Translational and transdisciplinary research in energy balance and cancer: past is prologue.

Abstract

Obesity, defined as a body mass index ≥ 30 kg/m2, is associated with an increased incidence of 13 cancers and increased mortality of 14 cancers (1,2). Obesity is strongly linked to poor diet and physical inactivity, which are also independent risk factors for cancer incidence and mortality (3-5). Estimates suggest that by 2030 obesity will overtake tobacco as the most common preventable risk factor for the development of cancer. Today, approximately 40% of US adults have a body mass index > 30 kg/m2, with rates significantly higher in Black and Hispanic individuals, especially women (6). Rising rates of obesity and associated factors threaten to slow advances in cancer prevention and treatment, underscoring the critical need for research on the causal role of body composition, physical activity, and diet in cancer risk and outcomes. Substantial gaps exist in our understanding of the relationship between energy balance and cancer. Much of the evidence to date has focused on breast cancer, generated from individuals of middle-to-higher socioeconomic status with early-stage malignancies (4). Research is needed to understand the role of obesity in influencing risk and outcomes of understudied obesity-associated cancers and in racial and ethnic minorities, patients undergoing active treatment or who have metastatic disease, cancer survivors with low income and who live in rural settings, as well as younger and geriatric populations. Mechanistic research is needed to elucidate associations of energy balance with the microbiome, epigenetics, immune function, immunotherapy, and cancer. Research is also needed on how to effectively implement and disseminate lifestyle interventions in oncology practice. In addition, research must focus on how to develop and assess successful multi-level intervention strategies at the individual and community levels. The National Cancer Institute Fiscal Year 2022 Annual Plan and Budget proposal featured obesity and cancer as a scientific topic and highlighted the importance of investing in training the next generation of cancer researchers (7). Transdisciplinary training is needed to prepare researchers to innovatively address these complex topics.