The Open Obesity Journal, 2010, 2, 81-94 81 1876-8237/10 2010 Bentham Open Open Access Policies and Actions for Cancer Prevention: Food, Nutrition and Physical Activity Kirsty Beck *,1 , Rachel L. Thompson 1 , Kate Allen 1 , Martin Wiseman 1 and Michael Marmot 2 1 World Cancer Research Fund International, London, UK, 2 University College London, UK Abstract: The 2009 World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) Report ‘Policy and Action for Cancer Prevention’ addresses the external influences on people’s eating and physical activity habits over a lifetime, and evaluates possible actions to change these behaviours. Estimates of preventability of cancer were calculated for USA, UK, Brazil and China. The estimates suggest that about 11 and 20 per cent of obesity-related cancers could be prevented, if everyone had a healthy weight. The Report makes 48 recommendations, all with some relevance to overweight and obesity, for policies and actions to create environments which are conducive to healthy behaviours, thereby reducing risk of cancer directly, and indirectly through obesity. The recommendations are addressed to nine groups of actors—those people who take decisions or make policy at all levels. These groups are multinational bodies, civil society organisations, government, industry, media, schools, workplaces and institutions, health and other professionals, and people (as members of families and communities). All actors have a responsibility to give priority to public health, including prevention of obesity and cancer. Leadership is required from governments in particular to ensure a coherent and coordinated approach. All relevant actors need to work together so that initiatives are more likely to be successful and have lasting impact. The Report is intended as a starting point and a spur to action. Keywords: Cancer, nutrition, physical activity, policy, prevention. INTRODUCTION Background In 2007, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) Report ‘Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective’ (the 2007 Diet and Cancer Report) was published [1]. The Report produced recommen- dations to reduce risk of cancer, presented as specific population goals and as personal recommendations for dietary and physical activity patterns, and for body weight. The Report reviewed the body of evidence relating food, nutrition, and physical activity to cancer risk. Systematic literature reviews (SLRs) on 17 different types of cancer, as well as one on the determinants of obesity, were conducted according to a detailed set of instructions [2]. A panel judged the evidence according to its strength, quality, and quantity. The evidence was graded (based on the likelihood that a par- ticular factor is either a cause of or protects against a specific cancer) as either ‘convincing’ or ‘probable’; or if there was not adequate evidence as ‘limited’. The main conclusions for overweight and obesity are summarised below. Body Fatness and the Risk of Cancer There was a convincing evidence that the greater the level of body fat, the greater the risk of cancers of the colon and rectum, oesophagus, pancreas, kidney, endometrium and *Address correspondence to this author at the World Cancer Research Fund International, 19 Harley Street, W1G 9QJ, London; Tel: +44 (0) 20 7343 4200; Fax: +44 (0) 20 7343 4220; E-mail: k.beck@wcrf.org breast (in postmenopausal women) [1]. Being overweight or obese probably also increase the risk of gallbladder cancer. Determinants of Overweight and Obesity The review of the determinants of obesity is summarised in Table 1. The strongest evidence showed that regular and sustained physical activity of all types protects against weight gain, overweight and obesity. Table 1. Factors that Modify the Risk of Weight Gain, Overweight and Obesity, Graded According to the Strength of the Evidence Decreases Risk Increases Risk Convincing Physical activity Sedentary living Probable Low energy-dense foods Being breastfed Energy-dense foods Sugary drinks ‘Fast foods’ Television viewing Source: Adapted from a matrix in the WCRF/AICR Report Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective [1], which also contains an explanation of the terms. Low energy-dense foods, such as vegetables, fruits, pulses and wholegrains, which provide dietary fibre, are probably protective; correspondingly high energy-dense foods, and in particular sugary drinks and ‘fast foods’ are probably a cause of weight gain, overweight and obesity. Here, the term ‘fast foods’ is related to readily available meals, snacks, foods and drinks that tend to be high in energy, and in sugar, refined starches, fat or salt, and tend to