regular physical activity is to have a standing date to work out together a few days each week. It can be a lunchtime walk, a spin class, or a ballroom dancing class. The most important thing is to set the date and keep it. If you don’t, you’re likely to hear about it.

Get a pedometer and shoot for 10,000 steps each day. If you’re looking for a great way to stay motivated, it’s hard to go wrong with setting a goal of getting 10,000 steps each day. This has become a standard for a healthy activity level and includes all the steps you take – at work, at home, at the park, at the grocery store. To get started, all you need to do is buy an inexpensive pedometer (good ones start at $10), put it on at the beginning of each day, and keep moving until is ticks over 10,000. You’ll be surprised how that simple little plastic pedometer can keep you on track with your exercise goals.

Do healthy activities with your kids. Life with little kids can be exhausting and leave very little time for regular exercise. One of the best ways around this is to do healthy, activities with your kids. Whether it’s riding bikes together, going for a run with them in the jog stroller, or just playing tag at the park – the important thing is that you get your exercise, and the kids do, too. Together, you build a fantastic family habit of activity and exercise.

Next Steps – Physical Activity

Looking for more in-depth information on physical activity? Here are some good sources:

National Heart, Lung, and Blood Institute
http://goo.gl/AMexBS

ChooseMyPlate.gov
http://goo.gl/Yv0wMM

Excerpted from TOGETHER - Every Woman's Guide to Preventing Breast Cancer

Photo: Flickr/giuseppemilo (CC license)

Bottom Line of New Study: Colon Cancer is Quite Preventable

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A large proportion of colon cancer is preventable with healthy lifestyle choices, even without taking into account the benefits of screening.  That's the finding in a new analysis from the large Nurses' Health Study released in print last week in Cancer Causes & Control.  The analysis, done by researchers from Stanford and Harvard Universities, calculated the percentage of colon cancers in women that could be attributable to a combination of lifestyle choices that have been found in previous research to be established risk factors for the disease: overweight/obesity, lack of physical activity, alcohol intake, smoking, low multivitamin use, and low calcium intake.

Comparing women who had only one or none of these risk factors with women having two or more, the researchers found that 37 percent of colon cancer cases in women could be avoided through healthy lifestyle choices.  This proportion was even higher when aspirin use was considered.  Though not a lifestyle choice, per se, long term aspirin use has been shown in many well-designed studies to lower the risk of colon cancer.  When aspirin use of just twice a week for six years or more was added to the analysis, the percentage of cancers estimated as preventable rose to 43 percent.

These percentages are quite significant and do not even take into account the further benefit of colon cancer screening, which in addition to catching cancer early can also prevent the disease by finding (and removing) pre-cancerous growths.

Though some other analyses have estimated even greater proportions of cases potentially preventable, these new findings still demonstrate that colon cancer is a very preventable cancer - and with lifestyle choices that many women can follow.  Key steps for lowering the risk of colon cancer include:

• Getting screened, beginning at age 50, or earlier if you have a family history.  Talk to a doctor about which screening test is right for you and when you should start screening.  
• Keeping weight in check
• Not smoking
• Being physically active
• Drinking only moderately, if at all
• Limiting red meat, especially processed meat
• Getting enough calcium and vitamin D
• Considering a multivitamin

Regular aspirin use has also been found to lower the risk of colon cancer, but it has some important risks as well (such as serious bleeding). One recent analysis, though, suggests that regular aspirin use may have overall health benefits for some older adults. However, it's important that anyone considering taking aspirin regularly talk to a doctor about the potential risks and benefits before doing so.   

For more on screening and other steps to prevent colon cancer, see 8IGHT WAYS to Prevent Colon Cancer (PDF version).

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Top photo: Flickr/thomasletholsen

New Study Shows Being Sedentary is Bad for Physical and Fiscal Health

Creative Commons photo (cropped): Flickr/hjl

There is no magic bullet that will guarantee good health.  That's just an unfortunate fact of life.  But there is something that can help stave off heart disease, diabetes, cancer, osteoporosis, and depression, while also helping us maintain a higher quality of life as we get older.  And it's largely free and accessible to just about everyone: physical activity.

