The Triple Health Threat of Diabetes, Obesity, and Cancer-Epidemiology, Disparities, Mechanisms, and Interventions

Abstract

Obesity and type 2 diabetes are both chronic, relapsing, progressive diseases that are recognized as risk factors for the development of multiple types of cancer. In a recent symposium titled "Hitting A Triple-Diabetes, Obesity, and the Emerging Links to Cancer Risk," convened by The Obesity Society during ObesityWeek 2019, experts in the field presented the current science and highlighted existing research gaps. Topics included (1) the epidemiology of obesity and diabetes and their links to cancer risk; (2) racial and ethnic differences in obesity, diabetes, and cancer risk; (3) biological mechanisms common to obesity and diabetes that may increase cancer risk; and (4) innovative interventions that can be used to prevent the development of cancers related to obesity and diabetes. This report provides an overview of the symposium and describes key research gaps and pressing questions in need of answers to advance the field. The collective burden of obesity, diabetes, and cancer represents one of the largest public health challenges of the century. Although the symposium was titled "hitting a triple," it was recognized that being able to disrupt the linkages among obesity, diabetes, and cancer would be a "grand slam" for public health and medicine.

Figure 1.

Cancers that have an established relationship with obesity. Cancers that also have an established relationship with diabetes have an asterisk.

Figure 2.

A simplified overview of the phosphatidylinositol 3-kinase, protein kinase B, mammalian target of rapamycin (PI3K-Akt-mTOR) pathway. The PI3K-Akt-mTOR pathway has been implicated in obesity, diabetes, and cancer risk, make this pathway a useful bridge between population studies and mechanistically based interventions.

Figure 3.

Managing obesity and diabetes as a cancer prevention and control strategy will likely require a multimodal approach that utilizes lifestyle modification as a foundation and offers evidence-based anti-obesity or anti-diabetes medication and metabolic surgery, as appropriate.