Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland.
Surg Obes Relat Dis. 2023 Jul;19(7):781-787. doi: 10.1016/j.soard.2023.01.029. Epub 2023 Feb 7.
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/m. 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.
在美国和世界各地，肥胖症及其相关代谢功能障碍的发病率呈上升趋势。代谢功能障碍常常导致慢性疾病，包括癌症。最近的证据表明，肥胖人群的体重减轻可能会降低癌症风险。代谢和减重手术（MBS）比非手术饮食策略更能实现最大和持续的体重减轻，并提供了最令人信服的证据表明体重减轻可以降低癌症风险。与 MBS 和其他非手术饮食策略相比，热量限制饮食结合 GLP-1 受体激动剂可实现中等程度的体重减轻，只要患者持续服用药物。初始体重减轻后的体重反弹是所有减肥策略的一个主要问题。为了更好地预防肥胖人群的癌症，我们需要个体化减肥策略，确定针对特定个体的有效策略以及如何实施。我们需要了解（1）个体在初始和持续减肥方面的障碍是什么；（2）最佳减肥策略是什么，无论是饮食改变、饮食改变+药物治疗，还是 MBS 后再进行饮食改变；（3）如何将运动纳入减肥策略；（4）药物在肥胖患者治疗策略中的作用；以及（5）MBS 影响癌症风险的机制是什么。我们还需要（6）探索将 MBS 的资格扩大到 BMI<35 kg/m 的个体。这些问题的答案需要更好地了解 MBS 如何影响癌症风险，包括 MBS 在哪些群体（女性与男性、哪些种族和族裔群体、哪些癌症、哪种 MBS 手术）中最能降低风险。美国国立卫生研究院通过新的资助机会，希望增进我们对肥胖如何驱动癌症风险以及肥胖个体如何预防癌症发展以及在癌症患者中预防疾病复发的理解。