We've written a lot over the years here on Cancer News in Context about the benefits of being active, but not very much about the economic costs of being inactive - both for individuals and for the nation as a whole.  Yet, with the nation growing older and health care costs continuing to accelerate, there's a fantastic need to highlight effective and simple approaches to address such issues. And a new study out this month in Progress in Cardiovascular Diseases highlights just how important regular physical activity is to the physical and economic health of the nation.

The Power of Youth: Beginning Breast Cancer Prevention in Childhood

Creative Commons photo: Flickr/CatDancing (cropped)

We've written a lot recently about the importance of breast cancer prevention starting early in life, both here on Cancer News in Context and in a guest post on the American Association for Cancer Research blog, Cancer Research Catalyst.  Though most breast cancer research focusses on women in midlife and older, more and more evidence supports the years between early adolescence and when a woman has her first child as key to laying down risk for breast cancer later in life.  Breast tissue in these years appears to be particularly vulnerable to certain risk factors that can have a durable influence on risk.

Diet and physical activity seem to be especially key in youth.  Eating foods rich in vegetable protein and low in animal products can help lower risk -- as can being physically active and keeping weight in check.  For teens and young adult women, avoiding alcohol - or at a minimum avoiding heavy drinking - is also important.

Our overarching message is that to optimize breast health a healthy diet, regular physical activity, and healthy weight are key habits that should begin in - and be fostered throughout - childhood and into adolescence and beyond.  Prevention is something that can almost never start too early.

A pie chart we use to illustrate the power of breast cancer prevention starting in childhood shows that healthy behaviors starting as early as age two years old could help avoid 68 percent of breast cancers (see figure).  The idea of beginning breast cancer prevention at two can seem extreme and has struck a chord with the media (see image).  And in many ways that is understandable, since breast cancer is a disease that seems so far off - striking most women much later in life - and breasts don't even fully develop until the teen and young adult years.

Yet, we know that healthy behaviors aren't easily turned on and off like spigots.  Healthy behaviors are learned over time, and the sooner in life they are set, the more likely they are to be carried on throughout childhood and into adulthood, and the more likely they are to have a positive impact on long term health.  This is why the Dietary Guidelines for Americans apply to everyone age two years old and over.  That breast tissue seems particularly vulnerable in youth and young adulthood adds even more reason to begin good breast health habits as early as possible.

For parents, the key is simply to help their children make healthy choices that they can follow throughout life.  This will not only help them lower their risk of breast cancer as adults, but also heart disease, stroke, diabetes, osteoporosis, and even depression.

See the excerpt below from our upcoming book on breast cancer prevention for breast health tips for the parents of young girls.

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Young daughters (2 years – 10 years)

As challenging as the period between ages 2 years old and 10 years old can be as a parent, it does offer some sense of control and the ability to steer your children in positive directions.

Within reason, the food you put on the table is the food they will eat and likely come to enjoy – even if it can take some struggling, pouting, and tears along the way, from them, and you. Similarly, if you’re a family that plays at parks and goes for walks throughout the week, that’s something that will become ingrained in a child as well and something they’ll likely wind up doing throughout their lives and eventually with their own children.

With young daughters, there are three simple things to focus on: healthy activity, healthy food, and healthy weight. Pretty straightforward stuff, but in today’s busy world where both parents often work and have very little time to think about such things, they can be much easier said than done.

Luckily, creating a healthy environment for our children isn’t very complicated or time-consuming - with a little planning and a little effort.

Let little legs move

We can easily get caught up in all the detailed recommendations we read about physical activity. Moderate intensity. Vigorous intensity. Aerobic. Strength. X number of minutes a week. And, yes, those can be important, but when it comes to young kids, it’s really less about making our kids reach some time targets for activity than it is about simply giving kids the opportunity to be kids. Because being active is really their natural state.

