Researchers increasingly agree that a smart goal for breast cancer survivors is to avoid weight gain. Those already overweight or obese may do well to consider steps that could bring modest weight loss, as long as those steps particularly focus on loss of excess body fat and maintaining or rebuilding lean muscle tissue. Yet these goals can be challenging even for people not facing a major health challenge. How can cancer survivors – often dealing with fatigue and a variety of other recovery issues – approach such goals?
In this, the second section of my video interview with Maura Harrigan, MS, RD, CSO, you’ll hear the voice of experience describing what she’s learned over the years from research and practice working one-on-one with cancer survivors. Her recommendations, like those of many registered dietitians, will surprise you if you are expecting her to advocate for “diets”.
Maura Harrigan is a registered dietitian who is a board-certified Specialist in Oncology Nutrition. Ms. Harrigan is a research associate at the Yale School of Public Health, and Nutrition Director of the Cancer Survivorship Clinic at Yale Cancer Center. Results from the Lifestyle, Exercise and Nutrition (LEAN) Study underway there are eagerly awaited for the anticipated guidance for breast cancer survivors’ care.
Following the video, read on for resources that may help support eating and lifestyle choices that promote cancer survivors’ health.
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Where to Focus
In the last Smart Bytes® post, you heard and read about the research linking excess weight and weight gain – really excess body fat – and worse outcome in breast cancer survivors. That could lead people to undertake extreme measures to lose weight, or to feel frustrated if cancer-related fatigue or general “life overwhelm” is keeping them from major weight loss efforts. It’s vital when we talk about the potential for weight management to impact health following cancer that we keep referencing these key points:
- Avoiding weight gain is a good goal in itself.
- Small amounts of weight loss – 5 percent of current weight (or perhaps even less, based on some studies) – can be enough to change metabolic biomarkers related to cancer risk. (That’s 8 pounds for a woman who weighs 160 pounds.)
- For overall health and survival, it’s likely better to focus on maintaining or improving lean muscle tissue along with weight maintenance or a modest weight loss than to target a huge weight loss that would almost surely bring a large loss of lean muscle.
It’s exciting to hear from Maura Harrigan, MS, RD, CSO, about her work with breast cancer survivors as an oncology dietitian at the Yale Cancer Center, guiding their focus away from weight and toward energy. With this focus, they feel better and can track toward a gradual change in body composition likely to benefit long-term health.
In an upcoming portion of our video interview, you’ll hear more from Ms. Harrigan about dealing with cancer-related fatigue, a challenge commonly faced by breast cancer survivors and by many, many survivors of other cancers as well.
The Three-Part Approach
In our interview, you heard Ms. Harrigan describe how she works with breast cancer survivors using a three-part approach.
- Nutrition: We are not talking about a “diet” that’s based on rules and deprivation. That is not helpful for most people, especially in the long run. However, healthful choices in what we eat and drink provide the nutrients we need for health and energy. What’s more, changing calories consumed is a key part of stopping weight gain or achieving weight loss.
- Physical Activity: Movement, rather than endless sitting, can promote a sense of physical and mental energy. It’s also essential for minimizing loss of lean muscle tissue. The goal is to feel energized, not exhausted, when you’re done.
- Lifestyle Behaviors: Creating positive behaviors that work for us, rather than against us, is what ties together the changes in nutrition and physical activity, and makes them truly doable long-term. It involves a positive mindset and a mindfulness about choices. And, after all, it is incorporating positive choices into a long-term lifestyle that ultimately affects health.
Resources to Help
Whether you’re “new” to being part of the Cancer Survivor community, or have been walking this journey for some time, I urge you to connect with people who can support you. For many years, in large part because we had no research to guide us, once cancer treatment concluded, cancer survivors were essentially released, with little guidance or support other than reminders to keep up with cancer screenings. Today, cancer survivorship programs are growing and recognized as essential elements at many cancer treatment centers, hospitals and community centers (such as a local YMCA).
