Trans-NCI Obesity & Cancer Work Group

The Prevention, Etiology, and Mechanisms subgroup is exploring the following challenges in obesity and cancer:

• What are the risk factors, biological mechanisms and pathways associated with obesity/overweight and cancer as it relates to excess body weight and/or adiposity driving the development of pre- and invasive cancers across the lifespan in all racial/ethnic and understudied populations across geographic locations?
• Does overweight/obesity in children and youth increase the risks for cancer development later in life?
• How do risk factors, such as sleep, stress, social determinants of health, the microbiome, metabolic and immune dysfunction, environmental obesogens, influence and/or interact with mechanisms through which obesity might increase risk of cancer?
• What effective strategies could prevent or intercept mechanistic biological changes such as inflammation, immune function, and metabolic dysregulation of obesity associated cancers?
• Does the timing, duration, and amount of weight loss in the life cycle influence cancer risk (i.e. in childhood/youth versus adult)?
• Which interventions decrease obesity and associated unhealthy lifestyle behaviors, applied across the lifespan, to reduce and/or delay cancer incidence?

The aims of this subgroup are related to the Metabolic Dysregulation and Cancer Risk Program, a transdisciplinary NCI initiative to enhance knowledge of the dynamics and underlying mechanisms that link obesity, metabolic dysregulation, and increased cancer risk.

Co-Chairs

Linda Nebeling [DCCPS]
Ed Sauter [DCP]

The Treatment and Survivorship subgroup is exploring the following challenges in obesity and cancer:

What are the effects of diet, exercise and body composition on cancer treatment efficacy & outcomes?*

• Need better characterization of optimal type, dose, frequency, duration, timing of exercise and diet as well as nutritional status on chemotherapy uptake, adherence, side effects, treatment response & clinical outcomes as it relates to obesity and cancer.
• Explore the relationships between obesity/body composition, cancer progression, and response to treatment.
• Study how diet, exercise, body composition, and nutritional status impact cancer-related symptoms and quality of life.

What are the effects of obesity/body composition, exercise & dietary regimens on post-treatment outcomes?*

• Need better characterization of post-treatment exercise and diet interventions on long-term treatment related toxicities and clinical outcomes, QoL, sleep, and general health outcomes.
• Explore how nutritional status and changes in nutritional status affect post-treatment outcomes.
• Need to understand how weight maintenance/loss interventions during treatment affect outcomes and survival.
• Need better precision weight maintenance/loss interventions for post-treatment cancer survivors.

*These questions need to be addressed across cancer sites/subtypes, stage of diseases, and in diverse groups of survivors with respect to age, body size, activity level, and race/ethnicity.

Co-Chairs

Tanya Agurs-Collins [DCCPS] 
Elaine Trujillo [DCP]

The Measurement and Methods subgroup is exploring the following challenges related to obesity and cancer:

• How can complementary assessment methods (e.g., self-report, sensor-based technologies, and/or biomarkers) be triangulated to improve insights into diet, physical activity, and sleep behaviors and environmental determinants?
• What assessment and analytic methods are needed to better integrate measures of diet, physical activity, and sleep within the 24-hour day?
• How can assessment tools for modifiable risk factors be developed or adapted and validated for cancer survivors?
• How can methods be enhanced to measure the food and physical activity environment in diverse populations using appropriate reference instruments?

Co-Chairs

Jill Reedy [DCCPS] 
Dana Wolff-Hughes [DCCPS] 

The Health Disparities subgroup is exploring the following challenges in obesity and cancer:

Why do cancer and the health consequences of obesity disproportionately affect Hispanics, non-Hispanic Blacks, and Native Americans more than other race and ethnic groups?

• Geography, economy, genetic and epigenetic predisposition, occupational and environmental health exposures, health care access, internet access, culturally-sensitive communication, differences in lifestyle, and citizenship status all contribute to the impact of the ability of diverse patient populations to seek and receive cancer information and care related to cancer prevention, screening and treatment - including risks/benefits associated with various treatment modalities - in equitable fashion.
• Need for greater understanding of the intersection and interplay among upstream and downstream Social Determinants of Health (SDoH) on cancer, persistent poverty areas, and generational wealth gap including food deserts on obesity and disparities within racially-ethnically diverse populations in the basic/translational, clinical and population sciences.
• Enhance understanding of the underlying protective and risk factors associated with rising obesity rates, especially among vulnerable and marginalized populations in cancer care continuum settings for early onset and aggressive recalcitrant cancers.

How can we tailor interventions influencing weight loss, exercise & dietary regimens to have better outcomes in diverse populations to reduce cancer risk?

