SOUTH AFRICAN LIFESTYLE MEDICINE ASSOCIATION

Precision Living – Tailoring Lifestyle to Beat Obesity-related Cancers

By:  Amanda Oakes-Cornellissen

Cancer is one of the most formidable diseases worldwide, and its impact intensifies when combined with obesity.  In their April 2025 perspective “Personalized Lifestyle Interventions for Prevention and Treatment of Obesity-Related Cancers: A Call to Action”, Motevalli and Stanford draw a compelling roadmap toward reversing this trend.  They advocate shifting from broad-based health guidelines to precision lifestyle medicine – an individualized approach that blends microbes, genes, environment, and behaviour into tailored cancer prevention and care.  The five take-home points they share are:

  1. The Global Challenge:  Cancer + Obesity
  • Cancer’s rise is staggering: Nearly 10 million annual deaths worldwide, and projected cases hitting ~28.4 million by 2040, which would be a 47% rise from 2020.
  • Obesity increases the risk: At least 13 cancer types are directly tied to excess weight, including breast (postmenopausal), colorectal, endometrial, liver, kidney, pancreatic, and gallbladder cancers.
  • Magnitude matters: A 5kg/m² BMI increase correlates with an ~11% higher cancer risk in general;  with comorbidities like diabetes, that rises to 17%.
  • Added complexity: Obesity fuels cancer via hormonal shifts (e.g. elevates insulin, IGF-1, estrogen), chronic inflammation, immune compromise, microbiome imbalance, and fat distribution (especially visceral fat).

 

  1. Lifestyle Interventions:  Solid evidence, Spotty application
  • Tobacco, diet & exercise: Avoiding smoking, embracing whole-food, plant-rich diets, limiting processed sugars, and staying physically active significantly reduce cancer risk.
  • Activity matters: Umbrella reviews affirm physical activity reduces the risk of the following cancer types: breast, colorectal, endometrial, lung, oesophageal, pancreatic, and meningioma.
  • Weight management counts: Intentional behavioural therapy, yoga, and psychoeducation can enhance sleep, reduce stress, and combat fatigue in survivors.
  • Gaps in practice: Despite strong data, most guidelines remain generalized.  Patients often show low adherence with programs failing to consider weight differences, insulin resistance, or hormone therapy responses.

 

  1. Why Personalization is the Game-Changer
  • Genetics & Biology: Only ~10% of cancers are traced to inherited mutations;  hence, modifiable lifestyle factors and environment play a greater role.

Genetic predispositions affect fat distribution (e.g. visceral vs. subcutaneous), hormonal receptor expression, metabolism – shaping both risk and response.

  • Metabolic health & inflammation: Elevated insulin/IGF-1, estrogen, leptin, inflammatory cytokines, and oxidative stress create fertile ground for tumor development.

Personalized diets (e.g. low-carb for insulin resistance, fiber-rich for gut health) can modulate these pathways.

  • Microbiome & gut-liver axis: Dysbiosis promotes colorectal and liver cancer via inflammation, toxic metabolites, and immune imbalance.

Pro-/pre-biotic dietary interventions may restore balance and reduce the risks.

  • Hormonal & enzymatic quirks: Alcohol metabolism varies by ALDH2/ADH1B genetic variants, especially in East Asian populations, suggesting tailored consumption limits.

Hormone-driven cancers (e.g. HR & breast cancer) may benefit from personalized glucose-targeted post-meal diets over generic Mediterranean-style plans.

  • Environmental & demographic influences: Age, sex, ethnicity, socio-economic status, and exposure to pollutants or “food deserts/swamps” all impact effectiveness.

 

  1. The Path Forward
  • Research & Technology: Biomarker discovery – genomic, epigenetic, metabolic, immunological, and microbiome markers can predict cancer risk and intervention response.

Digital health platforms – AI-driven apps and remote monitoring tools can deliver personalized recommendations, track compliance, and provide feedback loops.

  • Clinical Integration: Multidisciplinary Lifestyle Clinics – Integrating oncologists, dieticians, exercise physiologists, behavioural specialists, and genetic counsellors boosts survivor outcomes, evidenced by breast cancer programs which showed improved satisfaction and symptom control.

Tailored care plans – Choosing interventions aligned with genotype, phenotype, cancer type/stage, and treatment goals is vital.

  • Policy & Public Health: Access equity – Government support for personalized lifestyle services (insurance coverage, subsidies) is as essential as expanding health food access in underserved regions.

Environmental regulations – Zoning laws to limit fast food outlets and incentives for fresh produce retailers can reshape food landscapes.

Funding & regulation – Invest in biomarker research, digital health innovation, and enforce ethical frameworks for privacy, algorithmic fairness.

Education & awareness – Campaigns highlighting personalized lifestyle benefits, school programs, and corporate wellness can drive cultural shifts.

 

  1. Take-Home Action Points
  • For Health Professionals: Begin with precision – assess genetic/metabolic profiles before prescribing lifestyle plans.

Typical tools – insulin resistance panels, hormone levels, microbiome checks, genetic variant screening (e.g., ALDH2 status)

  • For Patients & Survivors: Know your numbers – BMI, waist-to-hip ratio, fasting glucose/insulin, inflammatory markers.

Choose food wisely – whole foods, fibre-rich, healthy fats, lean proteins, personalize based on metabolic needs.

Move smarter – opt for exercise plans aligned with your body type and cancer history, by combining aerobic and resistance training.

Mind & body – prioritize sleep, stress reduction, mind-body therapies such as yoga and meditation.

Genetic counselling matters – discuss inherited risk markers and metabolism-related variants.

  • For Community & Policymakers: Tackle food inequity – support zoning, food subsidies, and community gardens in under-resourced areas.

Back research – fund interventions that integrate biomarker-guided lifestyle medicine and standard oncologic care.

Educate widely – build curriculum and awareness campaigns around personalized lifestyle as preventative oncology.

 

Conclusion

Motevalli & Stanford’s vision is clear:  we are at the cusp of a precision lifestyle medicine revolution in oncology.  For too long we’ve relied on generic advice – “eat better, move more”, without significant impact.  Personalized nutrition, optimized physical activity, stress and sleep management, and environment-sensitive policies aren’t just wellness buzzwords, they’re essential weapons in reducing the global cancer burden.  Despite the well-written article and innovative ideas shared by the authors, health systems in developing countries may take many years to reach this level of innovation and implementation.

Reference:

Motevalli M, Stanford FC. Personalized Lifestyle Interventions for Prevention and Treatment of Obesity-Related Cancers: A Call to Action. Cancers. 2025; 17(8):1255. https://doi.org/10.3390/cancers17081255