About this ebook

This eBook is about managing weight gain after cancer treatment. It gives suggestions and tips to help you keep to a healthy body weight. We explain how changing the types of food you eat and being physically active can help you lose weight and feel healthier.

This eBook is part of a series of booklets on diet and cancer. The other booklets in the series are Recipes for people affected by cancer, Eating problems and cancer, Healthy eating and cancer and The building-up diet.

Check with your cancer doctor, nurse or dietitian that this is the right booklet for you, and whether you need more information.

How to use this eBook

This eBook is split into sections to help you find what you need. You can use the contents list to help you.

At the end of the eBook, there are details of other organisations that can help.

If you find this eBook helpful, you could pass it on to your family and friends. They may also want information to help them support you.

Quotes

In this eBook, we have included quotes from people who have changed their diet or lifestyle after cancer treatment. Some are from our Online Community. The others are from people who have chosen to share their story with us. To share your experience, visit macmillan.org.uk/shareyourstory

For more information

If you have more questions or would like to talk to someone, call the Macmillan Support Line free on 0808 808 00 00, 7 days a week, 8am to 8pm, or visit macmillan.org.uk

If you would prefer to speak to us in another language, interpreters are available. Please tell us, in English, the language you want to use.

If you are deaf or hard of hearing, call us using NGT (Text Relay) on 18001 0808 808 00 00, or use the NGT Lite app.

We have some information in different languages and formats, including audio, eBooks, easy read, Braille, large print and translations. To order these, visit macmillan.org.uk/otherformats or call 0808 808 00 00.

The benefits of being a healthy weight

After cancer treatment, many people want to make positive changes to their lives. Trying to have a healthy lifestyle is often a big part of these changes.

Keeping to a healthy weight and being physically active:

- helps you feel stronger

- gives you more energy

- increases your self-confidence.

Being a healthy weight reduces the risk of heart disease, strokes and diabetes. It may also reduce your risk of developing some cancers, or the risk of some cancers coming back. Your cancer doctor or nurse can tell you more about this.

Choosing to eat healthily is one of the best decisions you can make for your overall health. You get even more benefits if you are also physically active. Making positive lifestyle choices can also help you feel more in control. They can help you focus on what you can do for yourself.

Weight gain and cancer

For many people, a cancer diagnosis and cancer treatment can make it hard to have a healthy lifestyle. People do not usually expect to gain weight during cancer treatment. But some treatments, side effects or even lifestyle changes can cause you to gain weight:

- Treatments – Some treatments, such as chemotherapy, steroids and hormonal therapy, can cause weight gain. For example, they may increase your appetite. Or they may cause fluid to build up in the ankles, legs, arms or face. This is called oedema or lymphoedema. We have more information on our website.

- Feeling tired – You may feel tired because of the cancer or its treatment. This can make you less physically active than usual.

- Depression – For some people, feeling sad or worried about cancer can lead to depression. If you are depressed, you may eat more and exercise less.

- Stopping smoking – You may decide to stop smoking if you are diagnosed with cancer. If you stop smoking, your appetite may increase and your sense of taste might improve. This may mean you may eat more and gain weight. But it is important to remember that you will be much healthier if you stop smoking. You can gradually lose any weight you have gained.

- Comfort eating – Some people eat more when they are stressed.

- Kind offers of food – Friends, family or neighbours may offer food as a way of showing support and wanting to help. It can sometimes be hard to say no to these kind offers.

Do not be too upset if you find you have gained weight. Sometimes knowing why it has happened can help you think of ways to manage it. If you think you have gained weight because you are depressed, talk to your GP or nurse. There are treatments for depression, such as counselling and antidepressants.

If you are having hormonal therapy as part of your treatment, it is important to keep taking it even if you think it is causing weight gain. Talk to your cancer doctor or nurse if you are worried about this. Eating healthily and being more physically active can help you manage your weight.

If cancer or its treatment causes your weight to change, your clothes may no longer fit. The cost of buying new clothes can be worrying for some people. If you are worried about money, call the Macmillan Support Line on 0808 808 00 00 for information and advice. You may also find our booklet Help with the cost of cancer helpful.

‘At the hospital I was assigned a Macmillan nurse and a dietitian. It was amazing to have them there, to see me through the journey I went through in terms of my weight and how I was feeling. They were there to listen to me, which was really important. They knew exactly what I was going through.’ Diane

Talk to your doctor and nurse

Before trying to lose weight, it is important to speak to your GP, cancer doctor or nurse. They can talk to you about the right way for you to lose weight. They do this by looking at the type of cancer and treatment you have. They will also ask about your weight before the cancer diagnosis, and any other medical conditions you have.

Your doctor or nurse will measure your body mass index (BMI) to see if you are a healthy weight for your height. They may check other things, such as your waist measurement and blood pressure. You may also have a blood test to check for health conditions that may cause weight gain.

