Healthy Eating, Active Living, & Cancer: Making Healthy Lifestyles a National Priority
The Cancer Link
An unhealthful diet, excess body weight, alcohol consumption and physical inactivity account for at least 18.2% of cancer cases and 15.8% of cancer deaths in the U.S., the second highest percentages for any risk factor (after cigarette smoking) in both men and women.[i]
Excess body fat causes cancers of the breast (postmenopausal), endometrium, kidney (renal cell), esophagus (adenocarcinoma), colon, rectum, gastric cardia, liver, gallbladder, pancreas, ovary, thyroid, myeloma and meningioma.[ii],[iii] There is some evidence that excess body fat probably increases the risk of advanced, high-grade, or fatal prostate cancer and cancers of the oral cavity, pharynx, and larynx.[iv] Sustained weight loss, even modest amounts, is associated with lower breast cancer risk among women over 50 years of age.[v]
Poor diet, including the consumption of high-calorie foods and beverages, is a major contributor to excess weight and increases the risk of cancer. The American Cancer Society (ACS) recommends following a healthy eating pattern at all ages, in order to reduce cancer risk. A healthy eating pattern includes foods that are high in nutrients in amounts that help you get to and stay at a healthy weight, a variety of whole fruits and vegetables (including fiber-rich legumes), and whole grains. A healthy eating pattern limits or does not include processed and red meats, sugar-sweetened beverages, highly processed foods and refined grains. For cancer prevention, it is best not to drink alcohol.[vi] Recent research has found that non-smoking adults who followed the ACS guidelines for weight control, diet, physical activity, and alcohol consumption lived longer and had a lower risk of dying from cancer and cardiovascular disease.[vii], [viii]
Regular physical activity helps to reduce cancer risk through maintaining a healthy body weight, as well as well as through various biological mechanisms, including beneficial effects on metabolism, inflammation, and hormonal function. Physical activity may reduce the risk of 12 types of cancer. ACS and other experts recommend that adults engage in at least 150 - 300 minutes of moderate-intensity or 75 - 150 minutes of vigorous-intensity activity each week (or a combination of the two) and that children and adolescents engage in at least one hour of moderate- or vigorous-intensity activity each day.[ix],[x] Physical activity may also be beneficial after a cancer diagnosis by reducing the risk of recurrence or death and improving quality of life.[xi]
Combating the Problem
Despite the evidence linking excess weight, poor nutrition, excess alcohol consumption, and physical inactivity to increased cancer risk, most Americans do not meet recommended nutrition and physical activity targets.[xii] Social, economic, environmental, and cultural factors strongly inﬂuence individual choices about diet and physical activity. Reversing obesity trends and reducing the associated cancer risk will require a broad range of strategies that include policy and environmental changes that make it easier for individuals to regularly make healthy diet and physical activity choices, and access to evidence-based treatment for obesity.
COVID-19 Exposes Disparities in Healthy Eating and Active Living
The COVID-19 pandemic has exposed gross health disparities in communities of color, rural and low SES populations, with higher mortality from the disease among these populations.[xiii], [xiv] Black, Native American, and Latinx adults have a higher prevalence of excess body weight, diabetes and hypertension, putting them at greater risk not only of COVID-19 but of cardiovascular disease and cancer. In general, fewer opportunities exist for engaging in health-promoting dietary and physical activity patterns among groups that have been marginalized thus further increasing health inequities. Initiatives must address the unique challenges and barriers that certain groups (e.g., people of color, people with limited incomes) often face when attempting to modify lifestyle behaviors, with culturally appropriate tailoring and equitable support to promote healthy behaviors.
