High health stakes for teen behaviors after cancer treatment

Teenagers who are cancer patients or survivors are the same as all teenagers, but the stakes for reaching and maintaining optimal health are much higher: reducing the odds of the cancer's recurring. That's where Carol DeNysschen comes in.

DeNysschen, associate professor and chair of the Health, Nutrition, and Dietetics Department, has worked with breast cancer patients and survivors at Roswell Park Cancer Institute. The Academy of Nutrition and Dietetics Foundation awarded her the 2016 Abbott Nutrition Award in Women's Health, which recognizes a dietitian who has made "significant contributions to the importance of nutrition in women's health." So when the Teenagers Living with Cancer program (TLC) at Roswell Park Cancer Institute wanted a nutrition and exercise specialist for a fitness component, they approached DeNysschen.

"My motto is 'Never say no,'" DeNysschen said. "Everything you do leads to more opportunities. This project was especially interesting because I could involve my students. Working with people to improve their health habits is very different from reading a textbook about it."

Motivation for Healthful Behavior

"I grew up on a farm near Zoar Valley, and we ate basic, healthy food," DeNysschen said. "I never gave my diet a second thought until I took a nutrition course at Cornell University. The connection between nutrition and physiology fascinated me."

So DeNysschen earned a second bachelor's degree in dietetics at Buffalo State and became a registered dietitian. She earned a master's in public health at the University of Minnesota and a doctorate in exercise science at the University at Buffalo.

"We know what's good for us, but we don't often practice it," she said. "If we could fix the motivation switch, we'd have so much less chronic disease."

The TLC fitness program motivates participants to improve their diet and exercise habits by providing information, exercise opportunity, and individual attention and goal setting. Participants attend a session once a week for 10 weeks. Parents are welcome to attend.

Providing information is the first step. "We bring in a test tube with fat in it to show them how much fat is in, say, a fast-food cheeseburger," DeNysschen said. "We set individual goals with each participant. For example, everyone gets a Fitbit, but the goals vary. In one case, the first goal was simply to wear the Fitbit!"

Exercise Is Essential

Involving the cancer survivors in goal-setting is more than a motivational tool; it's an important part of improving their quality of life. "Having cancer takes away people's sense of having control of their lives," DeNysschen said. "Making decisions about what to eat and how to exercise is a way of regaining control."

In her work with breast cancer patients, DeNysschen has found that exercise can decrease fatigue and minimize weight gain. "Sometimes the drugs involved in cancer treatment cause patients to experience fatigue and subsequently gain weight," she said. "Exercise helps reduce weight gain." The TLC exercise program is designed so that those cancer survivors who have had bone marrow transplants can participate.

The goal of exercise isn't just burning calories. "We want to increase lean body mass and decrease body fat," DeNysschen said. "Lean body mass increases strength and helps with weight management. If two people have the same weight, but one has 30 percent body fat and the other has just 18 percent body fat, the person with less body fat will burn more calories while sleeping."

At first, TLC participants are quiet and engage mostly with their smartphones. "But after a few weeks, they start talking," DeNysschen said. "By the end, they're talking and laughing together and competing with each other in a friendly way."

Small Steps Lead to Success

DeNysschen practices what she preaches: twice a week, she attends a boot camp exercise program—at 5:45 a.m.—and runs 40 to 50 miles a week. She has run the Boston Marathon five times, most recently in 2016, and finished in under four hours four times.

But the real secret of her ability to help people develop healthful habits is her compassion for the challenges involved in shedding bad habits. "It's hard," she said. "Fast food is convenient. Marketing makes junk food look healthy. People don't have the information to navigate the food choices."

DeNysschen is also a cheerleader for any improvement. "Small changes are good," she said. "You can make better choices at a vending machine, like pretzels or peanuts or animal crackers. If you want to eat red meat, go ahead! Just have a smaller portion less often. Don't be fat phobic; some fat is okay. If your exercise is walking around the block, time yourself and try to do it a minute faster next time."

When it comes to exercise, DeNysschen believes that the most important thing is to choose something you like—Zumba, bicycling, spinning, walking. "Start out slowly," she said, "and find somebody to do it with. That's how any of us, healthy or unwell, can include exercise in our lives. When we start to feel better and energetic, we want to do more just because it feels so darn good."