Healthy Eating, Active Living & Cancer: Making Healthy Lifestyles a National Priority

September 7, 2017

The Cancer Link

Excess body weight, physical inactivity, and poor nutrition are major risk factors for cancer, second only to tobacco use. Approximately one fifth of the estimated 1.7 million cancer cases expected to be diagnosed this year can be attributed to poor diet, physical inactivity, excess weight, and excess alcohol consumption1.  Currently, approximately two in three adults and one in three youth are overweight or obese.

Excess body weight increases the risk for several common cancers, including cancers of the female breast (postmenopausal)2, colon and rectum3, uterus4, kidney5, adenocarcinoma of the esophagus6, pancreas7, ovary8, liver, gastric cardia, gall bladder9,  thyroid, meningioma, and multiple myeloma10.  The biological link between excess weight and cancer is believed to be related to multiple factors including fat and sugar metabolism, immune function, hormone levels and proteins that affect them, and other factors related to cell growth.11,12   Maintaining a healthy body weight throughout life is key to reducing cancer risk.

Photo of vegetablesNutrition

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 consuming a healthy diet, with an emphasis on plant foods, in order to reduce cancer risk. Recommendations include choosing foods and beverages in amounts that achieve and maintain a healthy weight, limiting consumption of processed and red meats, consuming fruits and vegetables and whole grains instead of refined grain products, and limiting alcohol intake for those who drink alcoholic beverages13.  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.14,15

Physical Activity

Regular physical activity helps to reduce cancer risk through maintaining a healthy body weight, as well as through hormonal and metabolic effects. Physical activity may reduce the risk of 13 types of cancer, including cancers of the esophagus, liver, lung, kidney, stomach, endometrium, colon, rectum, head and neck, bladder, and breast, and myeloid leukemia and myeloma.16 ACS and other experts recommend that adults engage in at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity activity each week and that children and adolescents engage in at least one hour of moderate- or vigorous-intensity activity each day.17,18   Physical activity may also be beneficial after a cancer diagnosis, reducing the risk of recurrence or death and improving quality of life.19

Combating the Problem

Despite the evidence linking excess weight, poor nutrition, and physical inactivity to increased cancer risk, the majority of Americans are not meeting recommended nutrition and physical activity targets. 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.

The American Cancer Society Cancer Action Network (ACS CAN) is focused on public policies that help to create healthy social and physical environments and provide consumers with clear, useful information that supports making healthy lifestyle choices.

Photo of a kid eating watermelon At the Federal Level

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 funding for evidence-based prevention programs. ACS CAN also advocates for ensuring that influential diet and physical activity guidelines reflect the current science regarding cancer risk.

 

School Nutrition

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.  Due to recent 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.  The more than 95 percent of school districts successfully meeting the updated nutrition standards for school lunch and breakfast are eligible for increased federal reimbursement.  ACS CAN opposes any efforts to weaken or roll back these important cancer prevention policies.

 

Nutrition Labeling

ACS CAN supports federal policy changes that increase access to calorie and other nutrition information that makes it easier for people to make healthier choices regardless of where they purchase their food.  

  • Menu labeling of calorie information for standard prepared food menu items in chain restaurants, supermarkets, convenience stores, and other retailers selling ready-to-eat foods will take effect in May 2018, following a recent one-year delay.  Additional nutrition information must also be available upon request. 
     
  • The Nutrition Facts label on packaged foods and beverages will be updated to include added sugars – which provide excess calories without any nutritional benefit – and format changes that make calorie and serving size information more prominent, as calories are the most important information in managing weight.  Updates to the Nutrition Facts label must be in place for many products by July 2018 – and all products by July 2019 - although the U.S. Food and Drug Administration has announced that it intends to delay these implementation dates.

ACS CAN opposes any efforts to weaken or delay implementation of existing nutrition labeling laws.

 

Insurance Coverage and Funding for Prevention and Wellness 

  • Preventive health services, including obesity screening, counseling, and behavioral interventions for both children and adults currently must be covered with no cost sharing through private insurance plans, Medicare, and Medicaid expansion plans.  ACS CAN supports implementation of these coverage requirements and advocates that states also cover preventive services with no cost sharing in traditional Medicaid plans, which they are incentivized to do with an increase in federal funding.
     
  • The Prevention and Public Health Fund is an important source of mandatory annual funding for prevention, wellness, and public health initiatives. Since its inception, a significant portion of the money has been spent on community-based initiatives to make community, school, and worksite environments healthier.  ACS CAN opposes any efforts to dismantle or defund this important source of funding for programs that help to prevent cancer.


