How to deal with cancer-related weight gain?


Pounds have a way of piling on after a cancer diagnosis. For some, the culprit is steroids prescribed during chemotherapy. For others, it's tamoxifen or aromatase inhibitors taken to ward off hormone-positive cancers. And for many, it's comfort-eating to assuage the awful anxiety. So women often call the SHARE helpline to ask for advice on dieting.

I'm one of the lucky women who've never had a serious weight problem, so I don't have much first-hand experience to share. But when I put the question to SHARE's team of volunteers, I learned a lot—and got inspired. Heeding the example of Kathy and Annie (read on), I've now signed up for a personal-training session to build bones and I've adopted the "80-20 rule."

In 2008, when Kathy was 50, she was diagnosed with breast cancer. At 5 ft. 5 in., she weighed 168 lb. Her oncologist advised her to exercise, so Kathy put in an hour a day on the treadmill at least five days a week. She lost 30 lb. during chemo and radiation and felt great. But then she stopped running and slipped back into her old eating habits, and the 30 lb. returned. These days, on the advice of a nutritionist, she logs everything she eats and all her exercise into a free app called MyFitnessPal. She's built six miles of walking into her daily commute, including eight flights of stairs twice a day. She lifts weights with a trainer (half an hour for $30, once a week) at the Blink gym ($20 a month for her membership). Not only has she lost 15 lb. and kept it off but she's also increased her bone density by 11%—despite taking Tamoxifen for three years and Aromasin for four. The bottom line: "You need to find a moderate program that you can maintain."

Another breast-cancer helpline volunteer, Meryl, put on weight after she finished chemotherapy and started Tamoxifen. "The only alternative was to drink fluids, eat lots of fruits and vegetables, join Weight Watchers, and exercise," she says.

Diane, SHARE's breast-cancer helpline scheduler, thought chemo would take away her appetite—and the extra weight she was carrying. She was horrified by what happened: "A 20-lb. weight gain! Was it the Tamoxifen? Or the chemo? Or simply overeating?" She's determined to get back her old body. "I have learned to accept the fact that chemo and Tamoxifen are responsible for only a small percentage of my weight gain," she says. "I know the weight will not come off overnight. I have to walk more and eat healthier. It will be a long journey, but I'm not looking back."

Unlike Diane, Sara did not gain weight during treatment. "I ended up weighing less then I had in many, many years," says Sara, a volunteer on the breast-cancer helpline. But what she ate while she was going through chemo would give heartburn to a nutritionist: "I was on an ice cream diet for a while—full fat, none of that fake stuff. Was this wise? I don't know, but I did what felt good to me. Now I am back to a normal diet—fruits and vegetables, and so forth. I miss the ice cream. But not the chemo!"

If anyone ever had an excuse for stress-eating, it's Annie, an 11-year ovarian-cancer survivor and four-year breast-cancer survivor. "I gained 40 lb. in the first four years after my ovarian-cancer diagnosis, thanks to instant menopause, steroids, and a sense of entitlement," she says. "During that time, I had two recurrences, three debulking surgeries, and five chemotherapy regimens. If I was going to die, it wasn't going to be with a carrot in my stomach. Give me chocolate cake!" Her primary-care doctor was disturbed by her blood-sugar and cholesterol levels, but her oncologist seemed less concerned, so Annie didn't worry. "Plus," she says, "I had read that people who gained weight during chemotherapy seemed to do better—and that was enough permission for me." But when her third remission reached two years, she thought, "Gee, maybe I'll live. Maybe I should take care of my heart." She joined Weight Watchers and learned to manage her emotional eating and balance nutrition with daily indulgences. "I'm now at goal weight. I try to stay active and follow the 80-20 rule: 80% healthy nutrition and 20% indulgences. It's not perfect, but life should taste good!"

That's advice others agree with. "Maintaining a healthy lifestyle shouldn't be torture. We only live once," says Agnes, a breast-cancer helpline volunteer and support-group facilitator. Over the years, Agnes has gotten shorter and heavier. "It's not too bad," she says, "but I don't want it to get worse." In addition to daily exercise, she has settled into an eating regimen that works for her: She stays away from fatty foods, red meat, sodas, and junk food like chips. She has two main meals—a continental breakfast and an early dinner—with some fruit in between and later a snack, usually nuts and cheese or yogurt and fruit. Her diet includes a dessert, like chocolate. "Luckily, dark chocolate is healthy, so I don't feel guilty," she says.

It's important to keep in mind that factors completely unrelated to cancer treatment can play a role in weight gain. And sometimes a multiplicity of elements—like menopause or pregnancy, cancer drugs, decreased activity, and stress—combine to create a perfect storm. "Many women struggle with their weight after menopause," explains Grace, who facilitates a breast-cancer support group. "If you have had a propensity to gain weight all your life, like me, it becomes even more difficult. And the emotional factor can be the hardest to manage." Like many other volunteers, Grace recommends Weight Watchers. "It works. But you have to put in the effort. And exercise is a must."

Do you have a question you'd like to ask our volunteer team? Please let me know.