Higher rates of all-cause and cancer mortality in African Americans may be due in part to racial inequities related to weight gain and obesity, including access to food and healthcare [Greenlee et al., 2016 as cited in reference i]. Higher rater of obesity at the time of breast cancer diagnosis and twice as much weight gain years after diagnosis are found in African American women when compared to white women [Greenlee et al., 2016 as cited in reference i]. Undoubtedly, cancer survivors experience significant stressors including symptom burden, financial difficulties, and relationship strain [Henderson et al., 2003, Leak et al., 2008, Tate, 2011, and Ashing-Giwa et al., 2004 as cited in reference i]. In the below study, the authors explore the relationship between all of these factors: stressful life events, weight loss, waist reduction, and behavior change in African American breast cancer survivors [i].
The association of stressful life events on weight loss efforts among African American breast cancer survivors
Journal of Cancer Survivorship
This randomized weight loss intervention trial included 246 overweight or obese African American breast cancer survivors in Chicago at least 6 months post-treatment. Participants were randomly assigned to a 6 month Moving Forward Interventionist-Guided program (IG) or a Moving Forward Self-Guided program (SG). Both groups received program binders that outlined weekly topics about cognitive behavioral approaches to weight loss such as goal setting and mindful eating. In IG, groups met twice per week in person for classes and received text messages twice per week related to self-efficacy, social support, and health promotion resources. Food Frequency Questionnaires (FFQs) were administered and a Healthy Eating Index (HEI) was calculated. The HEI scores range from 0 to 100 and involves 13 components related to the Dietary Guidelines for Americans. An activity questionnaire and a life stress questionnaire, Crisis in Family Systems (CRISYS), were also administered. The CRISYS includes items such as pregnancy, school, employment, finances, relationships, safety, medical issues, and prejudice. The authors looked at weight, central adiposity, and behavioral outcomes [i].
The authors found:
1. Median moderate and vigorous physical activity (MVPA) was 87.1 minutes per week, median HEI was 65.7, and median number of stressful life events was 3 (out of a possible maximum of 22) at baseline
2. The most common stressful life events involved relationships, safety, and finances
3. No association between stress and weight loss in either group during the 6 month intervention or maintenance phase (12 months from baseline)
4. No association between stress and change in physical activity in either group during the 6 month intervention or maintenance phase
5. No association between stress and change in HEI score or central adiposity in either group during the 6 month intervention or maintenance phase [i]
For the Patient and Caregiver
As outlined above, no significant associations were found between stress and the outcomes studied. This may be due to involvement in Moving Forward, where participants may have learned to apply skills to manage stress. Participants in the IG group may have benefited from the support of other breast cancer survivors at group classes. Consider the resources you have access to and your support system, as these may help to manage stress and provide physical and mental health benefits. Ask your healthcare provider for recommendations of groups in your area or virtually with individuals that may be going through the same things as you.
For the Healthcare Team
Consider if your center offers informative handouts related to cognitive behavioral techniques or group support for patients, as these may be powerful tools to help manage stressors, increase physical activity, and prioritize nutritious foods. More research can help further guide program development in specific populations. Additional research is also needed to explore the complex relationship of stressful life events, weight, and behavioral change in African American breast cancer survivors.
[i] Kwarteng JL, Matthews L, Banerjee A, Sharp LK, Gerber BS, Stolley MR. (2021). The association of stressful life events on weight loss efforts among African American breast cancer survivors. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-021-01054-2