Out of Reach

Obesity Care and Prevention: Less Death and Cancer?

Can obesity care and prevention lead to less death, cancer, and other complications of obesity? This question has been a hard one to answer. For one thing, we’re not too good at prevention. Obesity rates keep going up, not down. However, on the plus side, we have pretty good data on preventing death, cancer, and other complications of obesity by treating it aggressively with bariatric surgery.

Outside of that, showing an effect on death, cancer, and other major complications has been tough with prevention and behavioral therapies. Two recent studies give tantalizing, but not completely satisfying results.

Look AHEAD to Prevent Cancer?

The first of these studies is an analysis of the epic Look AHEAD study. It’s a huge randomized trial of intensive lifestyle intervention for obesity. Researchers from the Look AHEAD group examined 11 years of data from 4,859 patients in the study. They were looking for an effect on cancer from modestly effective obesity care.

The results were tantalizingly close to showing a significant effect. They found 16 percent less cancer in the treatment group. That would be meaningful. But it fell short of statistical significance.

Weight Loss in Early Adulthood

The second tantalizing study appeared in JAMA Network Open. Examining data on 24,205 adults from NHANES, researchers found a 54 percent reduction in the risk of death for people with obesity who lost weight in early adulthood. That included people who went from obesity to overweight or a healthy BMI status. A 54 percent risk reduction is an important finding any way you look at it.

But alas, this is an observational study. Not an intervention study. It provides support for the idea that losing weight in early adulthood can have big benefits for lifespan. But not definitive proof.

What Do We Really Know?

Nonetheless, we do know a few things about the benefits of obesity care and prevention for reducing death and suffering.

We know with good confidence that bariatric surgery delivers a long-term net benefit. People live longer, have less cancer, less cardiovascular disease, and less diabetes. With less aggressive treatment, we know that people benefit from a reduction in the more immediate effects of obesity. They have less hypertension, better cholesterol levels, better diabetes control. But the effect on long-term outcomes is still not so clear.

For prevention, we have a reasonable presumption. We can presume that prevention might reduce the considerable suffering and premature death that results from obesity. For sure, these new data from NHANES give us more reason to believe that. But still, definitive proof is just out of reach.

And it would help if we really knew how to prevent obesity.

Click here for the study of Look AHEAD data, here for further perspective, and here for the NHANES analysis.

Out of Reach, photograph © Eva Funderburgh / flickr

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August 26, 2020