title: The impact of a cancer diagnosis on weight change: findings from prospective, population-based cohorts in the UK and the US.
abstract: BACKGROUND
  Obesity is a risk factor for cancer incidence and survival, but data on patterns of weight change in cancer survivors are scarce and few stratify by pre-diagnosis weight status. In two population-based cohorts of older adults, we examined weight change in cancer survivors and cancer-free controls in relation to baseline weight status.
  
  
  METHODS
  In the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), we identified participants diagnosed with cancer who had pre- and post-diagnosis BMI data (ELSA n=264; HRS n=2553), and cancer-free controls (ELSA n=1538; HRS n=4946). Repeated-measures ANOVAs tested three-way interactions by group (cancer/control), time (pre-/post-diagnosis), and pre-diagnosis weight status (normal-weight/overweight/obese).
  
  
  RESULTS
  Mean BMI change was -0.07 (SD=2.22) in cancer survivors vs. +0.14 (SD=1.11) in cancer-free controls in ELSA, and -0.20 (SD=2.84) vs. +0.11 (SD=0.93) respectively in HRS. Three-way interactions were significant in both cohorts (ELSA p=.015; HRS p<.001). In ELSA, mean BMI change in normal-weight cancer survivors was +0.19 (SD=1.53) compared with -0.33 (SD=3.04) in obese survivors. In ELSA controls, the respective figures were +0.09 (SD=0.81) and +0.16 (SD=1.50). In HRS, mean change in normal-weight cancer survivors was +0.07 (SD=2.30) compared with -0.72 (SD=3.53) in obese survivors. In HRS controls, the respective figures were +0.003 (SD=0.66) and +0.27 (SD=1.27).
  
  
  CONCLUSIONS
  Over a four-year period, in two cohorts of older adults, cancer survivors lost weight relative to cancer-free controls. However, cancer survivors who were obese pre-diagnosis were more likely to lose weight than healthy-weight survivors or obese adults without a cancer diagnosis. Whether this was due to differences in clinical status or deliberate lifestyle change triggered by the cancer diagnosis is not known. Further research is needed to establish why weight loss occurs more frequently in cancer survivors who were obese at diagnosis, and whether this has favourable effects on mortality.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Jackson
authors.forename: Kate
authors.initials: K
authors.lastname: Williams
authors.forename: Andrew
authors.initials: A
authors.lastname: Steptoe
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK. j.wardle@ucl.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D056865:Ideal Body Weight; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis*; D009765:Obesity / Q000150:complications*; D017741:Survivors; D013997:Time Factors; D006113:United Kingdom; D014481:United States; D015430:Weight Gain; D015431:Weight Loss