We walked into a room full of 18 cancer survivors one August evening, unsure what to expect. We started the group by asking each of the women what had brought them to the program: a free weight management group we had created to help women with obesity who had survived cancer to lose weight. As we listened to each of their stories, we started to appreciate the challenges these women had faced. They truly were survivors. As each one told her story, the group seemed to echo one another with their motivations and challenges. One woman remarked that during a difficult chapter in her weight loss journey, she told herself that if she ever got cancer, she would forgo weight loss and “eat whatever [she] wanted.” However, when she got her cancer diagnosis, she experienced the opposite phenomenon. When her body was failing her and her mortality came into question, she realized she would do anything in her power to improve her health, and that had to start with weight loss.
Obesity rates in the United States have reached an all-time high as the second leading cause of death, according to the Centers for Disease Control, and there is a strong association between obesity and cancer. A 2003 New England Journal of Medicine article linked obesity to more than 100,000 cases of cancer yearly, including nearly 50 percent of endometrial cancers and 17 percent of breast cancers. Furthermore, obesity increases the risk of cancer progression, recurrence and mortality, according to the Institute of Medicine. As a modifiable risk factor, weight reduction is a crucial target for medical professionals to consider to improve patient outcomes. Many patients are looking for a straightforward medical or surgical approach to weight reduction, but these approaches in the absence of lifestyle change are unlikely to lead to desired results. Few patients have the social supports or motivation to make lifestyle change independently, and group-based programs are often expensive or inaccessible.
The program we initiated in collaboration with physicians and dieticians, called Step Up, was designed as a free weight management and nutrition program led by medical students for obese female cancer survivors. Created through a Schweitzer Fellowship, which is a community service fellowship that addresses health disparities by fostering the development of leaders in service, we wanted to help these women jump start weight loss. The women attended weekly group sessions where we taught a lesson about nutrition or exercise and discussed any challenges or questions participants had faced. Each week we weighed participants to track their progress. Participants were expected to journal their food and exercise every day using a free app called MyFitnessPal, and adhere to calorie, fat and exercise goals. Weekly, we reviewed their journals and sent individual emails providing encouragement and guidance to facilitate their progress. Participants loved getting this weekly individualized feedback and we enjoyed getting to know participants better allowing us to send meaningful, personalized messages.
We gained the appreciation that weight loss was more than numbers, and we reinforced this concept in class by encouraging the participants to focus on the positive aspect of their weight loss. We wanted them to be proud of all the hard work and effort they were putting in, and after 12 weeks the participants started to notice a difference in their health and well-being. One woman shared her health improvements with the group after losing nearly 10 percent of her body weight over the course of the program. She reflected that last year when she went to a hockey game with her husband, she was barely able to make it to her seat at the top of the bleachers, but this year she made it to the top of the stadium without any trouble – and had an even easier time coming down without any support. Another woman noted that her chronic pain and gout had become increasingly well-controlled, which she attributed to her improved eating and exercise habits. Yet another woman shared that she had been taking melatonin to aid in sleeping, but after her weight loss she found it easier to sleep, and had stopped taking the pills.
The program turned into a truly symbiotic relationship between us, as medical students, and the cancer survivors, and was a tremendous success in terms of weight loss. Over the course of 12 weeks, participants lost a collective 180 pounds! The women in Step Up gained the motivation and perspective necessary to take control of their health, and we gained a more realistic perspective of what it takes to achieve weight loss, and how different the journey toward a healthier weight can be for each person. The women in the program found a support group and a safe environment to express frustrations, giving us a window into how emotionally challenging weight loss can be, which will make us more empathetic and compassionate physicians in the future. The participants also had opportunities to ask questions about current research and the physiology of weight loss, so as a result we became more familiar with the literature on weight management and the pathophysiology of obesity. The combination of the youth and enthusiasm of the medical students and this group of motivated survivors was truly remarkable, changing the lives of all involved.