Do you ever feel the need to eat (too much and usually something unhealthy) whenever you feel stressed or anxious? For many of us, the answer is “been there, done that—sometimes on a weekly basis.” Breast cancer patients are prone to the same temptations, especially since cancer can take a toll on one’s mental well-being. In fact, according to research from the National Behavioral Health Network, one in three cancer patients experience mental or emotional distress. This concern is most common in people with breast cancer (42%). In addition, more and more studies regarding the relationship between anxiety, overeating, and cancer have been coming out.
How Does Anxiety Trigger Overeating or Binge Eating?
During a stressful or anxiety-inducing event, the body releases cortisol. This hormone helps the body protect itself from perceived dangers. However, prolonged exposure to high cortisol levels, such as the repeated and constant stressors associated with having cancer, can lead to higher-than-normal food consumption, increased fat storage, and unhealthy weight gain.
Before explaining further, allow us to clarify the relationship between anxiety and overeating to give better insight into the connections between anxiety and breast cancer, as well as overeating and breast cancer.
Understanding Anxiety
This response to stress often results in muscle tension and avoidance behavior. Anxiety-driven fear is also a common response to an immediate threat and is associated with the fight or flight reaction. For example, it can prompt an anxious and scared cancer patient to either stay to fight (go through treatment) or leave to escape the threat (give up).
While occasional anxiety is normal, anxiety disorders involve more than temporary worry or fear. The negative emotions do not go away, can worsen as time goes by, and can interfere with daily activities, job performance, school work, relationships, and in the case of our topic—treatment success.
Common types of anxiety disorders in cancer patients include:
- Generalized anxiety disorder (GAD): Excessive and uncontrollable worrying, sometimes regarding uncontrollable circumstances.
- Post-traumatic stress disorder (PTSD): This disorder develops in some people who have experienced a terrifying or shocking life event. Cancer-related PTS or PTSD can cause anxiety, nervousness, or panic attacks before or during doctor’s appointments, tests, or treatments.
- Social anxiety disorder: Intense fear of social settings and being judged or negatively perceived by others, even by strangers or people unlikely to cross paths with again.
- Panic disorder: Manifests as recurrent and unexpected panic attacks or sudden periods of intense fear.
- Phobias: Excessive fear of specific objects or situations.
- Obsessive-compulsive disorder (OCD): This mental and behavioral disorder often makes an individual feel the need to perform specific routines repeatedly to soothe the distress from the obsession to the extent that it impacts general function.
Anxiety disorders present themselves through a combination of the following:
- Physical symptoms: Increased heart rate, sweating, dizziness, trembling, muscle tension, headaches, and gastrointestinal issues.
- Emotional symptoms: Persistent worry, apprehension, irritability, and feelings of impending doom.
- Behavioral symptoms: Avoidance of anxiety-provoking situations, difficulty concentrating, and restlessness.
These symptoms can vary in intensity and duration, often interfering significantly with a person’s life.
Studies About Anxiety and Binge Eating
Until recently, many studies on the link between anxiety and overeating contradict one another. In a 2022 study on the effects of anxiety and stress due to COVID-19, the researchers witnessed that anxiety had an indirect effect on stress and overeating. The study involved 2,926 college students aged 18 to 25. They had to answer an online questionnaire regarding pandemic-related stress, anxiety, burnout, and overeating. The results supported existing theories regarding stress and problematic eating behaviors.
A 2021 study echoed similar findings. Appropriately titled “Binge eating disorder hidden behind a wall of anxiety disorders,” its researchers concluded that individuals with binge eating disorders (BED) have lower reward sensitivities, higher cognitive attentional biases to food, and altered brain activation in regions linked to impulsive and compulsive behaviors compared to those without BED. Moreover, according to Eating Disorder Hope, about 37% of people with BED also struggle with anxiety disorders.
In older studies (Oliver & Wardle, 1999; Sproesser et al., 2014; Pool et al., 2015), an estimated 35 to 40% of people eat more than they do when stressed. Fast forward to 2024, adults are more stressed than ever, meaning these numbers have likely doubled.
Based on these conclusions, we can say that there is a definite correlation between anxiety and overeating, particularly during high-stress situations.
Anxiety and Breast Cancer Link
Anxiety is a normal reaction to a breast cancer diagnosis. Emotionally, going through treatment, cancer progression, or experiencing recurrence can bring negative feelings, including fear and worry. In a 2019 systematic review, researchers reviewed 36 studies with a total of 16,298 breast cancer patients. They found that 41.9% of the patients had high levels of anxiety. Also, according to research from WebMD medical writer Evan Starkman, approximately 1 in 4 people with cancer have confessed to having a lot of anxiety.
Anxiousness usually eases up after the trigger goes away. But it can also intensify and interfere with a patient’s quality of life. When anxiety persists or does not go away, the patient may have an anxiety disorder. It can lead to insomnia, very low energy, inability to focus, lack of interest in activities, constant worrying, feeling on edge, loss of appetite, or binge eating tendencies.
