Tools for Coping With Weight Gain/Loss During Cancer Treatment

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Depending on the individual, some patients unintentionally gain or lose weight during cancer treatment. How can patients nourish their bodies and maintain weight? What small changes can people make to their daily routine to enhance their diet? Patient Power founder Andrew Schorr is joined by Julie Lanford, oncology dietitian and wellness director from Cancer Services, to tackle weight issues that accompany cancer treatments and share expert advice to help patients meet their weight goals. Julie discusses reasons for weight fluctuation or changes in metabolism, tips for managing proper nutrition and practical steps for patients to take to eat well during and after treatment. Julie also explains when it’s appropriate to use a dietary supplement and what kind is most beneficial for cancer patients.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello and welcome to Patient Power.  I'm Andrew Schorr on location as we travel in Quebec City, Canada.  And I'm delighted to be connected once again with my dietitian friend, oncology dietitian friend, Julie Lanford, who is the Wellness Director of Cancer Services in Winston-Salem, North Carolina.  Julie, welcome back to Patient Power. 

Julie Lanford:

Thanks.  I'm glad to be here. 

Andrew Schorr:

Okay, Julie.  So let's tackle some weight issues that go along with those of us who are being treated for cancer.  So I'll start with myself.  So for about six years now I've been taking one of these newer genetic inhibitors, cancer gene inhibitors, and it's worked great. And I'm doing really, really well, and I'm so grateful. 

But like with some of other medicines you may know of, cancer medicines and others, it's put weight on for me.  I don't know if I eat too much or it's something the way I process food, but I never had a gut and I do now.  So am I happy to be a cancer survivor?  Yes.  Am I happy to have a gut?  No.  So what's going on, and is there anything you can do about it? 

Julie Lanford:

Well, so you're not alone is what I'll say first.  There are some populations of cancer survivors who are facing challenges with gaining weight, either as a result of treatment, during treatment.  We don't exactly know why is what I would say first off, is that everybody is a little bit different.  So is it a result of the actual treatment?  Is it because maybe somebody became less active during treatment?  Maybe they ate differently during treatment, which is pretty common.  So we don't exactly know why, which when there's no answer, it's not always fun. 

But I think the thing to also recognize when you are facing that is to be a little bit more aware of what your typical daily patterns are.  So, you probably know, since you use a Fitbit.  Are you as active as you were before?  You know?  There you go.  And are there things we can do with that?  Are there things that you can do with diet?  Certainly, we focus on nutritious choices, making sure we're optimizing your nutrition.  And then it might be, it just might be that that is a side effect of the medication and if you're doing everything right behavior-wise, then it's something we sort of manage or live with. 

Andrew Schorr:

Well, I'm very grateful, and I know you've told me there are breast cancer medicines where you can put on weight.  And certainly maybe somebody's on an antidepressant, and those can put on weight.  Sometimes there are other medicines that can disrupt your sleep, and maybe that even has effect on your metabolism.  Okay. 

So can we make small changes to fight back?  Walk a little further, use olive oil instead of butter.  Are there little changes we can make where little changes over time can fight back, if you will? 

Julie Lanford:

Yeah.  So there are a couple of things I think can give you a really good bang for your buck.  For sure, paying attention to your physical activity, so I like people to focus, yes, on their steps and also on active minutes, so how many active minutes somebody does every day. 

And then, of course, weight-bearing activity is really important.  A couple of reasons especially for weight management we want you to maintain muscle mass.  Many people lose muscle during treatments or if they've had a surgery and they've been on bed rest, you lose muscle really quick.  It's hard to put it back on.  And so we want to change the body composition so that you have a good amount of muscle tissue.  So that's the exercise piece, which is not my expertise, so somebody else has to give more details on that. 

But from a nutrition standpoint, things that are really key are to limit sugar-sweetened beverages.  So people hear that, but, I mean, it can make a big difference if you're somebody who drinks them on a daily basis.  So simply cutting those out can be a big impact on your overall nutrition.  Making sure that you are getting enough of the foods that are actually good for you is another thing to focus on.  So that would be fruit, vegetables, whole grains, beans, nuts and seeds. 

And I find that when people focus on those pieces where they need to nourish their bodies that some of the other foods, you know, the portions get smaller, or they eat them less frequently just because they're not—there's not as much room in their day to fit those other foods in.  So those are some quick steps. 

Now, if somebody feels like they're already doing the right things and these are, well, I already do that, I already do that, I already do that, then I would say something that's really beneficial is to keep track of what you eat for a week or two weeks. And then you may need to have a dietitian to look over it and kind of see, well, what are the things that you're doing that maybe we can tweak, or maybe they would look at it and say, you know what?  You are doing a pretty good job and you need to pat yourself on the back.  But there are sometimes some things that I see with my patients that they don't quite realize, whereas maybe they're not eating enough protein at a meal, or maybe their—sort of their ratios of the types of foods they're eating are off balance. 

Andrew Schorr:

Tell you a couple of tweaks that I make.  So, first of all, if you go out to eat, even for lunch now, and you want to order—maybe you're used to having soft drink, one of those sugary drinks, with your turkey sandwiches, right?  Well, that's another two bucks, right?  And it's sugar.  So I am—always at lunch they say, what do you want to drink, and I say I'll just have a glass of water.  I'm saving the two bucks, and I'm not getting the calories, and I'm not getting the sugar.  That's one thing. 

The other thing I need to do is I've heard that drinking coffee is actually good for you, and there was I guess a new study I'm sure you've been asked about, and if you drink coffee, all things being equal you can live about 12 percent longer.  That's what I heard.  Anyway, I'm used to putting half-and-half in my coffee, so now I'm using skim milk. 

