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Publications

Journal Article Review Ahead of print

PubMed: 42611363 DOI: 10.1007/s11154-026-10074-1

Beyond weight: a stigma-free, integrated approach to obesity in patients affected by cancer.

Rev Endocr Metab Disord

Authors: Mikiko Watanabe, Edoardo Mocini, Carla Di Dato, Fiammetta Cipriani, Maria Grazia Tarsitano, Silvia Migliaccio, Andrea G Lania, Gianluca Aimaretti, Roberto Baldelli

Affiliations

  • Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, 00161, Italy.
  • Department of Theoretical and Applied Sciences (DiSTA), eCampus University, Via Isimbardi 10, Novedrate (CO), 22060, Italy.
  • Santo Spirito Hospital, Department of Medical Specialties, Unit of Endocrinology, Rome, Italy.
  • Endocrinology Unit, Department of Oncology and Medical Specialties, Rome, Italy.
  • Department for the Promotion of Human Sciences and Quality of Life, San Raffaele Roma University, Rome, Italy.
  • Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, 00161, Italy.
  • Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
  • Division of Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.

Abstract

BACKGROUND

Obesity affects a substantial proportion of patients receiving cancer treatment and shapes prognosis, treatment tolerance, and survivorship outcomes. The longstanding reliance on body mass index has shaped a weight-centric paradigm that misses the metabolic and functional phenotypes behind clinical risk, and too often delivers care driven by weight stigma rather than by physiology.

OBJECTIVES

This framework paper reconsiders the management of obesity in patients affected by cancer along three interconnected lines: assessment beyond BMI, stigma-free communication, and integrated, phase-sensitive care along the cancer continuum. Key content. Body composition phenotyping, including the recognition of sarcopenic obesity, ectopic fat deposition, and myosteatosis, is now within reach through opportunistic radiomics on staging computed tomography, and yields prognostic information that BMI alone cannot deliver. International consensus statements increasingly frame obesity as a chronic, complex, and relapsing disease rather than a matter of individual responsibility, and emphasize that person-first language and the active reduction of weight bias should be embedded as core components of cancer care. The therapeutic armamentarium spans nutritional strategies grounded in ESPEN principles, structured exercise with resistance training at its core, behavioural and psychological support, GLP-1 receptor agonists, and metabolic-bariatric surgery, the latter linked to substantial reductions in cancer incidence and mortality. Goals shift along the continuum: lean mass optimisation in prehabilitation, lean mass preservation during active treatment, fat mass reduction in follow-up, and cachexia prevention in palliative phases.

CONCLUSIONS

A phase-sensitive, multidisciplinary, stigma-free framework moves obesity care away from a weight-centric paradigm and toward optimisation of body composition and metabolic health throughout the cancer trajectory.

MeSH

Neoplasms, Obesity, Therapeutics