In a 2020 study, researchers analyzed the data for anxiety disorders and discovered a higher incidence of breast cancer in countries with a high prevalence of anxiety. New Zealand and the Netherlands are the two countries with high breast cancer rates and frequent cases of anxiety. The researchers suggest that the relationship between anxiety and breast cancer takes root in the underlying link between anxiety and the immune system. As mentioned, stress and anxiety stimulate the body to release cortisol, which can cause inflammation and a weaker immune system.
In addition, prolonged exposure to high estrogen levels, which is a breast cancer risk factor, can also make women more vulnerable to anxiety and mood disorders, which, in turn, can lead to cancer-risk-raising habits like smoking, excessive alcohol consumption, and overeating.
How Does Overeating Affect Breast Cancer?
We have established that stress and anxiety can lead to overeating, and that breast cancer can cause anxiety. Now, the question is, how does anxiety-driven overeating affect breast cancer? Is it worse than having a reduced appetite? Let us dive into this understudied topic.
Overeating, especially if the patient is already obese or if it leads to obesity, may affect breast cancer in the following ways:
1. Complicates Treatment Outcomes
Excess body fat can alter how the body responds to therapy and medications, which may reduce treatment efficacy and increase the risk of complications. Furthermore, surgical procedures can be more challenging and carry higher risks in obese patients.
2. Elevates Risk of Breast Cancer Recurrence
As discussed, obesity is a risk factor for cancer and recurrence. Adipose (fat) tissue produces hormones and growth factors that can promote cancer cell proliferation. Higher levels of insulin and insulin-like growth factors in obese individuals can also stimulate tumor growth, which may lead to a greater likelihood of cancer returning after treatment.
3. Worsens Prognosis
Obese breast cancer patients have a poorer prognosis than their non-obese counterparts. Obesity can also cause more aggressive breast cancer types at more advanced stages, which contributes to lower survival rates. In fact, a 2023 study reported that having a higher pre-diagnostic BMI, waist size, and body fat percentage increased the risk of breast cancer recurrence. The inflammatory state associated with obesity can also support cancer progression.
4. Impacts Quality of Life
Overeating and obesity can worsen a cancer patient’s overall quality of life. Obesity increases fatigue, reduces physical functioning, and complicates daily activities like walking or going up and down the stairs. The STOP Obesity Alliance adds that people with excess weight are more prone to depression and other mental health disorders. These complications can be more frustrating for cancer patients who are already dealing with the physical and emotional toll of their disease and its treatment.
5. Exacerbates Comorbid Conditions
Obese cancer patients are more likely to experience comorbid conditions such as cardiovascular disease, diabetes, and hypertension. These additional health issues can complicate cancer treatment and recovery, as well as increase the overall mortality risk. Managing these comorbid conditions can also divert attention and resources away from cancer treatment.
6. Impairs Immune Function
Obesity makes the immune system’s defense against cancer cells and infections less effective. A weakened immune response can hinder the body’s ability to respond to cancer treatment and recover from therapy-induced side effects. This can heighten susceptibility to infections and slower healing processes.
7. Nutritional Imbalances
Overeating often leads to poor nutritional choices, resulting in deficiencies in essential vitamins and minerals. Proper nutrition is critical for cancer patients to strengthen their immune systems, maintain energy, and aid recovery. Obesity-related nutritional imbalances can, therefore, negatively impact the overall health and recovery of breast cancer patients.
Studies About Breast Cancer and Overeating
There is a high volume of research on cancer and overeating as separate entities, but no study specifically explores the possibility of a relationship between cancer and overeating. However, overeating or binge eating that leads to obesity has long been an established risk for cancer. In fact, the American Cancer Society published that excess body weight is responsible for 11% of cancer cases in women and about 5% of cancer cases in men in the United States, as well as 7% of all cancer deaths.
In addition, a 2019 case-control study demonstrated a clear connection between overeating and breast cancer risk in terms of calorie intake. Researchers conducted the study on 973 pairs of premenopausal and postmenopausal women. The results showed that premenopausal women who consumed fewer calories than their expected calorie intake had a lower risk of breast cancer. In comparison, postmenopausal women who consumed more calories had a higher risk of breast cancer.
In light of the above findings, the researchers suggest that moderate calorie restriction may help reduce the risk of breast cancer. Also, women—and men (get breast cancer, too)—would benefit from participating in regular physical activity, as it can help shed excess body fat and reduce the risk of experiencing obesity-related health and breast cancer complications.
Why Mindful Eating Matters During Breast Cancer Treatment and Recovery
Mindful eating derives from the broader concept of mindfulness, which involves being fully present in the moment without judgment. In the context of eating, mindfulness means being aware of food’s taste, texture, smell, and appearance, and recognizing hunger and satiation cues from the body. This practice encourages people to savor their meals and make conscious food choices for a more balanced and healthy diet.
