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In the past several years, there has been mounting evidence that obesity, poor diet, and a lack of regular exercise significantly increase the risk of a wide range of cancers.
“Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective,” also known as The Expert Report, was considered ground-breaking when it was published in 2007 by the World Cancer Research Fund and American Institute for Cancer Research. The result of five years of work by an international panel of scientists, it is the most comprehensive report ever published on the evidence linking diet, physical activity and weight to cancer risk.
“The most striking finding in the report is that excess body fat increases the risk for numerous cancers,” said Dr. W. Phillip T. James, one of the expert panelists. “That is why body weight is the focus of our first recommendation.”
The report offers 10 recommendations for reducing the risk of cancer, such as maintaining a healthy body weight, getting regular exercise, and limiting consumption of energy-dense foods, sugary drinks, salt, alcohol, processed foods and red meat. If the recommendations were adopted around the world, according to Dr. James, “scientists estimate it could prevent about one-third of global cancer cases.”
The report finds that regular activity decreases one’s risk for developing colorectal cancer, one of the most prevalent cancers in the United States. The report also finds a probable association between regular exercise and the decreased risk of post-menopausal breast and endometrial cancers. The report goes on to conclude that “ways of life that reduce cancer risk also reduce the risk of cardiovascular disease, obesity, diabetes and other chronic diseases.”
These findings are largely backed up by “Health of Massachusetts,” a comprehensive report published in April by the Department of Public Health. The report links excess body fat and weight to six cancers: colorectal, pancreatic, post-menopausal breast, kidney, esophageal, and endometrial.
More than half of Massachusetts adults are either overweight or obese, according to the DPH report, and obesity prevalence is rising. Compounding matters, according to the DPH, is the fact that only about half of Massachusetts adults report moderate leisure and non-leisure physical activity.
Quantifying the cost of obesity is difficult because it is not generally recognized as a disease and is rarely listed as a primary diagnosis in medical records. The DPH estimated annual obesity-related medical costs for Massachusetts at $1.8 billion (in 2003 dollars).
Taking aAction
A follow-up to The Expert Report, “Policy and Action for Cancer Prevention,” published last November by the WCRF and AICR, outlines actions that can be taken by, among others, government bodies, industry, media, schools, workplaces and others to address the cancer risk factors substantiated in the 2007 report.
“Cancer is a largely preventable disease,” the “Policy and Action” report states. “The question then arises of how best to achieve this.
“[S]imply knowing what are healthy ways of life may not lead to these being adopted. … The improvement and protection of public health does not happen by accident – it requires policies and actions, and that all relevant sectors of society, from legislators to citizens, play their part.”
The “Policy and Action” report identifies five specific strategies for “workplaces and institutions” to implement to reduce the cancer risks among employees. They are:
• Use price and other incentives to encourage healthy eating and active commuting, and to discourage motorized transport
• Ensure that physical environments are designed or adapted and maintained to facilitate physical activity and weight control
• Encourage sustained breastfeeding, with supportive environments and employment contracts, and access to childcare
• Remove snacks high in sugar, fat or salt, as well as sugary drinks, from vending machines and cafeterias
• Provide healthy meals, facilities for physical activity, and access to advice on nutrition, fitness, weight control, and disease prevention
Municipal officials can use leadership strategies to promote healthy lifestyles to decrease the risk of cancer and obesity. Failing to be proactive is to risk employee health and productivity while contributing to rising health care costs.
The steps that municipal employers can take fall into three categories: providing education and building awareness, promoting lifestyle behavior changes, and developing policies and a healthy workplace culture.
Education and awareness actions include the following:
• Disperse information via e-mail, websites, kiosks, meetings, and at locations such as vending machines and cafeterias.
• Offer workshops focusing on how lifestyle habits – diet, exercise, stress, relaxation, sleep habits, alcohol intake and smoking – can affect cancer risk.
• Offer personal health assessments, where employees complete confidential online questionnaires that ask about their health habits and risks. The survey provides personalized reports that reinforce healthy habits and recommend changes where appropriate. Many health plans provide access to disease and lifestyle management services for those found to be at risk. Municipalities can receive aggregate reports that can be useful in program planning.
• Offer screenings such as body-mass index (BMI) and body composition, which provide information about risks for various conditions and diseases, including cancer.
Steps that focus on lifestyle behavior change include the following:
• Offer exercise and healthy cooking and eating programs over a period of time, which helps participants commit to life-long behavior change and develop useful skills. The MIIA Well Aware program recommends series programs that run for six to 10 weeks.
• Offer self-directed programs (activities that employees can participate in outside of the regular work day). The MIIA Well Aware program offers several options to Health Trust members, such as HEALTH 2010, a year-long exercise incentive program; walking programs with pedometers; and Color Your Plate, a two-week dietary program that rewards participants for consuming at least four different colored fruits and vegetables a day.
• Offer wellness coaching. Certified wellness coaches can help employees make and maintain healthy behavior changes. They help with goal setting, action plans, reinforcement, and “relapse prevention,” along with offering motivation and support.
Building a Wellness Culture
In order to achieve employee engagement in healthy behaviors, it is vital that leadership supports and works toward building a healthy work culture and environment. This can be demonstrated through written policies as well as the action steps below:
• Allow employees to participate in wellness programs during the workday whenever possible and include this in formal policies.
• Work with the municipal health plan as well as outside organizations to offer financial and other incentives for employee engagement in wellness.
• Evaluate food and beverage offerings. Do the foods and beverages served at meetings or available in vending machines or cafeterias promote weight gain or health? Leaders may want to develop formal healthy eating policies.
• Provide bicycle racks at municipal buildings and support for employees to ride to work.
• Promote taking the stairs wherever possible. All stairs should be clearly marked. Some employers have transformed stairwells to beautiful or fun places to walk. Some have posted motivational posters along the staircases. Wherever there may be elevators in a building, there should also be signs encouraging people to take the stairs instead.
• Include family members in wellness and other activities, which helps to engage employees. Behavior change is more likely to be long lasting if family members are involved.
• Employees are more likely to participate in wellness activities if leadership does as well.
Municipalities can turn to many different organizations for support and resources, including the MIIA Well Aware wellness program (for MIIA Health Benefits Trust members), health plan providers, the DPH and its Healthy Mass: Mass in Motion program, the American Cancer Society, the American Institute of Cancer Research, and local health clubs and YMCAs.
By Wendy Gammons and Carrie Milardo
The Expert Report and The Policy Report are both available at www.dietandcancerreport.org.
Wendy Gammons is MIIA’s Wellness Coordinator. Carrie Milardo is a MIIA Wellness representative. |
