Although breast cancer survivors are quick to express gratitude for the life-saving treatments we receive, we can be just as quick to bemoan how those same treatments yield untold numbers of lingering physical challenges. While the type, variety, and severity of treatment aftermath varies widely from person to person, if there’s a unified grouse from women who’ve walked the breast cancer path, it has to be weight gain.

Which, by the way, I find particularly egregious.

Isn’t it enough for a woman to go through the rigor and horror of breast cancer without being plagued by the one thing that compounds not only body dissatisfaction (a major concern for many breast cancer survivors), but according to research, an increased risk for recurrence?

While there’s a dearth of scientific literature pointing directly to weight gain and body dissatisfaction in breast cancer survivors, I can share anecdotally from many women, the extra weight and its stubborn reluctance or refusal to budge is frustrating at best, maddening at worst, and depressing as hell.

You could make a strong argument for kicking weight concerns to the curb, choosing instead to focus on the glorious miracle that is surviving breast cancer and the gift of continuing to exist on this planet. Seriously, what’s a little weight gain in comparison to not being alive? Are we honestly that vain – kvetching about how our favorite “pre-breast-cancer” jeans just don’t hang the way they used to – rather than celebrating the fact that we’re even around to complain about it in the first place?

Of course not! That isn’t vanity, now is it ladies? It’s about lamenting only one of the myriad of post-breast-cancer body changes that you’re encouraged to accept as your “new normal” – and if you’re honest – not liking one, dam bit.

Don’t get me wrong, I’m not suggesting you disregard the recommendations to maintain a healthy weight if you’re already there, or lose weight if you’ve gained, but I’ve recently participated in some discussions on my breast cancer social media outlets re: weight gain, and want to dive a little deeper here. Let’s begin with the weight gain thing that you may not even know is a thing; weight creep.

I spotted this scale on a Vienna sidewalk a number of years ago. On. The. Sidewalk. for heaven’s sake.

What is “Weight Creep”?

Weight creep, which tends to happen with age, is the phenomenon where the numbers on the scale gradually increase. Each new decade we’re alive (yay!) brings body composition changes (bleh), most notably, the loss of calorie-hungry muscle and an increase in slothful body fat.  For post-menopausal women (natural or surgically/medically induced), the dramatic decrease in estrogen encourages fat gain (especially in the belly and hips) which can result in weight redistribution and changes in body shape, even when the number on the scale may not move (much). Not only that, perfectly normal age-related joint creakiness and stiffness may be exacerbated by chemo regimens or long-term, post-treatment medications like tamoxifen or aromatase inhibitors, inciting true physical discomfort even pre-menopausal breast cancer patients are known to experience. Regardless of your chronological age, when your body feels like it’s 90 years old, how physically active are you? Probably not very. If you’re moving less, yet eating the same amount of food you did when you were younger and/or more active and carrying more muscle, you begin to see just how creepy weight creep can be.

How Does Breast Cancer Treatment Cause Weight Gain?

Chemotherapy can lead to weight gain by causing the body to hold more water (edema), producing fatigue, which may lead to inactivity, triggering nausea, which can be managed by eating (even in the absence of hunger), driving both physiological and psychological food cravings, and sending women into menopause. Also, steroid medications prescribed as part of the treatment regimen can increase appetite, and with long-term use cause an increase in fatty tissue in the abdominal area. Beyond chemo, the 5-10 year tamoxifen or aromatase inhibitor medication regimen prescribed for certain breast cancers can decrease estrogen or progesterone levels, leading to a reduction in muscle, increase in body fat, and lower metabolic rates.

Although many would have you believe the “idea” of weight loss is simple – eat less/move more – the basic physiology of weight loss is extremely complex, becoming even more so when breast cancer treatment is added to the mix. For example, some research suggests that lipoprotein lipase, an enzyme critical to the efficient breakdown and use of fats from the diet may become less effective with the menopause-induced decrease in estrogen.

What to do when it feels like so much is working against your weight loss efforts? Let’s start by identifying habits that may be hurting rather than helping. Habits which, unlike your rogue hormones, you can control and change!

Three HABITS That Cause Weight Creep and What to do About Them.

  1. You decide to worry about the weight later, and later keeps getting pushed further out on your calendar:
    • You may feel you can focus only on getting through the cancer – it takes everything you have – so the weight can, well, wait. And with all the disruption, appointments, emotional upheaval, and general turmoil breast cancer brings to your life, it’s easy to put your focus and energy on whatever is screaming for immediate attention, situations that if ignored, come with consequences attached. For example, you wouldn’t intentionally skip a doctor appointment or refuse to refill your medication, nor would you make your kids miss school because you don’t feel like driving them; each would result in consequences. The thing about weight gain and consequences? Those darn consequences aren’t immediate. Sure, you may not feel great in your body or your clothes don’t fit like they used to, but you tell yourself you can live with that; you’ll get to the weight when you have more time, energy, focus, or motivation. So you skip planning your meals, refuse to listen to the voice in your head encouraging you to go for a walk, and putting together that salad you want for dinner? You just don’t feel like it. Try starting with this: plan breakfast for M, W, F, walk 20 minutes one day/week, and buy pre-bagged salad. Done!
  2. You reward or justify your workouts with food.
    • If you’re just getting back to exercise, the intensity and duration of your workout may be less than what you’ve done in the past. That doesn’t negate the benefit of the workout, but it also doesn’t warrant extra food “because I worked out today.” Did you know that it’s entirely possible to burn less than 100 calories in a single workout? For example, if you weigh ~120 pounds and walk one mile at a 20 minute/mile pace, you won’t even hit the 100 calorie mark. While there’s absolutely nothing wrong with that effort, you’re simply not burning gobs of calories; if you burn 85 but eat 250, that explains (partially) why you may gain or maintain weight even though you’re active. And by the way, if you must reward your workout efforts? Book a massage, go to a movie, get in bed early with a great book. . .anything as long as it’s a NON-FOOD reward.
  3. Planning is not your forte’.
    • One of my favorite sayings (because it’s always so darn true) is “failing to plan is planning to fail.” And when it comes to getting health-supportive, nourishing food into your house and onto your dinner plate? It couldn’t be more true. There’s no need to stress yourself out by writing a week’s worth of menus, creating elaborate meal plans, or choosing a recipe for every meal and snack, but a little planning ahead ensures you’re getting in the foods that make you feel good. Try starting with this: choose two recipes, buy the ingredients you need, and block out a couple of hours to pull them together. Store in the fridge and heat up as needed. Done!