They may suggest you talk to other health professionals, such as:

- a dietitian, for advice about your diet

- a physiotherapist, for exercises to help improve your fitness

- a specialist nurse, for advice and support about managing weight gain.

Your doctor or nurse may also give you information about where you can get help and support in your local area.

What is a healthy weight for me?

Body mass index (BMI)

Body mass index (BMI) is a way of measuring if you are a healthy weight for your height. Your GP or nurse will work out your BMI for you. There is also a BMI calculator on the NHS website.

Your BMI score shows which weight category you are in:

- A BMI of less than 18.5 is underweight.

- A BMI between 18.5 and 24.9 is a healthy weight.

- A BMI between 25 and 29.9 is overweight.

- A BMI of 30 and over is obese (well above the healthy weight range for your height).

- A BMI over 40 is very obese.

BMI scores are different for older people, some ethnic groups and people who are very muscular. Talk to your doctor or nurse about your BMI before you start trying to lose weight. They can help you set a target weight that is healthy for you.

You can use the chart opposite to work out your BMI. Find the line that matches your weight and follow it until it crosses the line that matches your height. Talk to your GP or nurse if you are below or above the healthy range.

BMI chart

Waist measurement

Your waist measurement can also be used to see if you are a healthy weight. People who have more fat around their waist have a higher risk of health problems. To measure your waist, wrap a tape measure around your waist (like a belt). You should do this halfway between your lowest rib and the top of your hip bone.

A healthy waist measurement for:

- women is less than 80cm (31½ inches)

- men of South Asian origin is less than 90cm (35 inches)

- men not of South Asian origin is less than 94cm (37 inches).

Making changes to your diet

It is not always easy to make changes to your lifestyle. It can be more difficult when you also have cancer and cancer treatment to cope with.

Some people eat more when life is stressful. This is called comfort eating. Others are so busy that they do not have time to look for healthier options when food shopping. It can sometimes be easier to choose ready meals. For some people, the price of food is an issue.

You may want to make gradual changes to your diet when you feel ready, and at a budget you can afford. You could start by writing down what you eat for a few weeks, and compare it with our information about healthy eating. Then you can see if you need to make changes. You can set yourself small, realistic goals and decide how you will achieve them. For example, you could:

- look at the labels of food and choose a healthier option

- try swapping chocolate for a small portion of dried fruit and nuts

- add fresh or stewed fruit to cereal or porridge.

You can set more goals over time. Keep a record of your progress and how you feel physically and emotionally. You may decide to make small or big changes to your diet. It may take time to find healthy foods that you like, or a diet that works for you.

Before making changes to your diet, it can help to talk to a dietitian, your GP or a specialist nurse. This may also be useful if you have special dietary requirements or medical needs. A dietitian can help you make changes. They can also advise you about any other dietary problems you might have during or after cancer treatment.

Making changes can be enjoyable. It can help to try different foods. You may find new foods that you have not tried before. Trying different foods can stop you getting bored. This can help motivate you to continue with a healthy diet in the long term.

Fad diets

Some people try to lose weight with ‘fad’ diets. Fad diets claim to help you lose weight quickly. They are usually made up of only a few foods. With this type of diet, you often miss out important food groups. And as only some foods are allowed, fad diets can often be boring and difficult to continue with. They can also be expensive to follow. When people stop the diet, they usually gain weight.

If you eat a healthy diet and are physically active, you will lose weight gradually. This means you are more likely to reach and stay a healthy weight.

‘I’ve been fortunate not to suffer any major side effects, just fatigue here and there. I’m able to keep myself active with the running and have work to keep my mind in tune. I’ve changed my diet, my fitness regime (from non-existent to a massive passion).’ Adam

Setting a target for weight loss

Try to keep your weight within the healthy range for your height on the BMI chart. Your GP can also advise you on your ideal weight. If you are worried about your weight, ask your GP or a dietitian for advice and support. Dietitians can give you advice about healthier food choices that still make you feel full. It is better to choose fruit and vegetables rather than unhealthier snacks, such as biscuits and cake.

Losing weight is a gradual process, so be patient with yourself. It can help to set yourself a target weight to work towards. Talk to your doctor, specialist nurse or dietitian about this. Most people gain weight over several months or longer. It can take the same amount of time to reach your target weight. It is important to eat a healthy, balanced diet. This means you get all the nutrients you need to keep your body healthy. It is reasonable to aim to lose about 0.5 to 1kg (1 to 2 pounds) a week.

If you want to monitor your weight loss, you can:

- weigh yourself each week – do this at the same time each week and use the same scales

- measure your waist using a tape measure.

If you find it hard to get to your target weight, or if you reach it very easily, talk to your doctor, specialist nurse or dietitian. They can help you set a new target.

