“The Weight Is Even Worse Than the Cancer”: Exploring Weight Preoccupation in Women Treated for Breast Cancer

Abstract

Cancer-related changes in body weight are problematic given that excess weight is associated with an increased risk of cancer reoccurrence and mortality. The purpose of this qualitative study was to explore the experiences of weight-concerned women treated for early-stage breast cancer. A purposeful sample of women were selected based on criteria for high weight and body image concerns (n = 11; M_age = 65.31 ± 10.96 years). Each participant engaged in a one-on-one semi-structured interview. Five themes were identified: weight concerns contributed to psychological distress, prevalent history of weight cycling and ongoing quest to manage weight, shifting psychological impact of cancer versus weight, perceptions of failure around goal-oriented weight management behaviors, and internalized and explicit social pressures for weight loss in the context of risk reduction. In light of the fundamental challenges of weight management, and the present findings, improving weight-related distress should be a clinical priority to improve the well-being of women in survivorship.

Keywords

Weight obesity breast cancer psychological distress qualitative phenomenology Canada

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References

Allen-Collinson

(2009). Sporting embodiment: Sports studies and the (continuing) promise of phenomenology. Qualitative Research in Sport and Exercise, 1, 279–296. doi:10.1080/19398440903192340

Bacon

Aphramor

(2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 10(1), Article 9. doi:10.1186/1475-2891-10-9

Boquiren

V. M.

Esplen

M. J.

Wong

Toner

Warner

(2013). Exploring the influence of gender-role socialization and objectified body consciousness on body image disturbance in breast cancer survivors. Psycho-Oncology, 22, 2177–2185. doi:10.1002/pon.3271

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. doi:10.1191/1478088706qp063oa

Brownell

Kersh

Ludwig

D. S.

Post

R. C.

Puhl

Schwartz

M. B.

Willett

W. C.

(2010). Personal responsibility and obesity: A constructive approach to a controversial issue. Health Affairs (Project Hope), 29, 379–387. doi:10.1377/hlthaff.2009.0739

Brunet

Amireault

Chaiton

Sabiston

(2014). Identification and prediction of physical activity trajectories in women treated for breast cancer. Annals of Epidemiology, 24, 837–842. doi:10.1016/j.annepidem.2014.07.004

Brunet

Sabiston

Burke

(2013). Surviving breast cancer: Women’s experiences with their changed bodies. Body Image, 10, 344–351. doi:10.1016/j.bodyim.2013.02.002

Burgess

Cornelius

Love

Graham

Richards

Ramirez

(2005). Depression and anxiety in women with early breast cancer: Five year observational cohort study. British Medical Journal, 330, Article 702.

Carels

R. A.

Wott

C. B.

Young

K. M.

Gumble

Koball

Oehlhof

M. W.

(2010). Implicit, explicit, and internalized weight bias and psychosocial maladjustment among treatment-seeking adults. Eating Behaviors, 11, 180–185. doi:10.1016/j.eatbeh.2010.03.002

10.

Chan

D. S. M.

Vieira

A. R.

Aune

Bandera

E. V.

Greenwood

D. C.

McTiernan

. . . Norat

(2014). Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Annals of Oncology, 25, 1901–1914. doi:10.1093/annonc/mdu042

11.

Collins

K. K.

Liu

Schootman

Aft

Yan

Dean

. . . Jeffe

D. B.

(2011). Effects of breast cancer surgery and surgical side effects on body image over time. Breast Cancer Research and Treatment, 126, 167–176. doi:10.1007/s10549-010-1077-7

12.

Cui

Whiteman

M. K.

Flaws

J. A.

Langenberg

Tkaczuk

K. H.

Bush

T. L.

(2002). Body mass and stage of breast cancer at diagnosis. International Journal of Cancer, 98, 279–283. doi:10.1002/ijc.10209

13.

Demark-Wahnefried

Campbell

K. L.

Hayes

S. C.

(2012). Weight management and its role in breast cancer rehabilitation. Cancer, 118(Suppl. 8), 2277–2287. doi:10.1002/cncr.27466

14.

