Abstract
Obesity and associated metabolic dysfunction are on the rise in the United States
and around the world. Metabolic dysfunction often leads to chronic disease, including
cancer. Recent evidence suggests that weight loss among individuals with obesity may
decrease cancer risk. Metabolic and bariatric surgery (MBS) leads to greater maximum
and sustained weight loss than nonsurgical dietary strategies and demonstrates the
most convincing evidence that weight loss lowers cancer risk. Caloric restriction
diets combined with GLP-1 receptor agonists demonstrate weight loss intermediate between
MBS and other nonsurgical diet strategies so long as individuals consistently take
the medication. Weight regain after initial loss is a major problem with all weight
loss strategies. To better prevent cancer in individuals with obesity, we need to
individualize weight loss strategies, determining what strategy works for a given
individual and how to implement it. We need to learn (1) what an individual’s impediments
to initial and sustained weight loss are; (2) what the optimal weight loss strategy,
be it diet modification, diet modification + medication, or MBS followed by diet modification,
is; (3) how exercise(s) should be incorporated into weight loss strategies; (4) where
medications fit into the treatment strategy of individuals with obesity; and (5) what
the mechanisms driving the influence of MBS on cancer risk are. We also need to (6)
explore expanding the eligibility of MBS to individuals with a body mass index <35
kg/m2. Answers to these questions require a better understanding of how MBS impacts cancer
risk, including in which groups (women versus men, which racial and ethnic groups,
which cancers, which MBS procedure) MBS works best to reduce risk. The National Cancer
Institute, through new funding opportunities, hopes to advance our understanding of
how obesity drives cancer risk and how individuals with obesity can prevent cancer
development and, among those with cancer, prevent disease recurrence.
Keywords
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Article info
Publication history
Published online: February 06, 2023
Accepted:
January 29,
2023
Received:
January 4,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.