Energy (calories)

Food and drink contains energy. This is measured in units called kilocalories, which are often called calories or Kcals.

The recommended daily calorie intake for adults

Calorie intake

We need fewer calories as we get older. You can ask your GP or dietitian about how many calories you need.

If we take in the recommended amount of calories, our body will use about two-thirds of the energy for body functions. This includes controlling body temperature, digesting food and making new tissue. We use the rest of the energy when we are physically active.

When we take in more calories than we use, our bodies store it as fat. This means we gain weight. To lose weight, we need to use (burn off) more calories than we take in. You can do this by:

- reducing the number of calories you take in through food and drink

- being more physically active to burn off more calories.

Many weight loss programmes include calorie-controlled diets. Some food types have more calories than others. For example, a handful of biscuits has more calories than a handful of diced carrots. Eating healthy amounts of different food types can help reduce the number of calories you take in. This can help you lose weight, especially if you also increase the amount of physical activity you do.

What makes up a healthy, balanced diet?

A healthy, balanced diet contains a variety of foods, in the right amounts. This will give you enough energy, protein, vitamins and minerals to stay healthy.

Try to eat plenty of fruit and vegetables. They should make up over one-third of the food you eat each day. Starchy foods (carbohydrates) should also make up over a third of what you eat each day. The amount of protein you eat should be smaller. The amount of dairy you have should be even smaller. You should try to have only a small amount of oils and spreads.

Foods that are high in fat and sugar should be limited because they often do not have any extra vitamins or minerals.

You do not need to get the balance right with every meal, but try to get it right over a day or even a week.

This chart shows the amount of each food group you should try to eat for a healthy, balanced diet.

Food groups pie chart

Know your food types

Not many of us check the energy (calorie) content of everything we eat. But knowing about the different types of food can help you make healthier choices. It can also help you manage your weight.

Fruit and vegetables

Fruit and vegetables are a good source of vitamins, minerals and fibre. They are also usually low in fat and calories. Most of us do not eat enough fruit and vegetables. Fruit and vegetables should make up about a third of the food we eat every day.

You should aim to eat at least 5 portions a day. These are all examples of 1 portion:

- 1 apple or banana

- 1 slice of melon

- 2 small fruits – such as kiwi fruits or plums

- a handful of berries – for example strawberries, blackberries or blueberries

- a small can of tinned pineapple in juice, or a few slices of fresh pineapple

- 1 small vegetable – such as a courgette or a pepper

- 3 heaped tablespoons of vegetables – such as diced carrots, shredded cabbage or peas

- a cereal-sized bowl of mixed salad

- 7 cherry tomatoes

- 2 broccoli florets

- 1 small glass (150ml) of unsweetened fruit or vegetable juice (this only counts once a day)

- 3 heaped tablespoons of beans or lentils (this only counts once a day).

Different types and colours of fruit and vegetables contain different nutrients. Try to have a wide variety of fruit and vegetables of different colour groups – green, yellow, red, purple, orange and white.

Potatoes are not part of the fruit and vegetables group. They do not count towards your 5 a day.

Tips for eating more fruit and vegetables

- Have a mixed salad as a starter or as a side dish with your main meal.

- Eat smaller portions of starchy foods (carbohydrates) and replace with larger servings of vegetables and salad.

- If you need a snack between meals, choose fresh fruit or vegetables.

- Frozen vegetables and tinned fruit in juice (not syrup) are just as healthy as fresh ones and can be cheaper.

- Use vegetables in dishes such as soups, stews and pasta.

- Try to avoid adding butter, rich sauces or dressings to your vegetables and salads. This will increase the calories you eat and drink.
‘I think slow and steady wins the race. Exercise and eating well, with meals cooked from scratch. I had chemo which really wrecked my gut, so I now eat a very high-fibre diet with lots of fruit and veg and things that are good for my gut. I also aim to walk at least half an hour every day.’ Linda

Starchy foods (carbohydrates)

Starchy foods (carbohydrates) are an important part of a healthy diet. They are a good source of energy and contain nutrients including fibre, calcium, iron and B vitamins.

Starchy food should make up about one-third of what you eat in a day. Starchy foods include:

- bread

- breakfast cereals

- potatoes and yams

- rice

- pasta.

Tips for eating starchy foods

- Try to choose wholegrain or wholemeal starchy foods. They usually contain more fibre and make you feel fuller for longer.

- Try not to add butter, cheese or creamy sauces. They increase the number of calories you eat.

- Boiled or baked potatoes are healthier than deep-fried chips.

- If you want to eat chips, have low-fat, oven types, or choose thick cut chips rather than skinny fries.

Fibre

The main role of fibre (roughage) is to keep the digestive system and bowels healthy, and prevent constipation. Fibre is the part of cereals, fruit and vegetables that is not digested and passes down into the gut.