• Be physically active as a family, every day if possible. Go on walks, ride bikes, shoot hoops, dance – whatever gets everyone moving.
• Encourage children to play outside (when it’s safe) and to take part in organized activities, including soccer, gymnastics and dancing. 
• Walk or ride bikes with your kids to school in the morning. 
• Find safe places for children to play when weather is really bad: indoor playgrounds, YMCA, shopping malls.

Freeze the screens

Children grow up as digital natives these days, but that doesn’t mean that all that screen time doesn’t have health repercussions. Too much screen time takes time away from physical activity and can promote unhealthy eating.

• Limit TV, tablet, computer, and other screen time to under 2 hours a day. The less the better.
• Keep TV, tablets, and smartphones out of children’s bedroom’s. 
• Choose one day each week to go TV and tablet-free as a family. Board games and family book or cooking clubs are great screen-time alternatives.

Offer a lot of plant foods

When it comes to promoting breast health later in life, getting daughters to eat a lot of plant-based foods early in life is likely important. This means focusing on fruits, vegetables, nuts, whole grains, and eating less full-fat dairy and meat.

• Make fruits and vegetables a part of every meal. Put fruit on cereal. Cut up vegetables as a snack. 
• Dice vegetables into soups, sauces, even batters. It’s an easy – and tricky - way to add more veggies to meals. 
• Keep fruit out where kids can see it: on the counter, on a desk, in a backpack. If they can see it, they’re more likely to eat it.
• Offer whole-grain cereal, brown rice and whole-wheat bread over refined choices, like white rice and white bread. 
• Keep sugary drinks, like sodas, fruit drinks, and energy drinks to a minimum.
• Try a meat-free week. The family just might like it.
• Make dishes made with olive or canola oil, which are high in healthy fats. 
• Cut back on full-fat dairy, fast food, and store-bought snacks (like cookies), which are often high in unhealthy fats.

Don’t obsess but keep track of weight

Weight is clearly a loaded issue, especially for girls. And it’s important not to create or perpetuate in your daughters – or any girls for that matter – unhealthy body image. In today’s world of Photoshopped models and selfies, females of all ages have a hard enough time comparing themselves to unreal expectations of beauty and body size.

At the same time, however, it’s important for parents to be aware of their daughter's weight and to know whether it may be too low, too high, or in the normal range. Surprisingly, studies show that many parents have trouble knowing if their child is an unhealthy weight or not. So, simply knowing can be a victory in itself.

A good place to start if you have questions about your child’s weight is the CDC’s BMI Calculator for Child and Teen. This tool uses a special calculation of weight, height, gender, and age to estimate whether a child is underweight, normal weight, overweight, or obese. Because children are still growing and developing, these labels are not always perfectly accurate, so it’s important to bring up any concerns about your child’s weight directly with a healthcare provider.

• Keep track of your child’s weight and bring up any concerns with a health care provider.
• Help your daughter focus on healthy food choices and healthy activities rather than on weight and body image.
• Give your children the chance to be physically active every day.
• Limit sweets and processed foods, which are often high in calories as well as carbohydrates that can stimulate hunger.
• Limit TV, tablet, computer, and other screen time to under 2 hours a day. The less the better.
• Help your children get enough sleep by setting a bed time and sticking to it every day. Keeping electronics out of the bedroom also helps with sleep.

Time on the Side: New Analysis Finds That to Eat Less - Eat Slower

Photo: Flickr/thomashawk

It probably comes as no surprise, but mom was right: We really shouldn't eat so fast.

Apart from the noise and the mess and the ill-effects on dinner table conversation, wolfing down food may have ill-effects on health as well.

A detailed new analysis in the American Journal of Clinical Nutrition shows that taking your time when you eat can substantially cut down on how much you eat.  And in today's world, where at least two thirds of the nation struggles with weight, this can have important implications.

