<p>Obesity is a risk factor for endometrial cancer and is associated with worse outcomes. Data presented at the <strong>2025 ASCO Annual Meeting </strong>highlight the need to address obesity in patients with endometrial cancer.</p> <p><em><br></em></p> <p><em>Following this presentation, featured expert John K. Chan, MD, was interviewed by </em>Conference Reporter<em> Medical Director Lauren Weinand, MD. Clinical perspectives from Dr Chan on these findings are presented here.</em></p>

In their abstract from ASCO 2025, Youjin Oh, MD, and colleagues analyzed data from 198,710 hospitalized patients with endometrial cancer from the Nationwide Inpatient Sample database over a 4-year span (2016-2020; abstract e17648). They found that 33.9% of these patients had obesity and 18% were classified as having class III obesity. Patients with obesity had a higher risk of heart failure and acute kidney injury, significantly longer hospital stays, and a higher cost of care, but they also had lower mortality rates. We must identify these patients and provide the appropriate help to decrease the risks of complications associated with hospitalization. These findings are similar to those from an older study in which we showed that hospitalization stays were significantly longer for patients with endometrial cancer and class III obesity vs for those without obesity; the need for intensive care was also higher for patients with obesity. I think that these are impactful data because they show how difficult it is to care for patients who are hospitalized with class III obesity and endometrial cancer.

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In an abstract presented last year at ASCO 2024 and published this year, we evaluated the correlation between obesity and endometrioid endometrial cancer incidence in the United States. We used data from the United States Cancer Statistics database from 2001 to 2018 and the National Health and Nutrition Examination Survey (NHANES) database from 1988 to 2018. We found a 4.48% annual increase in endometrioid cancer in women aged 20 to 29 years and a significant increase in endometrioid cancer among Black and Hispanic women. So, a strong correlation was observed between obesity and endometrioid endometrial cancer in Black and Hispanic women, as well as in women aged 20 to 29 years. These findings highlight a need for targeted public health interventions.

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I think that obesity is an underaddressed problem in cancer care. Fortunately, a lot of patients have early-stage disease, and, after treatment, we have an opportunity to follow these patients every 3 to 4 months. This allows us to counsel them about nutrition and metabolic health throughout their follow-up visits. I have a mnemonic that I teach medical students and residents who rotate with me about addressing obesity in patients with endometrial cancer. It is called EMBRACE: empathize with the patients and meet them where they are; motivate patients with success stories; explain the biology of the conversion of fat into estrogen and how it impacts the risk of endometrial cancer; reinforce the importance of collaboration; advocate for weight management to reduce the risk of recurrence and maintain overall health; coach patients on nutrition; and encourage patients by emphasizing small wins every 3 to 4 months.

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In terms of whether diet or exercise is the best approach for reducing cancer mortality in women, I did a study analyzing data from 3590 patients in the NHANES III database from 1988 to 1994. A healthy diet was associated with a 30% reduction in cancer mortality. In addition, we found that a healthy diet may play a stronger role than physical exercise, which was not an independent predictor of reduced cancer mortality. Patients who ate a healthy diet but did not exercise regularly had decreased cancer mortality vs patients who ate an unhealthy diet but exercised regularly.