Starchy food can be a good source of fibre. Increasing the amount of fibre in your diet can help you feel full more quickly and for longer. This means you are less likely to eat too much.

Tips for eating fibre

Try to eat:

- wholemeal, seeded or granary breads, and wholemeal chapatis and pittas

- wholegrain (high-fibre) cereals and pasta

- brown rice

- yams and potatoes with their skins on

- peas, beans, lentils, grains, oats and seeds

- fruit and vegetables.

Sugar

Sugar gives us energy. It is found naturally in some food and drinks, such as fruit and milk. But fruit and milk have other nutrients too, so it is important not to cut these out of your diet to reduce the amount of sugar you eat. The body also gets sugar for energy by breaking down carbohydrates.

There are different types of sugar. It is better to get energy from natural sugar. Natural sugar is in foods such as nuts, whole fruits (not just fruit juice) and starchy foods, such as wholemeal breads.

Processed sugars are sugars that are added to many types of food and drink. These are sometimes called free sugars. Some free sugars are also found naturally in honey, syrups and some fruit juices. It is best to avoid processed sugars if you want to maintain a healthy weight.

You can find out how much sugar is in food by checking food labels.

Try to avoid food and drinks with added sugar. If you find it hard to reduce the amount of sugar in your diet, try a sweetener instead. But this might not reduce your craving for sugar, so it may not be a long-term solution.

Tips for eating less sugar

- When you are shopping, check food labels for the sugar content. Choose foods that are low in sugar.

- Choose tinned fruit in juice rather than syrup.

- Try a low-fat spread, sliced banana or low-fat cream cheese on toast instead of jam or marmalade.

- Try using less sugar in your recipes, or use a sweetener.

- Drink water, milk or reduced-sugar drinks instead of sugary, fizzy drinks.

- Dilute fruit juice with sparkling water to make a fizzy drink.

- If you add sugar to food or drinks, reduce the amount you add every day. This helps you get used to the change until you can stop having it altogether.

- Choose wholemeal breakfast cereal rather than those that are sugar-coated or high in sugar.

Fats

Having some fat in our diet helps us to absorb vitamins A, D, E and K. Foods that are high in fat are also high in energy (calories). Eating a lot of fat, or the wrong type of fat, can make you gain weight or develop other health problems.

There are two types of fat:

- Saturated fats are found mainly in meat, pies, sausages, butter, cheese, ghee, coconut oil, cakes and biscuits.

- Unsaturated fats are found mainly in vegetable-based cooking oils and spreads, nuts, avocado, seeds and oily fish such as salmon, sardines and mackerel.

It is important to try to eat less fat, and to choose foods that contain unsaturated fats instead of saturated fats. Unsaturated fats are still high-energy (high-calorie) foods.

Even foods labelled as ‘reduced fat’ or ‘low fat’ can still be high in calories. It is a good idea to choose reduced-fat options, but only have small amounts.

Tips for eating less fat

- When you are shopping, check the labels for unsaturated and saturated fat. Choose lower-fat options.

- Eat less red meat, or choose lean cuts of meat and trim off the fat.

- Eat skinless fish and chicken rather than red meat.

- Eat less fried food. Bake, grill, steam or poach food instead.

- Choose lower-fat dairy products when you can.

- Add vegetables and beans to stews and curries, and use less meat.

- Try more vegetarian recipes.

- Avoid fatty takeaway food, or reduce the number you eat. This includes burgers, curries and kebabs.

- Avoid snacks that are high in fat, such as pastries, crisps and biscuits.

Protein

Your body needs protein to do things like building and repairing muscles and other body tissues. When we are ill, injured or stressed, we need extra protein (as well as extra energy) to repair any damage to our body.

Protein-rich foods can also be a good source of vitamins and minerals. There is protein in:

- red meat

- poultry, such as chicken and turkey

- fish

- dairy products, such as milk and eggs

- pulses, such as peas, beans and lentils

- some plant-based meat alternatives, such as soya, tofu and mycoprotein (Quorn).

Meat

Red meat is high in protein, but it can also be high in fat. Red meat is beef, pork, lamb and veal.

Processed meats are high in saturated fat and salt. They include sausages, bacon, burgers and pies.

Tips for eating less meat

- Cut down on meat, especially red and processed meat which are high in saturated fat.

- Try to reduce your meat portions and have more plant-based (vegetarian) sources of protein instead.

- 1 portion of meat should be about the size of a packet of playing cards.

- Choose leaner cuts of meat that have less fat, such as those labelled ‘lean’ or ‘extra lean’. You can also look at the labels to see which cuts have the least fat. Or ask a butcher or grocer if you are not sure.

- Try to eat more fish, chicken, turkey, beans and lentils instead.

