We’ve all heard a whole lot of negative when it comes to obesity. Maybe I’m just extra sensitive to it given it’s part of my profession to help people fight obesity, but really, there’s a lot of bad out there. Here’s more: obese patients are more likely to die from cancer, regardless of what type of cancer.
Upon reading that fact, I immediately jumped to the (wrong) conclusion that it had to do with poor health, vascular complications, other diseases like diabetes and hypertension, or any of the many other downsides obesity brings with it. But perhaps the real reason? Doctors under-dose their chemo treatment.
Doctors are taught to calculate chemo dosages using “ideal weight.” This is a number we use frequently as dietitians as well, but not for anything as life-and-death as cancer medication. We use it instead for choosing weight loss goals or evaluating health. One thing most dietitians learn early on in their careers is that this is pretty much a useless number. It doesn’t matter what a chart or a calculator says, weight is a completely individual situation.
If it doesn’t work for something as unscientific as a weight loss goal, why would it make sense that it would work for precise medical calculations? On the other hand, doctors may fear overdosing because they may not know just how much chemo a patient can handle.
If a patient doesn’t get the adequate dose of chemo, it can significantly affect survival outcomes. This study shows up to 40% of obese cancer patients only get 85% or less of the recommended dose of chemo.
While this may seem like a minor “mathematical” issue, I’d hardly feel that way if it were one of my friends or family members that wasn’t getting enough chemo to fight their disease based on their weight. We’ve seen that doctors unfairly judge patients based on appearance — whether that’s a healthy or unhealthy appearance — and now there’s evidence of health ailments having the same effect. Though no comparison to cancer, my step-sister has expressed frustration with doctors and other healthcare providers over issues with chronic back pain. She’s had countless doctors brush over her complaints by blaming it on her BMI — yet another mathematical calculation that is biasing medical treatment options. My mom is a cancer survivor, and it gives me chills that an equation taught in med school could have potentially made a drastic difference in her treatment.
Luckily there’s already a fix for this oversight in place. The American Society of Clinical Oncology has developed new guidelines that use a patient’s actual weight for determining chemo doses.
Not only is the under-dosing a problem because it’s not providing adequate treatment, but it’s often not questioned by patients because they’re already overwhelmed by all that cancer entails, and don’t even think to question the doctor.