Julie Lanford:

Yeah. 

Andrew Schorr:

There you go.  Little things.  Okay.  That's weight gain. 

Let's talk about weight loss, and that is typical.  So here you're going through chemo or other drugs, you don't feel well, and you just don't feel like eating, and what do we do about that because you need the calories, right? 

Julie Lanford:

Yeah.  So people, you know, you always think the grass is greener on the other side.  So the people who are carrying more weight are feeling like, well, I wish I had the problem where I needed to put more weight on, but being on the other side is not easy either.  For those people who are maybe at the low end of their weight or they've lost too much and they need to put some back on, it's not easy. 

And so—but there are some, I would say, some key things that people need to do if they are dealing weight loss that they don't want.  The first thing to do is to make sure they eat frequently.  So I sort of have a rule where I like my patients to eat within an hour of getting up in the morning.  So I know that some people are on a medication that you have to take on an empty stomach, and it's this whole puzzle to figure out when you eat and when you take your medication.  But I say if it's morning medication, take it as soon as you get up, so you can eat an hour later.  Eat within an hour of getting up, and then eat every two to three hours going forward. 

So for a lot of people who are having unintentional weight loss their appetite is not telling them to eat, and they need to eat by the clock.  And so they might need to set an alarm for every two to three hours, or sometimes it can be the caregiver's job so gently nudge somebody that, hey, it's been two or three hours.  Maybe you should have a snack.  So that's one thing is to make sure to eat frequently. 

The other thing is to maximize the calories when they do eat, so making sure that when they're making choices we might actually want them to put the half-and-half in their coffee.  We might make sure that they're including healthy fats like avocados or nut butters or things that add more calories to their food because if they're only going to eat a small amount of food, we need it to really count. 

So—and then their beverages, we often might encourage them to drink juice or have milk as a beverage, and maybe they're drinking whole milk, something that adds even more calories.  And then we—you know, if somebody is still not able to meet sort of their weight gain goal with these tips, then we might add on to that, well, okay, Ensure or Boost or some other kind of nutrition supplement drinks.  Especially if they can't eat a full meal, it might be that they eat a part of a meal and then they drink one of those beverages because sometimes it's just less filling and they feel full already.  So the timing I think it really key and then which foods they choose. 

Andrew Schorr:

Okay.  So you mentioned about these supplements.  You can get dietary supplements in the store whether it's protein powders, the Ensures, the Boosts, the other brands that compete with that.  So that's a good thing, I mean if it needs to be added on? 

Julie Lanford:

Yeah.  So I always tell people that it's not what I prefer.  I would prefer people ate real food, and when you get your food in a can, you know, it's just not real food, but it is a good back-up plan.  So that's how I refer to it is if you cannot eat a meal or you just do not have—say someone lives alone.  They do not have someone there able to make food for them, sometimes they do not have the energy to get up and even make a sandwich.  And in those cases, their best back-up plan might be to have that Boost or Ensure or even a—more of a prescription-based nutrition supplement. 

Now, you can buy things, like Carnation Instant Breakfast is over the counter and a little bit cheaper.  It comes in powder packets that you can add to whole milk, so you can kind of mix that.  I've also done some recipes where you use one of the nutrition supplement drinks that comes in a can and blend it with like blueberries and spinach so that you do add some extra nutrition to it so it's kind of a good combination of bulk. 

I tend to steer people away from the powdered protein supplements that you would buy at like a GNC or a supplement store, because they're not regulated in the same way that food is.  So that's just kind of my preference on that. 

Andrew Schorr:

Good advice.  Okay.  So what I try to do, Julie, and see if I'm on the right track, is I try to have a lot of colors on my plate.  So if I have yogurt I have red strawberries and blue blueberries, and I put some nuts in there.  Sometimes I put a little honey in there.  So that might be in the morning.  In the evening my wife, Esther's, really good about, we have vegetables, we have a starch, maybe a meat or a protein, eggs, whatever.  But that's what you're talking about, that balance, and try to do it with enough frequency so that our body's being nourished. 

Julie Lanford:

Yeah.  And, you know, for the typical person even survivors who are kind of on maintenance treatment, we would really encourage them to pay attention to their body's cues as to when it's hungry and when it's full.  And so I think that's a good strategy when you're able to enjoy a variety of foods.  It's not such a great strategy when you are the person who's struggling to get enough food in because if you really pay—you know, if you're not hungry and then you don't eat, then you run into trouble. 

But I would say it's the same types of food that I want generally all survivors to focus on and have everything in the same proportions as well.  So plenty of fruits and vegetables, lots of different colors, and then some protein and some type of carbohydrates, that's kind of the basis of what a meal should be composed of.  So like your yogurt and berries and nuts would give you a good variety of carbohydrates, produce and your protein. 

Andrew Schorr:

Okay.  I'm on the right track, I hope, and I get rid of this gut if I can, cutting out half-and-half and using your Fitbit to do more steps.  Well, thank you so much. 

And I just want to put in a plug for our Patient Power recipes on our website.  And send one in.  If you have a suggestion, let's share it with everyone.  There are some great ones there now.  Julie Lanford from Winston-Salem, North Carolina, and the Wellness Director at Cancer Services, thank you so much for being with us once again. 

Julie Lanford:

Thanks. 

Andrew Schorr:

Andrew Schorr here reporting from Quebec City, Canada, and I'm going to eat right today and exercise, and I wish you all the best nutrition. 

Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on March 13, 2019