- Skinned turkey or chicken is a lower-fat alternative to red meat such as lamb, beef or pork.

- Grill or roast your meat instead of frying it to reduce the number of calories.

Fish

Fish is a good source of protein, vitamins and minerals. It is often low in saturated fat. If you eat fish, aim to have at least 2 portions a week.

Try to have:

- 1 portion of white fish, such as haddock, cod or plaice

- 1 portion of oily fish, such as sardines, salmon or mackerel.

Shellfish, such as prawns and mussels, are also a good source of protein. They are low in fat and a source of minerals, such as selenium and zinc.

Tips for eating fish

- Try to grill, steam, poach or bake fish. This is healthier than frying it.

- Tinned fish such as tuna, sardines and pilchards are also low in saturated fat. Avoid tinned fish in oil or brine.

- Frozen fish can be cheaper than fresh fish.

- Avoid high-fat, processed meals with fish in them, or fish in batter.

Milk and other dairy products

Milk and other dairy products are good sources of protein, vitamins and calcium. But some dairy products can be high in fat.

If you are trying to reduce the fat in your diet, try semi-skimmed, 1% or skimmed milk. Try to cut down on other high-fat dairy products, such as cream and cheese. Always try to eat low-fat versions, such as fat-free yoghurt or cottage cheese.

Pulses and nuts

Pulses, such as beans and lentils, and nuts are a good source of protein. Pulses can be used in a lot of meals, such as stews or soups.

Nuts can be used in both sweet and savoury dishes and are high in energy. They contain good amounts of protein and some healthier, unsaturated fats. Nuts are a good source of protein if you do not eat meat or animal products. If you are trying to lose weight, you should limit your portion sizes of nuts. This is because they are high in fat and contain a lot of calories.

Other sources of protein

Some vegetarians include eggs and dairy products, like cheese, to get protein in their diet. Eggs are a good source of protein. But hard cheese can be high in unhealthy saturated fats and should be eaten in small amounts. Vegan cheese is made from soya and can be a healthier alternative to dairy cheese. Other soya alternatives include soya mince, soya burgers and sausages, soya milk or tofu.

Mycoprotein (Quorn) can also replace mince, burgers and sausages as a source of protein.

There have been some concerns about soya and its effect on breast cancer. There is currently no evidence to suggest that a moderate amount of soya is harmful. Recommendations say it is safe to have 1 to 2 servings a day of whole soya foods.

Whole soya foods are unprocessed soya foods, for example miso, tempeh, tofu, soya beans (edamame), soya nuts and soya milk.

1 serving of soya is equal to:

- 1 large glass of soya milk

- 50g of tofu

- 100g of soya mince

- 28g of soya nuts or edamame beans.

If you have questions about soya, talk to your doctor, dietitian or specialist nurse.

Salt

Too much salt in your diet can lead to high blood pressure. This can cause heart disease and strokes. A diet that is high in salt can also increase the risk of developing stomach cancer.

Try not to have more than 6g of salt (1 teaspoon) a day. It is not just the salt you add to your food that counts. Some foods already contain high levels of salt. These include:

- many cured or processed foods – such as sausages, cured ham or bacon, and cheese

- tinned foods

- ready meals.

It is important to check the label for the salt content when choosing food.

You can find out how much salt is in processed foods by checking the labels. If there is more than 1.5g of salt per 100g, the food is high in salt. Low-salt foods contain 0.3g or less of salt per 100g.

Low-salt alternatives are not recommended as they can be high in potassium. Try to gradually reduce your salt intake instead.

Fluids

Your body needs fluid to work properly. You should aim to drink at least 2 litres (31/2 pints) of fluids each day. You will need to drink more if:

- you are more active than normal

- it is warm

- you are losing fluid through sweat.

Water is the best fluid to drink to keep your body hydrated. It contains no calories and no sugars. If you do not like the taste of plain water, you could add a slice of lemon or lime. Some flavoured water drinks contain a lot of sugar and calories, so check the label before you buy.

Milk is a good source of calcium, which is good for bone health. It also contains other vitamins and minerals. To reduce the fat in your diet, it is better to drink semi-skimmed, 1% or skimmed milk.

Fruit and vegetable juices and smoothies contain a variety of nutrients. But they also contain sugar and calories. Aim to have no more than 1 small glass a day.

Juice drinks, squashes, fizzy drinks and energy drinks can be high in sugar and calories but contain very few nutrients. You should try to limit the amount you drink each day.

You can include tea and coffee when you are adding up how much you drink each day. But try to have other drinks that do not contain caffeine as well.

Sometimes when you think you are hungry, you are actually thirsty. Try having a drink and waiting for 10 minutes before having a snack. This can help you eat less.

Food labels

Most packaged foods have labels giving information to help you make healthier choices when buying food. The labels give information about what the food contains, including:

- fats

- salt

- sugars

- calories.

