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The Health Zone Newsletter
Vol 10/2004

In this issue:
Inactivity, Obesity Are Killing World Populations
Obesity Raises Death Risk From Breast Cancer


Inactivity, Obesity Are Killing World Populations
By: Jeanie Lerche Davis, Web MD Medical News

More deaths expected from sedentary lifestyle and obesity than smoking over the next decade, unhealthy lifestyle is expected to cause more premature deaths than smoking, a new report shows. "We believe diet, inactivity, and obesity -- that constellation - will be the leading cause of death if things don't change," says study researcher James S. Marks, MD, MPH, a CDC epidemiologist.

Risky Lifestyle
In the report, researchers provide a complex analysis of studies on risk behaviors and deaths published from 1980 to 2002, blended with mortality data for 2000. From this, they have estimated the causes of preventable deaths during 2000. "The numbers were striking and compelling," Marks tells WebMD. "People have to understand there's a lot they can do to prevent these premature deaths."

During 2000:

  • 18% of deaths were due to smoking
  • 17% were due to poor diet and physical activity.
  • 4% were alcohol-related.

Other causes of preventable deaths: HIV, flu, and pneumonia; air pollution and other environmental toxins; car crashes; guns; sexual behavior; and illicit use of drugs.

A decade ago, when the last such report was released, tobacco was the leading cause of preventable death. "There was a pretty substantial gap between tobacco and poor diet and inactivity," says Marks. "We found that now the gap has narrowed substantially." The numbers of smoking-related deaths have not increased -- but they also haven't dipped, says Marks. "We were disappointed not to see improvements. That tells us that the major energy has been put into getting kids not to start, but not enough attention to getting adults to quit."

Top 7 Causes of Death in the U.S.A
The report also lists the top causes of death in 2000:

  • Heart disease (710,760 deaths)
  • Cancer (553,091)
  • Stroke (167,561)
  • Lung disease (122,009)
  • Injuries from accidents (97,900)
  • Diabetes (69,301)
  • Flu and pneumonia (65,313)

"With sedentary lifestyle and obesity, we see higher rates of hypertension and diabetes, which are risk factors for stroke or heart attack," says Joseph Miller, MD, a preventive cardiologist with Emory University School of Medicine in Atlanta. "It's why we encourage people to walk the dog, walk a little further in the parking lot, walk the concourses at the airport," Miller tells WebMD. "You don't have to be a Nike man or woman. You don't have to buy equipment, fancy shoes, or a gym membership."

The CDC report "doesn't surprise me," says Michael Crouch, MD, a family and community medicine specialist at Baylor College of Medicine in Houston. "We're seeing kids with diabetes, overweight teenagers. I work with many people to help them lose weight. Obesity has become a huge problem."

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Obesity Raises Death Risk From Breast Cancer
By Karen Pallarito
HealthDay Reporter

WEDNESDAY, Oct. 6 (HealthDayNews) -- Women who are obese when they are diagnosed with early stage breast cancer are at greater risk of dying from the disease than patients considered normal weight, a new study finds.

Even after adjusting for such risk factors as age and menopausal status, "obesity still came out as a significant independent predictor for worse outcomes," said Dr. Penny Anderson, lead author of the study and a radiation oncologist at Fox Chase Cancer Center in Philadelphia.

Five-year survival rates for normal weight and overweight women averaged 92 percent for each group of women, vs. 88 percent for women defined as obese. The five-year rate of distant metastasis, when cancer spreads to other parts of the body, was 7 percent for patients with normal weights, 6 percent for overweight women, and 10 percent for obese individuals.

The study, presented Oct. 6 at the American Society for Therapeutic Radiology and Oncology's annual meeting in Atlanta, helps to confirm a link between obesity and breast cancer survival. Previous studies have reported contradictory results about the influence of obesity on survival rates.

It's also among the first study to explore obesity's negative influence on outcomes in early-stage breast cancer, when the disease is generally believed to be most treatable.

Researchers at Kaiser Permanente of Southern California observed a similar connection between body weight and breast-cancer death in a study reported in the September 2003 issue of the Archives of Surgery. Women with early stage breast cancer in the heaviest weight group had a nearly 2.5-fold increased risk of dying from the disease compared to women in the lightest weight group.

Breast cancer is the most common cancer in women, excluding skin cancer, and the second leading cause of cancer-related death in women, after lung cancer, according to the American Cancer Society. In 2004, an estimated 217,440 women in the United States will be diagnosed with the disease and roughly 40,580 women will die from it.

In the study, researchers relied on data from 2,010 patients who underwent treatment from 1978 to 2003 for "stage I/II" breast cancer. Doctors use "staging" to determine the amount of cancer in the body and its location. That information is useful in planning the course of treatment and determining a patient's prognosis.

At stage I, a tumor is less than 2 centimeters and has not spread to the lymph nodes. Stage II tumors range from 2 to 5 centimeters and may have spread to the lymph nodes in the underarm area. Tumors larger than 5 centimeters also may be considered stage II if there is no lymph node involvement, according to the American Joint Committee on Cancer.

The women in the study received a breast-conserving lumpectomy, lymph node removal and radiation therapy. They may or may not have been treated with chemotherapy.

Researchers grouped the women into categories based on their body mass index, a ratio of height to weight. At diagnosis, 22 percent of the patients (452 women) were normal weight, 43 percent (857 women) were overweight and 35 percent (701 women) were obese.

Obese women tended to be older and postmenopausal, the study found. But there were no statistical differences among the three weight groups in tumor size or number of lymph nodes involved.

"These women were not presenting with bigger tumors," Anderson said, referring to patients in the obese group.

Obesity was not found to be a significant predictor of a recurrence of cancer in the treated breast. But it did put women in the study at greater risk for developing metastatic disease and dying of their cancer.

As the prevalence of obesity and the risk for breast cancer each increases with age, it's important for women to manage their weight throughout their life, Anderson said.

"Enhanced weight control can certainly help improve someone's outcome," she said.

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