ACS CAN: Advancing Evidenced-Based Policies that Encourage Healthy Lifestyles
The American Cancer Society Cancer Action Network (ACS CAN) is focused on public policies that help to create healthy social and physical environments and to provide consumers with clear, useful information that fosters healthy lifestyle choices. ACS CAN’s federal advocacy work is largely focused on protecting and implementing recent improvements in school nutrition and food labeling, increased access to evidence-based obesity screening and weight-loss interventions, and that the federal government’s diet and physical activity guidelines reflect the current science on cancer risk. ACS CAN also advocates for a range of public policy changes at the state and local levels that make it easier for children and adults to eat a healthy diet and to be physically active, thereby reducing their long-term cancer risk.
ACS CAN supports maintaining and continuing to implement evidence-based national school nutrition standards for school meals and snacks, including foods and beverages sold a la carte, in vending machines, and in school stores. ACS CAN opposes any efforts to weaken or roll back these important cancer-prevention policies. Thanks to improvements in the nutritional quality of school meals, school breakfasts and lunches have more, and a greater variety of, fruits and vegetables, more whole grains, and age-appropriate portion sizes. During the COVID-19 pandemic, ACS CAN supported the school meal eligibility expansion waivers for all students to receive nutritious meals and snacks before, during, and after regular school hours and the flexibility for school officials to safely deliver meals to students at various locations.
Federal Diet and Physical Activity Guidelines
ACS CAN strongly advocates that the federal Dietary Guidelines for Americans (currently being updated) and Physical Activity Guidelines for Americans reflect the current science regarding diet, physical activity, and cancer risk. These guidelines help Americans lead a healthy lifestyle, including lowering their risk of cancer, and form the basis of all federal policies and programs. They also inform many private and state and local initiatives on nutrition and physical activity.
For more information on ACS CAN’s advocacy work around healthy eating and active living environments, please visit https://www.fightcancer.org/what-we-do/healthy-eating-and-active-living.
[i] Islami F, Goding Sauer A, Miller KD, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68: 31-54.
[ii] International Agency for Research on Cancer. IARC Handbooks of Cancer Prevention: Weight Control and Physical Activity. Vol 6. World Health Organization/ IARC; 2002
[iii] Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body fatness and cancer—viewpoint of the IARC Working Group. N Engl J Med. 2016; 375:794-798.
[iv] World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: A Global Perspective. Continuous Update Project. The Third Expert Report. American Institute for Cancer Research; 2018. Accessed July 21, 2019. wcrf.org/dietandcancer
[v] Teras LR, Patel AV, Wang M, et al. Sustained weight loss and risk of breast cancer in women >/=50 years: a pooled analysis of prospective data. J Natl Cancer Inst 2019.
[vi] Rock, CL et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA Cancer J Clin 2020; 0:1-27.
[vii] Kohler LN, Garcia DO, and Harris RB. Adherence to Diet and Physical Activity Cancer Prevention Guidelines and Cancer Outcomes: A Systematic Review. Cancer Epidemiol Biomarkers Prev 2016; 25(7): 1018-28.
[viii] McCullough ML, Patel AV, Kushi LH, et al. Following Cancer Prevention Guidelines Reduces Risk of Cancer, Cardiovascular Disease, and All-Cause Mortality. Cancer Epidemiol Biomarkers Prev 2011; 20(6): 1089-97.
[ix] Rock, CL et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA Cancer J Clin 2020; 0:1-27.
[x] U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018. Available at https://health.gov/paguidelines/second-edition/.
[xi] Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and Physical Activity Guidelines for Cancer Survivors. CA Cancer J Clin 2012; doi: 10.3322/caac.21142.
[xii] Kushi, 2012.
[xiii] Belanger MJ, Hill MA, Angelidi AM, Dalamaga M, Sowers JR, Mantzoros CS. Covid-19 and Disparities in Nutrition and Obesity. N Engl J Med 2020.
[xiv] Adhikari S, Pantaleo NP, Feldman JM, Ogedegbe O, Thorpe L, Troxel AB. Assessment of Community-Level Disparities in Coronavirus Disease 2019 (COVID-19) Infections and Deaths in Large US Metropolitan Areas. JAMA Netw Open 2020;3:e2016938.