Cancer and Weight
Satisfying the urge to show off my home city of St. Louis this summer, I took my family to the downtown
river area. On its banks, we noticed the statue of a man waving his hat as if beckoning us to follow him.
He was more than knee deep in the Mississippi, and I concluded that he was either Lewis or Clark
waving his team to cross the river. My son laughed at such a folly saying they would all drown, pulled by
its strong currents and eddies. However, I later saw a photograph of an un-submerged Clark kneeling
besides Lewis’ bottom half. It became clear that the Mississippi had engulfed the statue of one of our
most famous explorers. A few days before, the water level even reached the steps of the Gateway Arch
which stands much higher, a reminder of what happened 15 years ago.
As an undergraduate in 1982 at St. Louis University, I vividly recall my geology professor predicting that
the great river responsible for the birth and growth of St. Louis would one day flood beyond any proportion
that one could imagine, possibly in our lifetime. Few took him seriously. After all, the worst flood
recorded was in 1927 and it was deemed the worst the river could ever achieve. However, his careful
study of the geological layers miles away from the river indicated that it was responsible for those
sediments, which only possible with massive flooding.
Just 11 years later, in October 1993 the Mississippi flooded an area 30.000 square miles. Amazingly, the
river had to climb only 20 feet beyond the flood stage to spill over to submerge an area 700 miles long
and 400 miles wide. The “500-year flood” my professor predicted left all the naysayers completely
speechless.
Not unlike destructive events in nature, epidemics in medicine also occur. Luckily they are not cyclic—we
don’t get a Bubonic Plague every 500 years. But like my geology teacher’s discovery, there are clear
signs both close and far from the source that a medical Tsunami is heading our way soon. We could
consider a “close” sign to be the fact that the number of obese people in the U.S. population and
worldwide is reaching not epidemic, but pandemic proportions—so much so, that some are beginning to
wonder whether obesity may be caused by a virus, and bonafide investigations to this effect are
underway. The CDC estimates that more than a third of our population is currently obese. This number
has doubled every 25 years. More “distant” signs in the sediment of evidence could be extrapolated from
the total number of hours people are spending in front of televisions and computers which is also
increasing exponentially.
If we assume this trend continues linearly as it has in the last 35 years, in less than 50 years the entire
country will be obese. Impossible? In the July issue of Obesity Dr. Youfa Wang confirmed this projection
stating that by the year 2030, at this rate obesity will hit 86%, and in the following decade, 100%!
How could this ever happen? If we want a glimpse of a future, just take your children to see the latest
Disney movie Wall-E. In the film, people in the future were so buried in computers and technology that
the population was indeed 100% obese, had lower bone mass, and weakened to the point that if they fell
out of their chairs, they became completely helpless, like walruses on ice, to help themselves back up.
Are we there yet?
And yet, no reversal in the trend is seen despite the well known danger even most children are aware of:
obesity is bad for your health.
The Mississippi didn’t flood in one day. Different events staged the flood of ’93 from various regions
upstream, starting from April, until the flood crested in October. Similarly, this medical pandemic won’t
occur tomorrow. No one knows exactly how long it takes for obesity to begin to reveal its damage to our
health. But we can assume an approximate period of about fifteen to twenty-five years, that is, from young
adulthood until our middle ages. A frightening fact is that about twenty five years ago, the obesity
numbers began to climb. This lag time in obesity and the onset of disease means that we will begin to
see the flood level rise—not in months like the Mississippi, but still in a few short years. In fact,
contributions to the flood have already begun upstream at our workplace. More and more sick days
accumulate as obese people begin to feel the aches and pains of arthritis, gallstones, sleep apnea,
lower back pain, gout and depression worsen. Very soon the next stage upstream of the flood will be
evidenced through our own pocketbooks with more and more serious illnesses beginning with
hypertension and diabetes. Insurance rates will climb as we try to keep up with the cost of prescription
drugs and outpatient and inpatient treatments from cancer patients. The care of breast, colon and
endometrial cancer patients will translate into millions to billions of dollars as the cost of technology
increases to help cure or control their disease.
The next stage upstream before the obesity flood is the surge of disability claims due to the association
of obesity and its ensuing effects on cardiovascular disease, and on diabetes. These effects include but
are not limited to stroke, heart attacks, kidney problems, carpal tunnel syndrome, and visual problems
including blindness. There are also many other obesity -associated complications for example deep vein
clots, infections, preeclampsia in pregnancy just to name a few. These will all contribute to a
catastrophic loss of people in our workforce. The water level continues to rise.
