A Case-Based Look at Healthy Weight Loss for Survivors of Cancer

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/m 2 , 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/m 2 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