If you are a cancer survivor, see what is available to support you in creating a healthy lifestyle while addressing those issues and concerns unique to cancer survivors. If you have a cancer survivor among the people in your life about whom you care, please send them this post and/or encourage them to find local sources of support.
Nothing beats personal support from well-trained professionals and people who understand the journey you’re on. If cancer centers in your area don’t offer a survivorship program, ask them to start one, and urge them to make sure a registered dietitian with expertise in oncology nutrition* is part of the team.
With or without personalized professional support, a variety of resources are available to help you with the three elements Maura Harrigan identified as key to reshaping lifestyle for long-term health.
- The New American Plate is the approach developed by the American Institute for Cancer Research (AICR) to support healthy eating patterns that reduce cancer risk, including weight management. This eating pattern is excellent for cancer survivors. Start with a basic overview in the free New American Plate brochure. Then get further ideas from online or print brochures focused on specifics like One-Pot Meals, Vegetables, Beans and Whole Grains, and more. Some brochures also provide specific help on how the New American Plate can support Weight Loss, and how you can use smart choices to have More Food, Fewer Calories.
- One strategy for eating more healthfully is to cut down on grab-and-go eating and cook at home more often. If that sounds daunting, check AICR for tips in Homemade for Health on how to make it more flavorful in less time. You can also get a continuous stream of new recipe ideas from AICR’s Health-e-Recipes.
Physical Activity as Part of Lifestyle
- AICR offers a brochure on physical activity specific for cancer survivors, as well as a three-part series suitable for everyone that helps people gradually create a lifestyle that incorporates regular physical activity. Different brochures target individual stages: Start Where You Are, Keep It Up, and Mix It Up (targeting long-term lifestyle).
- To find someone certified by the American College of Sports Medicine (ACSM) and American Cancer Society (ACS) as qualified to work around unique concerns some cancer survivors may have, visit the ACSM ProFinder website to find an ACSM/ACS Certified Cancer Exercise Trainer near you: http://certification.acsm.org/pro-finder
- LIVESTRONG at the YMCA is a twelve-week, small group program designed for adult cancer survivors led by specially trained instructors. The LIVESTRONG Foundation website can show you program availability in your specific community.
Lifestyle Behavior & Mindset Patterns
- Is moving toward more mindful eating — which is the opposite of eating that is hurried or rooted in stress — your target? If so, you have much to gain from Michelle May, MD. This is her passion and expertise. For help in becoming more mindful in eating, exercising…and living! …check information that Dr. May offers. You’ll find a variety of articles on the website AmIHungry.com, as well as information on her book, Eat What You Love, Love What You Eat.
- Intuitive Eating is another approach for getting off the dieting bandwagon and learning how to escape emotion-based eating, as you learn to eat in a way that is truly nourishing to body and spirit. It was created by two registered dietitians, Evelyn Tribole, MS, RD and Elyse Resch, MS, RDN, CEDRD, F.iaedp, F.A.N.D. Having used their books with countless patients over the years, I enthusiastically endorse what you will find here.
- The Center for Mindful Eating offers resources that may be helpful to health professionals working with people who seek to become more mindful in their eating and adoption of a healthy lifestyle.
When it comes to nutrition, did you know that there are registered dietitians who are certified by training, experience and testing as experts in oncology nutrition? CSO – Certified Specialist in Oncology nutrition – is the designation that appears after their names. Don’t rely on information from unfounded sources. Ask your doctor, cancer center or hospital about CSOs in your area. Or go to the website of the Oncology Nutrition dietetic practice group of the Academy of Nutrition and Dietetics, oncologynutrition.org, and use the Find an Oncology Registered Dietitian service. Some you find there will be CSOs; all have expertise in oncology nutrition.
What’s next? Come back for more from my conversation with Maura Harrigan, MS, RD, CSO, when we discuss physical activity, fatigue and the all-important mindset factor in more detail. Today, sign up to receive Smart Bytes® by email so you don’t miss a thing from these conversations… and much more that’s ahead on other important aspects of taking nutrition and a healthy lifestyle from daunting to doable.