Demark-Wahnefried

Hars

Conaway

M. R.

Havlin

Rimer

B. K.

McElveen

Winer

E. P.

(1997). Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy. The American Journal of Clinical Nutrition, 65, 1495–1501.

15.

Drury

C. A.

Louis

(2002). Exploring the association between body weight, stigma of obesity, and health care avoidance. Journal of the American Academy of Nurse Practitioners, 14, 554–561. doi:10.1111/j.1745-7599.2002.tb00089.x

16.

Fann

J. R.

Thomas-Rich

A. M.

Katon

W. J.

Cowley

Pepping

McGregor

B. A.

Gralow

(2008). Major depression after breast cancer: A review of epidemiology and treatment. General Hospital Psychiatry, 30, 112–126. doi:10.1016/j.genhosppsych.2007.10.008

17.

Fazzino

T. L.

Hunter

R. C.

Sporn

Christifano

D. N.

Befort

C. A.

(2017). Weight fluctuation during adulthood and weight gain since breast cancer diagnosis predict multiple dimensions of body image among rural breast cancer survivors. Psycho-Oncology, 26, 392–399. doi.org/10.1002/pon.4035

18.

Figueiredo

M. I.

Cullen

Hwang

Y.-T.

Rowland

J. H.

Mandelblatt

J. S.

(2004). Breast cancer treatment in older women: Does getting what you want improve your long-term body image and mental health? Journal of Clinical Oncology, 22, 4002–4009. doi:10.1200/JCO.2004.07.030

19.

Fredrickson

B. L.

Roberts

T.-A.

(1997). Objectification theory: Toward understanding women’s lived experiences and mental health risks. Psychology of Women Quarterly, 21, 173–206. doi:10.1111/j.1471-6402.1997.tb00108.x

20.

Giorgi

(2009). The descriptive phenomenological method in psychology: A modified Husserlian approach. Pittsburgh, PA: Duquesne University Press.

21.

Giorgi

(2008). Phenomenology. In Smith

J. A.

(Ed.), Qualitative Psychology: A practical guide to research methods (pp. 26–52). London: Sage.

22.

Halbert

C. H.

Weathers

Esteve

Audrain-McGovern

Kumanyika

DeMichele

Barg

(2008). Experiences with weight change in African-American breast cancer survivors. The Breast Journal, 14, 182–187. doi:10.1111/j.1524-4741.2007.00551.x

23.

Irwin

McTiernan

Baumgartner

R. N.

Baumgartner

K. B.

Bernstein

Gilliland

F. D.

Ballard-Barbash

(2005). Changes in body fat and weight after a breast cancer diagnosis: Influence of demographic, prognostic, and lifestyle factors. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 23, 774–782. doi:10.1200/JCO.2005.04.036

24.

Kirk

S. F. L.

Price

S. L.

Penney

T. L.

Rehman

Lyons

R. F.

Piccinini-Vallis

. . . (2014). Blame, shame, and lack of support: A multilevel study on obesity management. Qualitative Health Research, 24, 790–800. doi:10.1177/1049732314529667

25.

Kwan

(2009). Competing motivational discourses for weight loss: Means to ends and the nexus of beauty and health. Qualitative Health Research, 19, 1223–1233. doi:10.1177/1049732309343952

26.

Lende

D. H.

Lachiondo

(2009). Embodiment and breast cancer among African American women. Qualitative Health Research, 19, 216–228. doi:10.1177/1049732308328162

27.

Maley

Warren

B. S.

Devine

C. M.

(2013). A second chance: Meanings of body weight, diet, and physical activity to women who have experienced cancer. Journal of Nutrition Education and Behavior, 45, 232–239. doi:10.1016/j.jneb.2012.10.009

28.

Moreira

Canavarro

(2010). A longitudinal study about the body image and psychosocial adjustment of breast cancer patients during the course of the disease. European Journal of Oncology Nursing, 14, 263–270. doi:10.1016/j.ejon.2010.04.001

29.

Patton

(1990). Qualitative evaluation and research methods (2nd ed.). Thousand Oaks, CA: Sage.

30.