Federal Diet and Physical Activity Guidelines

ACS CAN strongly advocates that the federal Dietary Guidelines for Americans and Physical Activity Guidelines for Americans reflect the current science regarding diet, physical activity, and cancer risk, and help Americans lead a healthy lifestyle, including lowering their risk of cancer.  These guidelines form the basis of all federal policies and programs and inform many private and state and local initiatives on nutrition and physical activity. 

 

ACS CAN at the State & Local Levels

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 be physically active, thereby reducing their long-term cancer risk.  While ACS CAN may work on these policies at multiple levels of government, the following policies are priorities with opportunities for state and local action:

Funding for Research and Programs: ACS CAN supports protecting and increasing government investments in research and policies and interventions to reduce overweight and obesity, improve nutrition, increase physical activity and reduce inactivity, with the ultimate goal of reducing cancer incidence and mortality.

School Nutrition: ACS CAN supports establishing, maintaining, strengthening and implementing evidence-based nutrition standards for all foods and beverages sold, served or marketed in schools, before, during and after regular school hours. 

Physical Education and Physical Activity in Schools: ACS CAN advocates for increasing the quantity and improving the quality of K-12 physical education, supplemented by additional opportunities for school-based physical activity.

Active Transportation and Recreation: ACS CAN advocates for providing funding for infrastructure and programs such as Safe Routes to School and Complete Streets to create additional opportunities for physical activity. This also includes establishing shared use agreements for community members to share physical activity facilities.

Sugary Drink Taxes: ACS CAN supports well-designed policies to increase the price of sugary drinks relative to healthy beverages through excise taxes, and dedicating the revenue to healthy eating and active living interventions and other public health initiatives, as a way to fund these important programs.

Healthy Public Places: ACS CAN supports establishing nutrition guidelines for foods and beverages that are provided or sold in government buildings and other public service venues to increase access to healthy options.

Food Marketing: ACS CAN supports reducing the marketing of unhealthy foods and beverages, particularly to youth, through setting, and encouraging companies to comply with, strong nutrition standards. 

Healthy Food Access and Affordability: ACS CAN advocates for enacting policies and incentives to encourage retailers to offer healthy food and beverage options and to locate healthy food retailers in underserved areas.

Healthy Restaurant Meals: ACS CAN supports Improving the nutritional quality of food and beverage options in restaurants, particularly for children’s meals, and promoting healthier options.

Insurance Coverage for Weight Management:  ACSC CAN advocates for ensuring access to adequate insurance coverage for recommended prevention, screening, diagnosis and treatment of obesity for both cancer prevention and survivorship.  As a preventive service, access to these services should be provided without cost sharing.  Cancer survivors should also have access to nutrition and physical activity support services both during and after treatment.

 

View more information on ACS CAN’s healthy eating and active living advocacy work.

 


References

  1. American Cancer Society. Cancer Facts & Figures 2017.  Atlanta, GA: American Cancer Society, 2017.
  2. Chan DSM, Vieira AR, Aune D, et al. Body mass index and survival in women with breast cancer—systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol 2014; 25 (10): 1901-1914.
  3. World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR). Continuous Update Project Report. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. Washington, DC: WRCF/AICR; 2011.
  4. WCRF and AICR. Continuous Update Project Report. Food, Nutrition, Physical Activity, and the Prevention of Endometrial Cancer. Washington, DC: WCRF/AICR; 2013.
  5. WCRF and AICR Continuous Update Project Report. Diet, Nutrition, Physical Activity, and Kidney Cancer. Washington, DC: WCRF/AICR;2015.
  6. WCRF and AICR. Continuous Update Project Report. Food, Nutrition, Physical Activity, and the Prevention of Esophageal Cancer. Washington, DC: WCRF/AICR; 2016.
  7. WCRF and AICR. Continuous Update Project Report. Food, Nutrition, Physical Activity, and the Prevention of Pancreatic Cancer. Washington, DC: WCRF/AICR; 2012.
  8. WCRF and AICR. Continuous Update Project Report. Food, Nutrition, Physical Activity, and the Prevention of Ovarian Cancer. Washington, DC: WCRF/AICR; 2014.
  9. WCRF and AICR. Continuous Update Project Report: Diet, Nutrition, Physical Activity and Gallbladder Cancer. Washington, DC: WCRF/AICR; 2015.
  10. 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: 8.
  11. Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. CA Cancer J Clin 2012; 62:30-67.
  12. Iyengar NM, Hudis CA, Dannenberg AJ. Obesity and cancer: local and systemic mechanisms. Annu. Rev. Med. 2015;66:297–309.
  13. Kushi, 2012.
  14. 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.
  15. 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.
  16. Moore SC, Lee IM, Weiderpass E, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016. doi:10.1001/jamainternmed.2016.1548
  17. Kushi, 2012.
  18. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington (DC): U.S. Department of Health and Human Services; 2008. ODPHP Publication No. U0036. Available at http://www.health.gov/paguidelines
  19. 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.