Fighting Weight Gain in Childhood Leukemia

little girl being weighed in doctors office

Weight loss can often be a profound side effect of cancer treatment. Yet, for children with a blood cancer called acute lymphoblastic leukemia (ALL) – the most common childhood cancer – the opposite tends to be true.

“One of the side effects that has really become apparent in the literature is the increase in obesity during treatment,” says Elena J. Ladas, PhD, an assistant professor of nutrition in pediatrics at Columbia University Medical Center. Ladas is investigating the reasons for obesity occurring during childhood leukemia treatment with support from an American Cancer Society grant.

A significant number of children with the disease can be cured, but around half of them become overweight or obese by the time they finish treatment – and they continue to battle the weight gain for years to come. Obesity is especially concerning for these kids because it can have a negative impact on survival.

The Search for Answers

To investigate why kids with ALL gain weight during treatment and how obesity affects their care and survival, Ladas spearheaded the Diet and Acute Lymphoblastic Leukemia Treatment (DALLT) Cohort study. The large prospective study collected information on dietary intake in kids with ALL.

“This study is going to use evidence to help parents [of children with ALL] determine what they should and should not feed their children,” says Ladas. “Right now, because we don’t have the science, we don’t know what to say.”

One of Ladas’ findings so far is that adolescents in particular tend to reduce their calorie intake quite significantly, yet still tend to gain a lot of weight. “Understanding what is happening here is really the focus of our study that is supported by the ACS,” says Ladas. In addition to dietary factors, Ladas notes that long-term use of steroids (as part of treatment) and lack of exercise are also likely contributors to obesity in kids with ALL.

When and If to Intervene

Programs to prevent or treat obesity in kids with ALL could help improve health and survival. The question is if and when such an intervention should take place.

“We know how to monitor weight gain and we know how to intervene. We just need to learn how to do it at the right time and with the right approach,” explains Ladas.

She plans to begin recruiting for an ALL obesity-related intervention trial at the end of 2016 or in early 2017. However, she acknowledges that asking children to change their diets and lose weight while undergoing cancer treatment is controversial, given how overwhelming the disease itself can be.

“There are emotional factors that are understandable and reasonable,” she says. “But if we can give parents something with evidence behind it, something that empowers them to play an active role in their child’s recovery, this research will potentially improve their opportunity for survival.

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