title: The Obesity Paradox in Cancer: a Review.
abstract: There is a common perception that excess adiposity, commonly approximated by body mass index (BMI), is associated with reduced cancer survival. A number of studies have emerged challenging this by demonstrating that overweight and early obese states are associated with improved survival. This finding is termed the "obesity paradox" and is well recognized in the cardio-metabolic literature but less so in oncology. Here, we summarize the epidemiological findings related to the obesity paradox in cancer. Our review highlights that many observations of the obesity paradox in cancer reflect methodological mechanisms including the crudeness of BMI as an obesity measure, confounding, detection bias, reverse causality, and a specific form of the selection bias, known as collider bias. It is imperative for the oncologist to interpret the observation of the obesity paradox against the above methodological framework and avoid the misinterpretation that being obese might be "good" or "protective" for cancer patients.
authors.affiliation: Institute of Cancer Sciences, University of Manchester, Manchester, UK. Hannah.lennon@manchester.ac.uk.|Farr Institute, MRC Health eResearch Centre (HeRC North), University of Manchester, Manchester, UK. Hannah.lennon@manchester.ac.uk.
authors.forename: Hannah
authors.initials: H
authors.lastname: Lennon
authors.affiliation: Farr Institute, MRC Health eResearch Centre (HeRC North), University of Manchester, Manchester, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sperrin
authors.affiliation: Institute of Cancer Sciences, University of Manchester, Manchester, UK.|Farr Institute, MRC Health eResearch Centre (HeRC North), University of Manchester, Manchester, UK.
authors.forename: Ellena
authors.initials: E
authors.lastname: Badrick
authors.affiliation: Institute of Cancer Sciences, University of Manchester, Manchester, UK.|Farr Institute, MRC Health eResearch Centre (HeRC North), University of Manchester, Manchester, UK.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Renehan
mesh_terms: D050154:Adiposity / Q000502:physiology; D015992:Body Mass Index; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D009765:Obesity / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D050177:Overweight / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D015996:Survival Rate
keywords: Adiposity; BMI; Body mass index; Cancer; Cancer survival; Epidemiology; Excess weight; Mortality; Obesity; Overweight; Prognosis