The researchers performing the analysis combined the results from 22 separate studies looking at speed of eating and the amount of food eaten.  What they found was that those who ate their food slower ate less overall than those who ate their food faster, and apparently without feeling deprived.  Eating speed - fast or slow - had no effect on feelings of hunger, either right after a meal or three and half hours later.

We live in a society that often works against us when it comes to choosing healthy food and getting physical activity.  This can make it tough to lose weight, or even stay at the same weight. Yet, there are some simple steps we've promoted for a long time that can help with cutting back on calories and burning more calories through exercise.  Eating more slowly is one of these.  It may take some re-training of eating habits but in the end, its a pretty simple step  - just sit back, enjoy your food, and let time do the hard work.  In the end, we're likely to have eaten less - and to feel just as satisfied.

Try this and other tips to help keep weight in check: 

Choose smaller portions, and eat more slowly.  At the most basic level, eating slowly gives our stomachs time to tell our brain when we’ve had enough food.  As competitors at the Nathan’s Hot Dog eating contest will tell you, it takes about 8 minutes or so for the brain to register when the stomach’s full.  If you eat too quickly, you can down a plate of food, grab more, and then down that before your brain knows what hit it.  By then, you may have had twice as much food as you needed or even really wanted.  So why not slow down and enjoy your food.  You won’t even miss the extra food you’re not eating and that you didn’t even really want.

Fit physical activity and movement into your life each day.  Regular activity is one of the best ways to keep weight in check.  Choose things you enjoy that get you moving and shoot for at least 30 minutes a day.  And studies show that 60 minutes or more is even better for weight loss. 

Limit time in front of the TV and computer.  Screen time – the phrase given to time spent with our TVs, computers, phones, and tablets – is a double whammy when it comes to weight and health. Not only does it up the amount of time we spend each day in complete inactivity, but it also makes it more likely that we’ll overeat (especially unhealthy foods) while we’re sitting in front of those screens.  Shoot for under two hours of non-work screen time each day.  Less is even better.  Zero is ideal.  

Eat a diet rich in fruits, vegetables, and whole grains.  Eating a lot of plant-based foods can help keep appetite and weight in check.  Not only are they very filling but they also keep at bay wild swings in blood sugar that make you want to eat – even if you’ve just had a big meal.  Shoot for at least 3 servings of whole grains a day, 5 serving of fruits and vegetables, and keep red meat to a minimum.

Data Show More Support Warranted for Worksite Wellness Programs

Photo: Flickr/abraj

This week I had the privilege of addressing the American Cancer Society CEOs Against Cancer at their annual meeting that this year was held at Washington University in St. Louis. As a member of the panel addressing worksite wellness, I was able to briefly summarize the strong evidence that worksite wellness programs can generate substantial savings. For example, in a critical meta-analysis of the literature on costs and savings associated with workplace disease prevention and wellness programs, Baicker, Cutler and Song (2009), show that medical costs fall by about $3.27 for every dollar spent on wellness programs. In addition, absenteeism costs fall by about $2.73 for every dollar spent.

Others have summarized the evidence on worksite physical activity and nutrition programs. A systematic review and meta-analysis of 18 programs shows that physical activity and nutrition programs are effective in reducing body weight when compared to usual care (van Dongen et al., 2012).

Even more impressive are the benefits of smoking cessation. Halpern and colleagues (2007) show savings in terms of reduced healthcare costs. The savings per smoker range from $350-$582 at 10 years, with internal rate of return ranging from 39% to 60% at 10 years. In addition, as noted in the 50th anniversary Surgeon General’s Report on Smoking and Health (2014) after stopping smoking, former smokers experience an increase in their quality of life. Never smokers have the lowest health care costs in the age range of 45 to 64. Smokers have a loss of productivity in the workplace through absenteeism and also incur more hospitalization and medical charges as a result of outpatient visits. It is the sum of these benefits of quitting smoking, over several years, that drives the benefits of worksite wellness.

