1. Nutrition, Physical Activity and Cancer: What’s the Connection?
Colleen Doyle, MS, RD
Director, Nutrition and Physical Activity
American Cancer Society

2. 758,757
ME adults do not eat at least five fr/veg per day
CDC, US Census

3. 453,146
ME adults do not meet min PE recs
CDC, US Census

4. 674,450
# overweight/obese adults
CDC, US Census

5. Causes of Cancer
Estimate percentage of total cancer deaths attributable to established causes of cancer
Tobacco
Adult diet/obesity
Sedentary lifestyle
Occupational factors
Family history of cancer
Viruses/other biologic agents
Perinatal factors/growth
Reproductive factors
Alcohol
Socioeconomic status
Environmental pollution
Ionizing/ultra-violet radiation
Prescription drugs
Medical procedures
Salt/other food additives/contaminants 5 10 15 20 25 30 35
Source: Harvard Report on Cancer Prevention, Cancer Causes and Control, November/December, 1996

6. 2012 Recommendations for Individuals: Communities:
ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
Individuals:
1) Maintain a healthy weight throughout life.
2) Adopt a physically active lifestyle.
3) Consume a healthy diet, with an emphasis on plant sources.
4) If you drink alcoholic beverages, limit consumption.
Communities:
Work together to make it easier for people to eat better and be more active.

7. Society Recommendations for Individual Choices
ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
Maintain a healthy weight throughout life.
Be as lean as possible throughout life without being underweight.
Avoid excess weight gain at all ages. If currently overweight or obese, losing even a small amount of weight has health benefits and is a good place to start.
Engage in regular physical activity and limit high calorie foods and beverages as key strategies for maintaining a healthy weight.

8. BMI and Specific Cancers
Established
Men Women
Colon/rectum Breast (postmenopausal)
Kidney Colon/rectum
Esophagus Endometrium
Pancreas Kidney Esophagus
Pancreas
Kushi, et al. CA Cancer J Clin. 2012

9. BMI and Specific Cancers
Probable
Men Women
Gall bladder Gall bladder
Liver Liver
Multiple myeloma Multiple myeloma
Non-Hodgkin Lymphoma Non-Hodgkin Lymphoma
Prostate Cervix
Ovary
Kushi, et al. CA Cancer J Clin. 2012

10. Why the obesity connection is so important
In the United States, overweight and obesity accounts for about 14% to 20% of all cancer deaths.
About 2 out of 3 Americans are overweight or obese.
Calle, et al. NEJM. 2003; CDC

11. Obesity Among U.S. Adults, 2011
15%–<20% 20%–<25% %–<30% %–<35% ≥35%
Source: Behavioral Risk Factor Surveillance System, CDC.
Prevalence reflects BRFSS methodological changes in 2011, and these estimates should not be compared to previous years.

12. Childhood Obesity
Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years.
The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010.
The percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period.
In 2010, more than one third of children and adolescents were overweight or obese.
CDC

13. What About Weight Loss?

14. Adopt a Physically Active Lifestyle
ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
Adults: Engage in at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity each week, preferably spread throughout the week.
Children and adolescents: Engage in at least 1 hour of moderate- or vigorous- intensity activity each day, with vigorous-intensity activity at least three days each week.
Limit sedentary behaviors such as sitting, laying down, and watching television and other forms of screen-based entertainment.

15. Consume a Healthy Diet, With an Emphasis on Plant Sources
ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
Choose foods and beverages in amounts that help maintain a healthy weight.
Limit consumption of processed meat and red meat.
Eat at least 2.5 cups of vegetables and fruits each day.
Choose whole grains in preference to refined grain products

16. If You Drink Alcoholic Beverages, Limit Consumption.
ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
Drink no more than one drink per day for women or two per day for men.
One drink of alcohol =
12 oz. beer
5 oz. wine
1.5 oz. of 80-proof liquor

17. Alcohol and Cancer Risk
Heavy drinking – esp combined with tobacco use - increases risk of cancers of:
Mouth & pharynx
Larynx
Esophagus
Liver
Even moderate drinking increases risk of breast cancer in women

18. “I thought a glass of wine was good for me!”
Moderate intake of alcohol appears to decrease risk of heart disease
Other approaches to reduce heart disease risk
Not recommended that non-drinkers begin drinking
Consider risk of both heart disease and cancer to make an informed decision

19. ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
Conclusion: Adherence to cancer prevention guidelines for obesity, diet, physical activity and alcohol consumption is associated with a lower risk of death from cancer, CVD and all causes in non-smokers.

20. ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.