• Better characterization of optimal prevention strategies and delivery of interventions, type, dose, frequency, duration, timing of exercise & diet on health behavior outcomes & QoL.
• Identify evidence-based interventions and preventative strategies to improve weight, physical exercise, and diet, including effective ways to ensure affordability and address barriers, such as those relating to SES and environmental constraints (e.g. time constraints) that pose obstacles to implementing such strategies.

Co-Chairs

Tanya Agurs-Collins [DCCPS]
Anil Wali [CCHE] 

The Time-Restricted Eating subgroup is exploring the following challenges in obesity and cancer:

• What are the effects of time-restricted eating (TRE) compared to other diet strategies, including, but not limited to, caloric restriction or other intermittent fasting approaches, on weight loss, weight maintenance, and long-term dietary adherence?
• What role does TRE play in reducing cancer incidence and progression, cancer treatment response, and cancer recurrence?
• What are the emerging obesity risk factors, including the hormonal milieu, microbiome, and epigenetic modifications that impact TRE’s efficacy?

The TRE subgroup is following NIH/NCI supported projects and their impact on cancer endpoints, including:

• A project that evaluates the impact of TRE on cancer cell growth in women with breast cancer between diagnosis and definitive surgery
• Two projects, one in lean and the second in overweight/obese individuals, on cancer risk endpoints
• Four TRE projects evaluating the impact of TRE on risk of breast and colorectal cancer

Co-Chairs

Ed Sauter [DCP] 
Tanya Agurs-Collins [DCCPS]

The Pediatrics and Physical Activity subgroup is exploring the following challenges in obesity and cancer:

• What is needed to accelerate the application of pediatric exercise and physical activity intervention knowledge from bench to bedside to communities and policy?
• What are research opportunities for exercise, physical activity and physical education for pediatric cancer patients and survivors?
• What role do pediatric exercise and physical activity interventions play in improving cancer treatment outcomes?

Co-Chairs

Heather Bowles [DCP] 
Frank Perna [DCCPS] 

• Dietary Assessment Resources
• Exercise and Nutrition Interventions to Improve Cancer Treatment-related Outcomes (ENICTO) in Cancer Survivors
• Metabolic Dysregulation and Cancer Risk Program: A Transdisciplinary Approach to Obesity-Associated Cancer Research
• National Collaborative on Childhood Obesity Research. Advancing Measurement for Childhood Obesity Workshop Series
• NIH Obesity Research Task Force
• Nutrition Research Task Force
• Obesity and Cancer Fact Sheet, NCI
• Physical Activity Assessment Resources

