title: Risk factors for obesity in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.
abstract: OBJECTIVE
  Many Childhood Cancer Survivor Study (CCSS) participants are at increased risk for obesity. The etiology of their obesity is likely multifactorial but not well understood.
  
  
  METHODS
  We evaluated the potential contribution of demographic, lifestyle, treatment, and intrapersonal factors and self-reported pharmaceutical use to obesity (body mass index ≥ 30 kg/m2) among 9,284 adult (> 18 years of age) CCSS participants. Independent predictors were identified using multivariable regression models. Interrelationships were determined using structural equation modeling (SEM).
  
  
  RESULTS
  Independent risk factors for obesity included cancer diagnosed at 5 to 9 years of age (relative risk [RR], 1.12; 95% CI, 1.01 to 1.24; P = .03), abnormal Short Form-36 physical function (RR, 1.19; 95% CI, 1.06 to 1.33; P < .001), hypothalamic/pituitary radiation doses of 20 to 30 Gy (RR, 1.17; 95% CI, 1.05 to 1.30; P = .01), and paroxetine use (RR, 1.29; 95% CI, 1.08 to 1.54; P = .01). Meeting US Centers for Disease Control and Prevention guidelines for vigorous physical activity (RR, 0.90; 95% CI, 0.82 to 0.97; P = .01) and a medium amount of anxiety (RR, 0.86; 95% CI, 0.75 to 0.99; P = .04) reduced the risk of obesity. Results of SEM (N = 8,244; comparative fit index = 0.999; Tucker Lewis index = 0.999; root mean square error of approximation = 0.014; weighted root mean square residual = 0.749) described the hierarchical impact of the direct predictors, moderators, and mediators of obesity.
  
  
  CONCLUSIONS
  Treatment, lifestyle, and intrapersonal factors, as well as the use of specific antidepressants, may contribute to obesity among survivors. A multifaceted intervention, including alternative drug and other therapies for depression and anxiety, may be required to reduce risk.
authors.affiliation: Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105-2794, USA. daniel.green@stjude.org
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Cox
authors.forename: Liang
authors.initials: L
authors.lastname: Zhu
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
authors.forename: Deo Kumar
authors.initials: DK
authors.lastname: Srivastava
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Vikki G
authors.initials: VG
authors.lastname: Nolan
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Donaldson
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
authors.forename: Lillian R
authors.initials: LR
authors.lastname: Meacham
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D017741:Survivors; D014481:United States / Q000453:epidemiology; D055815:Young Adult