The label also sometimes gives information about sodium and fibre.

Many food manufacturers and supermarkets use a food traffic light system on their labels. This tells you the amount of fats, saturated fats, sugars and salt in 100g (3½ ounces) of the product.

The colours show if the level is high, medium or low:

- Red – the level is high.

- Amber – the level is medium.

- Green – the level is low.

You should eat more foods with amber and green labels and fewer with red.

If a product does not have traffic light labelling, you can use the diagram below to check by comparing it with the list of ingredients.

Food labelling diagram

Healthy eating tips

These tips will help you make healthy decisions when choosing or cooking your food. They will also help you eat less and keep to a healthy weight. Tell your family and friends what you are doing, so they can support you.

Change your habits

- Try to plan what you are going to eat for the week. This means you will be less likely to buy unhealthy food at the last minute.

- Start the day with a healthy breakfast. This may help you to stop eating unhealthy snacks in the morning.

- Try to eat meals at regular times. This will help your body get used to a routine of when you eat. This may mean you are less likely to snack between meals.

- Make sure you drink plenty of fluids. Sometimes we mistake being thirsty for being hungry. Try to have a glass of water before meals.

- Turn off the TV and put down mobile phones or other devices during meals. You are less likely to eat more than you need if you concentrate on your meal.

Change how much you eat

The amount you eat is just as important as what you eat. If you eat big portions, you are more likely to gain weight. If you want to lose weight, there are things you can do to help you eat smaller portions:

- Use a smaller dinner plate. Bigger plates need more food to fill them.

- Choose a healthy starter, such as low-fat soup, melon or salad.

- Eat slowly and avoid having second helpings. It takes about 20 minutes for your stomach to tell your brain that you are full. Try to wait a while before deciding whether you want more.

- Avoid snacking straight from a bag or packet. Put the amount of food you want to eat on a plate.

Fast foods and eating out

Fast food is usually high in calories and fat. If you eat a lot of fast food, you could try to cut down.

Try to plan your healthy meals and snacks in advance. If you do not plan, you may end up buying take-away food when you are hungry.

Even when you have changed to a healthier way of eating, there may be times when you want to be more relaxed about it. You can still enjoy treats or meals out with family or friends.

If you have a take-away or eat out, try to follow these tips:

- Look for the healthier options on the menu. These may be labelled as a ‘light’ option.

- Have a boiled or jacket potato instead of chips. Or ask for boiled rice instead of fried rice.

- Choose baked options rather than fried.

- Try to avoid bread or nibbles before the starter or main course.

- Ask for a standard or smaller portion size, or order a starter as a main course.

- You could share a main course with someone.

- Choose tomato-based sauces with vegetables rather than creamy sauces.

- Order vegetables or a side salad to add to your meal.

- After you finish your main course, wait a while before you decide whether to order a dessert.

- If you order dessert, choose one that is fruit-based. Ask for low-fat, low-sugar yoghurt instead of ice cream or cream.

Eating and socialising

Food gives us what we need to keep our bodies healthy and energised. But it is also an important part of our social lives. This may be spending time with family and friends at barbecues, or celebrating an event with treats like cakes.

Even when you have successfully changed to a healthier balanced diet, you may not always feel like following

it strictly. This is normal. Everyone enjoys having an occasional treat or meal out. Try having a smaller portion than you would normally.

Healthy menu ideas

Here are some ideas for healthy meals and snacks.

Breakfast

- Low-sugar, wholegrain cereal, muesli or porridge. Have this with skimmed, 1%, or semi-skimmed milk, or an unsweetened, fortified plant-based milk such as almond milk.

- Fresh fruit or berries with low-fat or diary-free yoghurt.

- A boiled, poached or scrambled egg with a slice of wholemeal toast. Or you could have scrambled tofu with toast.

- A bagel with low-fat cream cheese, nut butter or mashed banana.

- A homemade smoothie, made from fruit, vegetables and low-fat yoghurt or an unsweetened plant-based milk.

- Vegetarian or vegan sausages with a grilled tomato and mushrooms.

- A grilled breakfast instead of a fry-up.

Lunch

- Homemade vegetable or lentil soup with a wholemeal bread roll.

- Grilled chicken salad.

- A poached or scrambled egg on a slice of wholemeal toast.

- An omelette with a side salad.

- A baked potato with tinned tuna (in spring water), sweetcorn or low-fat coleslaw.

- A wholemeal wrap with reduced-fat hummus and salad.

- Pilchards, sardines, mackerel or baked beans on toast.

- A wholemeal bread sandwich or pitta bread with egg or cold meat, served with salad.

- Falafel and salad with a flat bread.

Dinner

- Vegetable curry or chilli with boiled brown rice.

- Wholegrain pasta with a low-fat sauce, vegetables and a side salad.