• Agurs-Collins T, Ross SA, Dunn BK. The many faces of obesity and Its influence on breast cancer risk. Front Oncol. 2019 Sep 4;9:765. doi: 10.3389/fonc.2019.00765.
• Al Hennawi H, Zohaib M, Khuzzaim Khan M, Ahmed F, Mathbout OF, Alkhachem A, Ameen Ahmed U. Temporal trends in obesity-related mortality rates: an analysis of gender, race/ethnicity, and geographic disparities in the United States. Curr Probl Cardiol. 2024;49:102108. doi: 10.1016/j.cpcardiol.2023.102108
• Ballard R, Arteaga S, Berrigan D, et al. Advancing measurement to address childhood obesity: results of three workshops. Am J Prev Med. 2021;61(6):e296-e304. doi: 10.1016/j.amepre.2021.05.025
• Belcher BR, Wolff-Hughes DL, Dooley EE, et al. US population-referenced percentiles for wrist-worn accelerometer-derived activity. Med Sci Sports Exerc. 2021;53(11):2455-2464. doi: 10.1249/MSS.0000000000002726
• Boyd P, O’Connor S, Heckman-Stoddard BM, Sauter ER. Time-restricted feeding studies and possible human benefit. JNCI Cancer Spectr. 2022;6(3):pkac032. doi: 10.1093/jncics/pkac032
• Brown JC, Carson TL, Thompson HJ, Agurs-Collins T. The triple health threat of diabetes, obesity, and cancer-epidemiology, disparities, mechanisms, and interventions. Obesity (Silver Spring). 2021 Jun;29(6):954-959. doi: 1002/oby.23161.
• Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375-2390. doi: 10.1249/MSS.0000000000002116.
• de Cabo R, Mattson MP. Effects of intermittent fasting on health, aging, and disease. N Engl J Med. 2019;381(26):2541-2551. doi: 10.1056/NEJMra1905136.
• Garcia MB, Schadler KL, Chandra J, et al. Translating energy balance research from the bench to the clinic to the community: Parallel animal-human studies in cancer. CA Cancer J Clin. 2023; 73(4):425-442. doi: 10.3322/caac.21773
• Hiatt RA, Clayton MF, Collins KK, Gold HT, Laiyemo AO, Parker Truesdale K, Ritzwoller DP. The Pathways to Prevention program: nutrition as prevention for improved cancer outcomes. J Natl Cancer Spectr. 2023;886-895. doi: 10.1093/jnci/djad079
• Lin W, Leider J, Shang C., et al. The association between state physical education laws and student physical activity. Am J Prev Med. 2020;58(3):436-445. doi: 10.1016/j.amepre.2019.09.018
• Look AHEAD Research Group, Yeh HC, Bantle JP, Cassidy-Begay M, et al. Intensive weight loss intervention and cancer risk in adults with type 2 diabetes: analysis of the Look AHEAD randomized clinical trial. Obesity (Silver Spring). 2020;28(9):1678-1686. doi: 10.1002/oby.22936.
• Energy balance and obesity. IARC Working Group Reports, Volume 10, Edited by Isabelle Romieu, Laure Dossus, and Walter C. Willett. Chapter 12. Molecular and metabolic mechanisms underlying the obesity–cancer link, Ciara H. O’Flanagan, Laura W. Bowers, Emma H. Allott, and Stephen D. Hursting. 2017, International Agency for Research on Cancer, Lyon, France.
• Ezpeleta M, Cienfuegos S, Lin S, Pavlou V, Gabel K, Tussing-Humphreys L, Varady KA. Time-restricted eating: watching the clock to treat obesity. Cell Metab. 2024;36(2):301-314. doi: 1016/j.cmet.2023.12.004
• NIH Obesity Research Task Force. Strategic Plan for NIH Obesity Research. 2011. Available at: https://www.obesityresearch.nih.gov/
• Obesity, Diet, Physical Activity, and Cancer: Transdisciplinary and Translational Approaches Towards Energy Balance and Cancer Research from the Bench to the Clinic and Community. JNCI Monographs. 2023;61.
• Orgel E, Framson C, Buxton R, et al. Caloric and nutrient restriction to augment chemotherapy efficacy for acute lymphoblastic leukemia: the IDEAL trial. Blood Adv. 2021 Apr 13;5(7):1853-1861. doi: 10.1182/bloodadvances.2020004018.
• Park Y, Dodd KW, Kipnis V, et al. Comparison of self-reported dietary intakes from the Automated Self-Administered 24-h recall, 4-d food records, and food-frequency questionnaires against recovery biomarkers. AmJ Clin Nutr. 2018;107(1), 80-93. doi: 10.1093/ajcn/nqx002.
• Parsons HM, Forte ML, Abdi HI, et al. Nutrition as prevention for improved cancer health outcomes: a systematic literature review. 2023; JNCI Cancer Spectr. 2023;7(3): doi: 10.1093/jncics/pkad035
• Perez-Escamilla R, King A, Rivera J (Eds). Childhood obesity prevention across borders: The promise of US‐Latin American research collaboration [Special Issue]. Obesity. 2021.
• Piekarz-Porter E, Lin W, Leider J, et al. State laws matter when it comes to school provisions for structured PE and daily PE participation. Transl Behav Med. 2021;11(2):597-603. doi: 10.1001/jamainternmed.2021.7755
• Saint-Maurice PF, Graubard BI, Troiano RP, et al. Estimated number of deaths prevented through increased physical activity among US adults. JAMA Intern Med. 2022;182(3):349-352. doi: 10.1001/jamainternmed.2021.7755
• Sauter ER, Heckman-Stoddard B. Metabolic surgery and cancer risk: an opportunity for mechanistic research. Cancers (Basel). 2021;13(13):3183. Doi:
• Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric surgery and the risk of cancer in a large multisite cohort. Ann Surg. 2019;269(1):95-101. doi: 10.1097/SLA.0000000000002525.
• Shams-White MM, Romaguera D, Mitrou P, et al. Further guidance in implementing the Standardized 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score. Cancer Epidemiol Biomarkers Prev. 2020;29(5):889-894. doi: 10.1158/1055-9965.EPI-19-1444
• Sharfman AS, Berrigan D, Galuska DA, Kettel Khan L, Stowe EW, Reedy J. National Collaborative on Childhood Obesity Research efforts to advance childhood obesity research: progress and next steps. Am J Prev Med. 2023;65(2):339-344. Doi: 1016/j.amepre.2023.02.017
• Tylavsky FA, Ferrara A, Catellier DJ, et al. Understanding childhood obesity in the US: the environmental influences on child health outcomes (ECHO) program. Int J Obes. 2020;44(3):617-627. 10.1038/s41366-019-0470-5