Here are some of the benefits of mindful eating for breast cancer patients:
- Stress reduction: Having breast cancer and undergoing treatment can cause anyone’s stress levels to skyrocket and fuel overeating tendencies. Mindful eating helps minimize stress by promoting a calm and focused eating environment, which can improve digestion, nutrient absorption, and satiety.
- Weight management: Mindful eating helps control portions and reduce overeating by raising self-awareness of hunger and fullness cues.
- Enhanced enjoyment: Savoring each bite and fully engaging with the eating experience can enhance one’s enjoyment of food, which is particularly important for those who may experience changes in taste or appetite due to cancer treatment.
Tips for Practicing Mindful Eating
Try one or more of the following tips to establish a mindful eating practice that promotes overall wellness and aids in the path to recovery:
1. Create a Peaceful Eating Environment
Patients and their caregivers should set aside time for meals in a quiet, comfortable space without distractions like television, phones, or computers. Distractions can derail mindful eating by shifting focus away from the experience. For example, watching an online video while eating can lead to mindless consumption, overeating, and reduced awareness of hunger and fullness cues.
2. Eat Slowly and Chew Thoroughly
Take small bites and chew each mouthful thoroughly. Eating slowly allows the patient to savor each bite, enhancing the eating experience and promoting better digestion. Chewing thoroughly also breaks down food more effectively and assists nutrient absorption. This practice gives the body time to recognize satiety signals, which can avert overeating and promote a more mindful approach to meals.
3. Engage All Senses
Pay attention to each meal’s colors, smells, textures, and flavors. Engaging all senses in the eating experience helps increase satisfaction and enjoyment. Notice the vibrant colors of fruits and vegetables, the aroma of freshly cooked meals, the varied textures, and the rich flavors. This sensory engagement can foster a deeper appreciation for food. It encourages healthier choices and reduces the likelihood of overeating.
4. Measure Hunger from One to Ten
Before eating, take a moment to assess hunger-fullness levels on a scale from one to ten
- 10: Beyond stuffed or way too full to the point of feeling ill or nauseous.
- 9: Stuffed to the point of discomfort or feeling stomach pains.
- 8: Very full, completely full, or overfull with no desire to eat further.
- 7: Moderately full or comfortably full and satisfied.
- 6: Lightly full or satisfied but could eat more.
- 5: Neutral or feeling neither full nor hungry.
- 4: Lightly hungry, when hunger starts to set in. The stomach may growl.
- 3: Moderately hungry. The stomach growls more, and irritability, discomfort, and lack of concentration begin to rise.
- 2: Very hungry. The stomach may begin to hurt along with low energy and weakness.
- 1: Starving, which can cause dizziness, headaches, fatigue, and inability to concentrate.
The goal is to eat when lightly or moderately hungry and stop when comfortably full. This intuitive eating practice helps prevent overeating and promotes better digestion.
5. Avoid Emotional Eating
While it is normal for cancer patients to experience a range of emotions, it can trigger emotional eating. Identifying non-food-related ways to cope with emotions, such as talking to a good friend, practicing yoga, or engaging in a hobby, can help thwart emotional eating. Recognizing emotional triggers and finding alternative coping mechanisms promotes healthier eating habits and better emotional well-being during cancer treatment and recovery. This approach can also reduce reliance on food for comfort and help maintain a balanced diet.
6. Plan Balanced Meals
Balanced meals help maintain a healthy weight and are customizable to address specific nutritional needs during treatment. For instance, a mix of lean proteins, healthy fats, whole foods, and plenty of fruits and vegetables provides the necessary vitamins and minerals to support healing and improve energy levels.
7. Practice Gratitude
Take a moment before meals to express gratitude for the food, acknowledging the effort that went into its preparation and the nourishment it provides. This practice can enhance the emotional experience of eating.
8. Mindful Portion Control
Use smaller platters to control portion sizes. Serve modest portions and resist the urge to go for seconds unless truly hungry to prevent overeating and support healthy weight management.
9. Stay Hydrated
People commonly mistake thirst for hunger. Staying hydrated can curb unnecessary snacking due to misinterpreted hunger. Some health experts recommend eight glasses of water daily, even more if a cancer patient has diarrhea or vomiting symptoms. It is important to ask a cancer patient’s doctor how much is right for them, as there is no one-size-fits-all answer, not even for healthy individuals.
10. Reflect on Eating Habits
Keep a journal to track eating habits. Note the foods and drinks consumed, the timing of meals, and the feelings experienced during and after eating. Reviewing these notes can identify patterns and areas needing improvement, such as recognizing triggers for unhealthy eating (e.g., when stressed, bored, angry, or sad). This practice can also help patients and their doctors make informed adjustments toward a mindful approach to nutrition.