Patton

(2002). Two decades of developments in qualitative inquiry: A personal, experiential perspective. Qualitative Social Work, 1, 261–283. doi:10.1177/1473325002001003636

31.

Pearl

R. L.

Lebowitz

M. S.

(2014). Beyond personal responsibility: Effects of causal attributions for overweight and obesity on weight-related beliefs, stigma, and policy support. Psychology & Health, 29, 1176–1191. doi:10.1080/08870446.2014.916807

32.

Pedersen

Groenkjaer

Falkmer

Mark

Delmar

(2016). “The ambiguous transforming body”—A phenomenological study of the meaning of weight changes among women treated for breast cancer. International Journal of Nursing Studies, 55, 15–25. doi:10.1016/j.ijnurstu.2015.10.011

33.

Pila

Solomon-Krakus

Egelton

Sabiston

C. M.

(2018). “I am a fat baby, who moved to a fat child, who moved to a fat teenager, who moved to a fat adult”: Women’s reflections of a lifetime of body and weight concern. Journal of Women & Aging, 30, 158–177. doi:10.1080/08952841.2017.1295669

34.

Porter

G. A.

Inglis

K. M.

Wood

L. A.

Veugelers

P. J.

(2006). Effect of obesity on presentation of breast cancer. Annals of Surgical Oncology, 13, 327–332. doi:10.1245/ASO.2006.03.049

35.

Przezdziecki

Sherman

K. A.

Baillie

Taylor

Foley

Stalgis-Bilinski

(2013). My changed body: Breast cancer, body image, distress and self-compassion. Psycho-Oncology, 22, 1872–1879. doi:10.1002/pon.3230

36.

Puhl

Moss-Racusin

C. A.

Schwartz

M. B.

(2007). Internalization of weight bias: Implications for binge eating and emotional well-being. Obesity, 15, 19–23. doi:10.1038/oby.2007.521

37.

Rodgers

R. F.

(2016). The role of the “Healthy Weight” discourse in body image and eating concerns: An extension of sociocultural theory. Eating Behaviors, 22, 194–198. doi:10.1016/j.eatbeh.2016.06.004

38.

Sabiston

C. M.

McDonough

M. H.

Sedgwick

W. A.

Crocker

P. R. E.

(2009). Muscle gains and emotional strains: Conflicting experiences of change among overweight women participating in an exercise intervention program. Qualitative Health Research, 19, 466–480. doi:10.1177/1049732309332782

39.

Smith

McGannon

K. R.

(2017). Developing rigor in qualitative research: Problems and opportunities within sport and exercise psychology. International Review of Sport and Exercise Psychology, 1–21. Advanced online publication. doi:10.1080/1750984X.2017.1317357

40.

Smith

(2004). Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qualitative Research in Psychology, 1, 39–54. doi:10.1191/1478088704qp004oa

41.

Starks

Brown Trinidad

(2007). Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qualitative Health Research, 17, 1372–1380. doi:10.1177/1049732307307031

42.

Swinburn

Egger

(2004). The runway weight gain train: Too many accelerators and not enough brakes. British Medical Journal, 329, 736–739.

43.

Tomiyama

A. J.

(2014). Weight stigma is stressful. A review of evidence for the Cyclic Obesity/Weight-Based Stigma model. Appetite, 82, 8–15. doi:10.1016/j.appet.2014.06.108

44.

Whitehead

Lavelle

(2009). Older breast cancer survivors’ views and preferences for physical activity. Qualitative Health Research, 19, 894–906. doi:10.1177/1049732309337523

45.

Wood

A. J. J.

Shapiro

C. L.

Recht

(2001). Side effects of adjuvant treatment of breast cancer. New England Journal of Medicine, 344, 1997–2008. doi:10.1056/NEJM200106283442607

46.

Wright

C. E.

Harvie

Howell

Evans

D. G.

Hulbert-Williams

Donnelly

L. S.

(2015). Beliefs about weight and breast cancer: An interview study with high risk women following a 12 month weight loss intervention. Hereditary Cancer in Clinical Practice, 13(1), 1. doi:10.1186/s13053-014-0023-9