Abstract
Patients with cancer are generally encouraged to prevent weight loss during their active treatment phase. Yet when a patient completes active treatment and transitions into survivorship, weight loss may be needed. Although it is ideal for a registered dietitian to be a part of survivorship care planning, this article will provide the AP with information about popular weight loss methods. A case study of a 47-year-old breast cancer survivor provides the framework for an ideal weight-loss approach.
Case Study
Ms. D is a 47-year-old female who was diagnosed with stage IIIA triple-negative breast cancer in 2014. She completed neoadjuvant therapy with doxorubicin, cyclophosphamide, and paclitaxel and then had a left mastectomy and radiation therapy.
During an appointment in the survivorship clinic, she reveals to her advanced practitioner (AP) and dietitian that she is concerned about her weight. Her body mass index (BMI) is 42.5 kg/m2, which places her in the obese category. She has multiple questions regarding weight loss, including the use of phentermine, and is interested in losing weight “the fastest way possible.” She is only eating one meal a day in an attempt to lose weight. Other than obesity, her physical examination is normal, and her laboratory results are unremarkable.
The AP discussed Ms. D’s BMI with her. She reviewed the risk of cancer recurrence, noting that a BMI of ≥ 35 kg/m2 may be associated with a higher risk of recurrence. She emphasized the role of exercise in weight loss. She encouraged Ms. D to begin an exercise routine at 5 minutes per day and work up to a goal of 30 minutes of moderate to strenuous exercise at least 5 days per week. Ms. D stated that there is a track near her home and that she could begin walking daily there.
The AP stressed the importance of following good nutritional guidelines and eating from every food group. She reviewed the safety data on phentermine, specifically the cardioexcitatory effects. She noted that long-term efficacy and safety evidence is lacking.
The dietitian discussed Ms. D’s desire for rapid weight loss. She educated her on healthy weight loss, which may seem slow but is much better for the body. She encouraged colorful, healthy food from all food groups such as fruits and vegetables, whole grains, beans, lean meats, and avoiding processed items such as fast foods and convenience foods. The dietitian discussed the importance of hydration, and Ms. D revealed that she drinks about three cola drinks and at least one glass of sweetened iced tea per day. The dietitian told her that caffeine-free and calorie-free beverages are best for hydration, stressing that water is the healthiest choice.
The dietitian asked about Ms. D’s meal setting. She said that she eats in front of the TV daily. It was recommended that she eliminate distractions and eat with the TV off, so she would be more cognizant of portion size and stop eating when she was satisfied. She encouraged Ms. D to take smaller bites and chew slowly to help minimize overeating by giving the satiety center in the brain time to receive messages of fullness from the stomach.
The dietitian discussed the need for weight loss utilizing adequate nutritional intake vs. a “quick-fix” pill such as phentermine. A calorie-restricted diet is still required for weight loss when using phentermine. Weight is usually rapidly regained after the drug is stopped unless there are behavioral and lifestyle changes. She gave Ms. D a tip sheet for successful weight loss, including having consistent meal times, avoiding skipping meals, using portion control, limiting alcohol intake, eating meals in one specified location, and adequate hydrating with noncaloric, caffeine-free liquids. They brainstormed about healthy snacks to have on hand, and Ms. D said she likes apples, raisins, and yogurt. The dietitian gave her some ideas about planning ahead for lunches to take to work, so she could avoid fast food. They discussed other times of temptation to overeat and ways to prevent it, all with a goal of long-term, sustainable weight reduction.