21. How Are Things In Maine? ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
How Are Things In Maine?

22. Maine Overweight and Obesity (BMI)
(Adults 18 and older, 2012)
Source:Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,, 2011.

23. Participated in 150 minutes or more of Aerobic Physical Activity per week. (Adults 18 and older, 2011)
Source:Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,, 2011.

24. Adults who have consumed fruits and vegetables five or more times per day. (Adults 18 and older, 2009)
Source:Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,, 2009.

25. Maine High School Students, 2011
16% overweight
13% obese
Only 38% report attending PE one or more times per week (down from 47% in 1997)
24% report watching at least 3 hrs tv/day
31% report playing video games or using a computer for something other than school work for 3 hours or more per day.
2011 ME Integrated Youth Health Survey

26. Why?

27. Available Calories Have Increased
We produce about twice what the average person needs each day

28. Where Our Calories Come From
A lot of high calorie, low nutrient foods

29. Evidence of life on Mars….
Access and availability
Evidence of life on Mars….

30. High Calorie Foods Available at Low Cost….Whenever You Want Them!
CALORIES
Double Cheese Burger = 690
Super Size Coke =
Biggie Fries =
TOTAL = ,540
Ad in Sports Illustrated 6/15/02

31. Portion sizes, out and at home

32. ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
Mixed messages

34. Marketing and Advertising to Kids
Food and Drink Packages
Computers and TV
Mobile Devices
Games and Toys
Schools
Including in schools

35. Still a lot of junk in school – school meals and competitive foods

36. Physical (In)Activity

38. Community design

39. ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
Barriers to active commuting

41. Connection between community design, phys activity and obesity

42. IOM - “It is unreasonable to expect that people will change their behavior so easily when so many forces in the social, cultural, and physical environment conspire against change.”
From: Healthy People 2010, Understanding and Improving Health, Volume 1

43. ACS Recommendation for Community Action
Public, private and community organizations should work collaboratively at national, state and local levels to implement policy and environmental changes that:
Increase access to affordable, healthy foods in communities, worksites and schools, and decrease access to and marketing of foods and beverages of low nutritional value, particularly to youth.
Provide safe, enjoyable and accessible environments for physical activity in schools and worksites, and for transportation and recreation in communities.

44. What’s It Going To Take?
Multi-strategy, coordinated and comprehensive approach at national, state and local levels
Policies that make it easier for people to eat better and be more active
Policy and environmental changes in priority systems
ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
No one strategy is going to make “the difference” – it will take multiple strategies at multiple levels.
Policies at national, state, local levels that reduce barriers to eating better and being more active (racial/ethnic minorities, socioeconomically disadvantaged communities)
tools that support policy development and environmental changes in priority systems – schools, worksites, healthcare. Creating a culture of wellness – going beyond individual behavior change

45. A New Shift In Communications
ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
Messaging that increases awareness of key issues that influence eating and exercise habits
From “Eat More Fruits and Vegetables” to:
What’s being served at your child’s school?
Got a salad bar at work?
We need better quality produce at this store.
From “Be More Active” to:
No sidewalks? Speak up.
What’s the school policy on PE?
Hey – can we get some bike racks at the office?
Need a new shift in communication to consumers and decision-makers (policy and system decision makers)
People know they need to eat better, be more active, but they do not know the extent to which the environment influences their/their family’s choices. Need to communicate in ways that turn people into change agents – in their homes, communities, workplaces, kids schools
Leverage existing initiatives to for messaging

46. Strategic, Sustainable and Effective Collaborations
ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.
Traditional
Health Organizations
Government
Media
Industry
Non-Traditional
City Planning and Architecture
Transportation Planners
Parks and Recreation
Legal and Policy Experts

47. Calls to Action
Recommended Community Strategies and Measurements to Prevent Obesity in the United States (2009)
IOM Reports
Cancer Prevention and Control (2003)
Childhood Obesity (2004)
Food Marketing and Advertising (2005)
Local Government Actions to Prevent Childhood Obesity (2009)
Policy and Action for Cancer Prevention: Food, Nutrition and Physical Activity, World Cancer Research Fund (2008)
Guide to Community Preventive Services (2001/2010)

48. General Population Smoking In The US
Annual Adult Per Capita Cigarette Consumption and Major Smoking and Health Events – United States 1900 – 1998.

49. ACS Recommendations for Individual Choices
1.       Eat a variety of healthful foods, with an emphasis on plant sources.
·         Eat five or more servings of a variety of vegetables and fruits each day.
·         Eat other foods from plant sources several times each day.
·         Limit consumption of red meats, especially those high in fat and processed.
·         Choose foods that maintain a healthful weight.

50. Thank you!