A rigorous evaluation by investigators at RAND evaluating a worksite wellness program that included prevention services as well as navigation and support for those with chronic conditions also shows substantial savings (Liu et al 2013). Disease management interventions reduce costs per employee per month significantly. The prevention interventions also substantially reduced costs. While such a program has expenses in the first year, savings are visible in 3 to 5 years after implementing a worksite wellness program.

In sum, worksite wellness programs save employers in terms of health care costs and increase productivity of the workforce. It is hard to see why we don’t have even more support for these programs across all workplaces.

References
Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Aff. 2010;29:304-311.

DeVol R, Bedroussian A. An Unhealthy America: The Economic Burden of Chronic Disease. Santa Monica, CA: Milken Institute. 2007. 

Halpern, MT, Dirani, R, and Schmier, JK. Impacts of a Smoking Cessation Benefit Among Employed Populations. J Occup Environ Med. 2007;49:11–21. 

Liu, H, et al. Effect of an Employer-Sponsored Health and Wellness Program on Medical Cost and Utilization. Population Health Management. 2013;16:1–6.

U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014. 

van Dongen, JM, et al. A systematic review of the cost-effectiveness of worksite physical activity and/or nutrition programs. Scand J Work Environ Health, 2012. 38:393-408.

Sitting, Cancer Risk, and Developing Strategies to do Something About It

Photo: Flickr/DanielGo

This post seems a bit cruel, coming out as it does during the current TV season's finale week and the beginning of the World Cup.  But, science doesn't rest - not even for Game of Thrones or the Brazilian national soccer team. So, neither do we.

Just released on the Journal of the National Cancer Institute's website is a new analysis by two German researchers that combined the results from numerous studies on sedentary behavior and found that the simple act of sitting can significantly increase the risk of multiple cancers, including colon cancer, endometrial cancer, and lung cancer.  Even in those who exercised regularly, being sedentary increased cancer risk.

The large analysis looked at data from 43 observational studies that included nearly 70,000 cancer cases.  The researchers found that, compared to those who sat the least, those who sat the most had a 24 percent higher risk of colon cancer, a 32 percent higher risk of endometrial cancer, and a 21 percent higher risk of lung cancer.  When looking only at TV viewing, the risks jumped considerably, with the risk of colon cancer increased by 54 percent and endometrial cancer by 66 percent.

Researchers hypothesized that time spent watching television was linked to greater risk than say, time spent sitting at work, because people who are watching TV are more likely to spend that time eating unhealthy foods, drinking alcohol, and smoking.

Although regular physical activity is a great boon to health, this new report also helped confirm that exercise is not enough on its own to protect against the health risks of an overall sedentary lifestyle.  Even after taking activity level into account, high levels of sedentary behaviors still increased the risk of colon cancer by 20 percent and endometrial cancer by 32 percent (see figure).

In an accompanying editorial, Washington University School of Medicine researchers, Lin Yang and CNiC's Graham Colditz, discuss how the continuing modernization of society sets the stage for increasingly sedentary lifestyles and the negative health effects that go with it.  To successfully combat sedentary lifestyles it will take approaches similar to those that helped rein in tobacco use and that have just started to show some success against obesity. The key is targeting multiple layers of society, and with appropriate resources.  These include worksite policies that can help reduce sitting time (such as, standing desks, regular standing/walking breaks, and active (vs. passive) commuting benefits) and programs focussed on youth that promote physical activities as an attractive choice to sedentary screen time.  

With recent high profile studies, sitting is quickly being recognized as the health risk that it is.  For many years, it was seen simply as the direct opposite of exercise and physical activity.  And while there are clearly close links between the two, it's now clear that it is an important cancer risk factor even in those who exercise regularly.

Because this relationship has taken a while to be broadly recognized, we're behind in developing strategies to effectively address the issue.  As Yang and Colditz state:  "strategies remain poorly defined to meet this goal [of reductions in sedentary behavior]."

Now that we have the results of this latest analysis to further show the impact that sedentary lifestyles are having on our health, it's time to develop an approach to address the issue with the energy and resources that are equal to its impact.