- Grilled or baked fish, with boiled or baked potatoes and vegetables.

- A vegetarian or vegan burger with vegetables or salad.

- Vegetable, turkey or tofu stir-fry with noodles.

- Lean beef casserole with potatoes and vegetables.

- Grilled chicken with vegetables and potatoes.

- Reduced-fat mince and potatoes. You could replace half the mince with vegetables or lentils.

Snacks

- Fresh fruit.

- Seeds, mixed nuts and berries. It can be cheaper to buy these in bulk, from a supermarket or health food shop.

- Oatcakes with cherry tomatoes.

- Fresh carrot, cucumber or celery sticks, dipped into a low-fat dip such as hummus or salsa.

- A handful of raisins or other dried fruit.

- Plain rice cakes with reduced-fat cheese.

- Homemade plain popcorn.

- Low-fat fruit yoghurt.

More recipe ideas

We have lots of healthy recipes in our booklet Recipes for people affected by cancer.

The World Cancer Research Fund also has healthy recipes from all over the world

Eating a healthy, balanced diet does not mean you have to buy expensive foods. The NHS has useful tips on how to eat well for less.

Alcohol

Alcohol is high in calories and can cause weight gain. It is also linked with an increased risk of some cancers. Following the recommended drinking guidelines is good for your health and weight.

NHS guidelines suggest that both men and women should:

- not regularly drink more than 14 units of alcohol in a week

- spread the alcohol units they drink in a week over 3 or more days

- try to have several alcohol-free days every week.

1 unit of alcohol is:

- half a pint of ordinary strength beer, lager or cider

- 1 small glass (125ml) of wine

- 1 single measure (25ml) of spirits.

We have a table to show this (see opposite).

Drinkaware has more information about alcohol and drinking guidelines.

Number of calories and units of alcohol in a drink

Drink

Calories

Units of alcohol

Pint of lager

170 to 250

2

Standard glass of white wine (175ml)

130 to 160

2

Single vodka (25ml with a mixer)

115

1

Tips for having less calories when drinking alcohol

- Have a shandy instead of a beer – this is beer mixed with low-calorie (diet) lemonade.

- Add low-calorie or calorie-free mixers to spirits or white wine.

- Have a low-calorie, non-alcoholic drink between each alcoholic drink.

- Have a glass of water with each alcoholic drink.

- Try alcohol-free beer, wine or cider. These can often be low in calories too.

Being physically active

Doing more physical activity is another positive change you can make to your lifestyle. Being active helps you burn off energy (calories) from food. This can help you lose weight and make you feel healthier. Even if you do not lose weight, being more active can boost your immune system. It can also help you recover from treatment side effects. Together with eating a healthy diet, it can help reduce the risk of some cancers coming back.

Being physically active can mean doing activities like walking or gardening. Or it can mean more energetic activities, such as running, cycling or going to the gym. Any increase in physical activity is good for your health and will help you burn more energy (calories).

If you have problems with walking or balance, your doctor may refer you to a physiotherapist. They can assess you and show you how to exercise safely. Some doctors may be able to refer you to an exercise programme run by fitness trainers in your area.

If you want more information about exercise, we can send you our Move More pack. This includes a DVD and our booklet Physical activity and cancer. We also have information on our website about physical activity during and after cancer treatment, including several videos.

The NHS has useful tools, including how to move more, eat well and be healthier. You can also download them as free apps using your mobile phone or tablet.

‘While I was going through chemo I took up yoga. I also kept up with my aerobics classes. I found yoga helped give me an energy boost that was so needed. Weight training was something I started towards the end of chemo to get back the muscle strength I had lost.’ Bei

Getting started

You might be nervous about starting a physical activity plan, especially if you have not been active for a while. If you are not used to exercise, get advice before you start. Your GP or cancer specialist can talk to you about the type and amount of exercise that is safe for you.

Your fitness level may have reduced over time, so it is important to increase your activity slowly. Try to do 30 minutes of activity on 5 days of the week. You could break this up into 10 minutes of activity, 3 times a day. We have more information about these guidelines in our booklet Physical activity and cancer.

Start gently and try to do a bit more each week. For example, you could walk a bit further or a bit faster each time. You will gradually find you can do more.

Do not do too much, too soon. At the end of an activity, you should feel warm and slightly out of breath, but not exhausted. With practice, you will soon find you can do more.

Tips for getting started

- Walking is good exercise. Start with short walks at a comfortable pace, then slowly build up the speed and distance. Walking to the shops, taking children to the park and walking a dog all count.

- Walk upstairs instead of taking a lift. Climbing stairs burns double the energy that walking on flat surfaces does.

- Housework can be a form of exercise. Listening to fast-paced music while you clean and tidy can help you do it faster and burn more energy.

