Weight Loss After Chemo (Breast Cancer)

BeautifulScars

I am 45 years old, and I was diagnosed with breast cancer last May. I decided to get double mastectomy last August (after considering family history) with reconstruction at the same time. I ended up with necrosis and had to go back into surgery to remove them and decided to stay flat (best decision for me). I then had to go through four rounds of "clean-up chemo" to be sure the cancer cells didn't spread during surgery. I didn't realize at the time that breast cancer chemo is one of the very few that actually make you gain weight. Long story short, I am NED and back on my health journey, but this chemo weight is stubborn! I have about 20 lbs of chemo weight to lose. I am counting calories (working on consistency) and working out 4-6 days a week. I would really appreciate any tips or tricks that have worked for others who have been through a similar situation? I know I have to do my part in logging my calories; I just get frustrated when I do and still don't lose weight.

AnnPT77

Hello, and welcome!

I'm so sorry to hear about the necrosis . . . the last thing we need in that situation is for things to get more complicated.

I have a somewhat similar cancer history - now long past - but the bilateral mastectomies with no reconstruction was my initial preference. (My surgeon didn't want to do the 2nd one as a preventive, even though there were 5 tumors in the other breast, so I tricked him by getting a tumor in the 2nd breast, just to get my way. 😆 It was done all in one surgery, though I didn't know until I woke up whether the during-surgery biopsy had been malignant, so it was good news to me that I was fully flat. Stage III breast cancer, diagnosed over 24 years ago, still NED. I'm happy.) I was 44 at the time of diagnosis, so close to your current age, too.

I got much more active post-treatment - I felt I needed to, in order to regain normal strength, energy and even happiness. I improved my nutrition somewhat, too, but didn't lose weight.

Certainly, there are factors in treatment that can increase body weight during and after, in breast cancer. One is simply that because most patients tend to drag through their days to some extent, we tend to move less, and not only burn fewer calories but tend to lose muscle mass. That muscle loss can reduce future activity, as well as reducing resting calorie expenditure very slightly.

For anyone, it's important to recognize that calorie estimates from MFP, TDEE calculators, or fitness trackers are basically founded on the statistical average calorie need for demographically similar people. Most people are close to average, but a few may be surprisingly far off. That's the nature of statistical estimates, right?

If we've subtly decreased activity during treatment - not just exercise but also daily life stuff including non-obvious things like even fidgeting - and that becomes habitual, that can reduce our calorie needs a bit below the average. So can muscle-mass reduction in and of itself. That's just an example, there are other possible reasons whether a person's been through cancer and treatment or not, and those reasons may not be obvious.

Your workouts should help, both in direct calorie expenditure, as well as countering potential muscle-mass reduction (assuming the workouts include meaningful strength challenge). The payoff from some of that - exercise activity calorie burn - is immediate, but the payoff from improved muscle mass among other factors is more slow.

Personally, I stayed overweight/obese for a dozen years post-treatment. Honestly, in my case I don't think that was directly from cancer, treatment, menopause (triggered by chemo for me), anti-estrogen drugs (7 years of those, sequence of 2 types). I'm not suggesting this is/was true for you, but personally I was still over-eating, including eating all the calories I was burning from the good exercise routine and even some from muscle gain. That's all few enough calories that it's easy to eat them, when not counting. Again, not saying that's true in your case, not at all.

Along the way - within a year post treatment - I was diagnosed as severely hypothyroid. I learned that hypothyroidism post-treatment is somewhat common, plus is more common in all women as we age. That has a quite small calorie needs reduction, but if you haven't been tested, that could be a thing to discuss with your doctor if you haven't already done so. There are also nutritional factors that can reduce calorie needs - mostly through subtle fatigue - so other blood tests might be helpful, if you and your doctor think they're appropriate. I think it's more a PCP thing than an oncologist thing.

For anyone, a part of the calorie counting path to success is IMO realizing that fact about calorie needs: It's individual. What any calorie calculator or fitness tracker suggests is a starting estimate. If sticking close to a given activity/eating regimen over 4-6 weeks (full menstrual cycle if that still applies) and no weight loss, it's unfortunately time to lower calorie goal a bit, generally. Short of that time, I wouldn't. Water fluctuations at first can be pretty weird, and distort scale results.

I also should've asked what kind of weight loss rate you're aiming for. Fast loss can be a trap, and it's common for people to be influenced into thinking very fast loss is not just good (which IMO it isn't) but to be expected. If the 20 pounds is all you have to lose to be at a good weight, a pound a week would be a good to aggressive rate, and slowing it down to half a pound later would be health-promoting IMO. Slower loss takes longer to show up on the scale amongst routine water/waste fluctuations that can be multiple pounds from one day or week to the next.