Like smoking, there is a strong association with obesity and a wide spectrum of illnesses. Obesity
causes up to 70% of diabetes and cardiovascular diseases, two of the three major killers in the United
States; the last of these being cancer. During the nineties in medical school, we learned of the
association of cancer and obesity. But in practice, I noticed that more and more of my cancer patients
were overweight or obese. I often wondered if it was not just an association, but rather, that there was a
direct link between the two. To my chagrin my suspicions were confirmed. Evidence continues to amass
to reveal a much stronger and dangerous link than I imagined. In fact, about a third of the incidence of all
cancers is now thought to be due to obesity. Unfortunately, if these trends continue, the second stage of
the flood will inevitably meet and then surpass the numbers of patients suffering from smoking related
illnesses.
Finally the water level will breach the floodwalls. Just like the Mississippi, exceeding only 20 feet above
flood stage to devastate an area covering much of the Louisiana Purchase, very rapidly our entire health
system will find itself deluged and overflowing with inpatients and outpatients alike due to strokes, heart
failure, end stage renal disease, amputations, coronary heart disease and cancer. The natural cycle of
this stage of disease lasts about 15 years or so from its onset, and thus we should expect the “real” flood
to begin about the year 2015 give or take a few years.
The Mississippi finally receded later that year in 1993, and the costs were in the billions of dollars to
repair its aftermath. Could something else have been done to prevent the floods from breaching the
levees?
A logical question is: should we build higher levees? These diseases have already begun to mature,
and there may be little to do to reverse it. Higher flood walls translates into building more hospitals and
clinics, and preparing our government to increase funding to Medicare urgently, and very, very
generously. But would that prevent the multi-billion dollar catastrophe in the end?
To our dismay, unlike the Mississippi, this flood won’t recede in one year. The total population only
increases every year; currently it stands at about 300 million. With an estimated 50% obesity rate in 15
years, this means 150 million people will be obese. A third of these diseases is attributed directly to
obesity, and another third indirectly. What does this mean? We haven’t seen anything yet! Fifty to one
hundred million sick people to care for with neither the means nor the funds to do so. Ours and many
other countries will become bankrupt trying to keep up with their care, and finally many will go without it,
or have low quality care at the most.
Armed only with evidence from these early upstream swells, and still recovering from 9/11 and the Gulf
Wars, and a flood naysayers that are bound to emerge to act as contrarians, we simply won’t be able to
convince our government and the private sector to fund the construction of 100 foot flood walls for this
second wave. The first flood is inevitable, and already too late to prepare for. But unlike our
helplessness against the powers of Mother Nature, we have the means to reverse the second flood
before it even happens.
Not only can many of these diseases be reversed through weight loss, but obesity itself can be avoided if
the culture of internet and television most of us enjoy becomes a lesser part of our lives. With the
irresistible call of TV and its ever increasing fun and diverse content, cooler and more complex
videogames, and our always-improving and fascinating internet with its venues such as chatting and
social networking, this will be extremely difficult—not just for kids, but especially for adults. Unless
technology finally becomes less interesting and physical activity becomes the rage, we may be able
reverse the beginnings of these floods today.
There is hope. Last year, the "WINS" study involving women with breast cancer determined that a change
of diet to reduce fat intake from about 50 grams to about 30 grams daily, which also led to weight loss,
resulted in a 25% reduction in breast cancer relapses. Another link between weight loss and avoiding
cancer in patients not currently with cancer has recently been determined. This summer, a very exciting
finding by investigators at McGill University was reported at the annual meeting of the American Society
for Metabolic and Bariatric Surgery. Dr. Nicolas Christou and his team discovered that weight loss
experienced after the implementation of a gastric procedure paralleled a very significant decrease in the
incidence of cancer in their patients. The decrease in weight led to a decrease in breast cancer by 80%,
and colon cancer by 70%, and reduced the incidence of other cancers as well. Likewise, weight loss
through any other method should bring the same proportional decrease, be it surgical or more non-
invasive methods, especially dieting.
Ironically, the high cost of gasoline may end up helping the economy more than hurting it, as more
people are forced to walk and depend less on their automobiles. But this isn’t nearly enough. It took
massive efforts from several organizations to reverse the trend of smoking. Still, we have about five years
to act. This will require a cultural tectonic shift to reverse this trend in such a short period. But using the
very media that contributed to this epidemic, from the internet and television to the classroom, the
workplace, and the doctors’ offices—we can and must spread the word now. “Lighten up for Life!”
William Dunn is a cancer doctor in Michigan. Though cancer is a treatable disease, he has made it his
priority to increase public awareness of cancer prevention and the link of cancer and other serious
diseases to obesity, and the future calamity waiting for us all unless we all do something today to avoid it.
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