You mention working out 4-6 days per week. Was that a sudden increase to that exercise load? Sometimes increasing exercise dramatically can be counter-productive for weight loss. If it triggers that subtle fatigue, it can essentially reduce calorie burn from daily life activity, since we may rest more, move less, and burn fewer calories than we'd expect that way. For most of us, daily life calorie burn significantly exceeds exercise calorie burn, so the impact can be surprising.

Increasing exercise load gradually can be a more productive approach. IMO the sweet spot is a total exercise load - combination of frequency, duration, intensity and exercise type - that's manageably challenging, but energizing rather than fatiguing for the rest of our day(s). A few minutes of "whew" right after the exercise session is fine, but it's ideal for normal energy to be the same or better than without the exercise. A common rule of thumb among recreational athletes is that increasing total load by maybe no more than 10% per week is a good limit.

You mention consistency. Yes, important, but for calories/nutrition on a basis that's "on average, over a few days to a week". Maybe it's not where you're coming from, but I see people here who think it's essential to be exactly exact every single day on calorie intake or nutrients. It's not. If average calories by the end of about a week are close to goal, that's fine. (You can see average weekly calories in the MFP phone/tablet app, if logging consistently.) Our bodies don't reset at midnight, even though MFP does.

Consistent logging of everything eaten every day helps with establishing a realistic personalized calorie goal, of course. If a person can do that for the 4-6 weeks/1 cycle, and establish new habits that keep them in that range, it may even be less important to log every single day long term . . . though I was pretty consistent in that way, and it helped me.

Back to personal history: My activity level post-treatment did help me gain significantly improved fitness, including strength and muscle mass. It even improved my overall health. Those were a big quality of life improvement, for me. But I stayed fat until I finally committed to losing weight in 2015. That's when I started using MFP. I've been in maintenance mode at a healthy weight and the same jeans size since, though I admit some slight creeping up and down of weight over that time. Still, I'd been overweight/obese for around 30 years before loss, so I'm calling that a win.

I'm personally not a fan of the trending named diets or restrictive eating rules. What I wanted was a personalized approach that would gradually get me to a healthy weight, staying reasonably happy along the way, plus establishing habits I could continue long-term to stay at a healthy weight. I decided I wasn't going to do anything to lose weight that I wasn't willing to continue permanently to stay at a healthy weight, other than the sensibly moderate calorie deficit until I reached a reasonable weight. Also, I'm basically a hedonistic aging-hippie flake, and I mostly don't like following rules someone else dictates. 😉😆 YMMV.

What I did was a "remodel your eating" kind of approach, making changes gradually in (to me) a priority order. That approach is described in more detail in this thread:

https://community.myfitnesspal.com/en/discussion/10636388/free-customized-personal-weight-loss-eating-plan-not-spam-or-mlm

I'm not saying that's the right approach for you, because we're all individuals with different preferences, strengths, challenges and lifestyles. It's just one option to consider. I think that's all other people can give us: Ideas to try. I don't think there's just one universal perfect path. But that approach worked very well for me.

The last thing I'll say is that I think the best idea is to focus on modifying routine habits - they're the power tool for weight management. That one day when I eat too much cake or work out for 5 hours is a drop in the ocean. The things I do on repeat on the overwhelming majority of days is the ocean. I'm also a big plan of making an easier plan that still leads gradually to success, rather than shooting for aggressively fast loss, as if weight were a project with an end date. (It's not.)

Apologies for the silly-long essay. I'm sorry to say I'm like that. 🙄😬

Wishing you huge success here: IME, the reward in improved quality of life is more than worth the effort!

BeautifulScars

Thank you so much! This is very helpful!

naomib04

I have SBC and have had it for 15 years.
I’ve tried lots to drop the weight but nothing worked. I gained about 2 stone but then just kept going until I’d put on 6 stone! Gosh I’ve never calculated that before!

About 2 years ago I started the weight loss injections. I have to say they have worked wonders for me and I have lost 3 stone. I’ve not taken it religiously as it is so expensive but I’ve now found somewhere that is half the price so I hope to keep it up now. I obviously worry about when I get to my goal weight and how to maintain, but I’m working hard to change the way I live/eat and keep a routine.
I do love the gym but it takes a while until I really get addicted. I’m hoping now I’ve lost 3 stone and I can see a difference that it will inspire me to train to tone the body into one I like. I too have had necrosis on the breast and in the mouth so I know how annoying it can be after you’ve been through so much.
I really hope you find the thing that works for you. In a big believer in that everyone has a different way that works for them depending on our bodies. Best of luck x