- Gardening is a good way to get active and enjoy the fresh air. If you do not have a garden, you could volunteer to help at a community garden. Visit do-it.org.uk to find volunteering groups in your local area.

- Bowling and dancing are ways to get fitter while socialising.

Getting stronger

As you get fitter, you will be able to increase the amount of physical activity you do. Start with exercise you enjoy. When you get stronger, you may want to increase your target to 45 to 60 minutes a day. You can do this a few days a week to meet the guidelines.

Being part of a group can make exercise more enjoyable. Here are some ideas for when you feel able to do more:

- Swimming is good exercise for your whole body. It does not put much strain on joints. Aqua aerobics classes can be a good way to get fit in the pool.

- Joining an exercise class or club can be a good way to get more active and socialise. You could try aerobics, yoga, pilates or tai chi. Beginners’ classes are usually available. Joining a club or gym does not always have to be expensive – look at some in your area to find prices.

- Cycling is a good way to get fitter. There is a National Cycle Network for cycling outdoors. It has safe cycling routes throughout the UK that try to avoid busy roads. Visit sustrans.org.uk for details. You can also cycle indoors on an exercise bike.

- Join a walking group, or build up the distances you walk. There are free, guided health walks across the UK.

Get fit for free

There are many ways to get fit for free. You can contact your local authority for information about schemes in your area.

Some areas may offer free swimming classes on certain days of the week to encourage people to exercise. Other areas have free outdoor gym equipment in parks so people can exercise in the fresh air. There are park runs held each week across the country. These are free and you can walk or run 5km. You can also volunteer to help at these which means they are a good way to get fit, and also socialise.

If you are under 16 or over 60, or get benefits, you may be able to use local leisure services for free.

Who can help?

Family and friends

Tell your family and friends what you are doing and ask them to support you. They might even join you in healthy eating and exercising. This can encourage you, and it is good for them too.

If you are getting used to life after cancer treatment, it can help to talk to people going through the same thing. Our Online Community is a place where you can make friends, blog about your experiences and join groups to meet other people going through the same things.

Healthcare team

Your doctor or nurse can give you advice or refer you to a dietitian. If you are struggling, your GP may refer you to an NHS weight loss clinic.

Exercise groups

You can find more information about local exercise groups at your local library, healthy living centre, community centre or leisure centre. You can also look online.

Weight loss groups

These can be a good way to meet other people who can encourage and support you. Remember that weight loss programmes should be based on:

- a healthy balanced diet

- regular physical activity

- weight loss of no more than 0.5 to 1kg (1 to 2 pounds) a week.

Using a food and activity planner

Writing down your meals and physical activity for the week ahead can help you plan what you are going to eat and do. This can help you keep track of your goals each week. Remember to go easy on yourself. If you are not sticking to the plan, think about why that might be. Maybe you can set yourself other goals.

Tips for using the planner

- Photocopy or print the planner before you fill it in. This means you can use a new one each week.

- Try to write down everything you plan to eat for a week. Make a note of when you do not stick to the plan. At the end of the week, you can see what you have done and use it to plan for the next week. You will also have a record to show your doctor or dietitian.

- Use our healthy meal suggestions when you are planning your meals.

- Mark down each portion of fruit and vegetables you plan to eat and record if you did.

- Use the activity section to plan and record physical activity.

- If you eat a lot in one sitting, make a note of where you were, who you were with and how you were feeling. This may help you find any eating habits that are causing weight gain.

About our information

We provide expert, up-to-date information about cancer. And all our information is free for everyone.

Order what you need

You may want to order more booklets or leaflets, or download more eBooks like this one. Visit be.macmillan.org.uk or call us on 0808 808 00 00.

We have booklets on different cancer types, treatments and side effects. We also have information about work, financial issues, diet, life after cancer and information for carers, family and friends.

Online information

All of our information is also available online at macmillan.org.uk/information-and-support There you’ll also find videos featuring real-life stories from people affected by cancer, and information from health and social care professionals.

Other formats

We also provide information in different languages and formats, including:

- audiobooks

- Braille

- British Sign Language

- Easy Read booklets

- large print

- translations.

Find out more at macmillan.org.uk/otherformats If you’d like us to produce information in a different format for you, email us at cancerinformationteam@macmillan.org.uk or call us on 0808 808 00 00.

Help us improve our information

We know that the people who use our information are the real experts. That’s why we always involve them in our work. If you’ve been affected by cancer, you can help us improve our information.

We give you the chance to comment on a variety of information including booklets, leaflets and fact sheets.

If you’d like to hear more about becoming a reviewer, email reviewing@macmillan.org.uk You can get involved from home whenever you like, and we don’t ask for any special skills – just an interest in our cancer information.

Other ways we can help you

At Macmillan, we know how a cancer diagnosis can affect everything, and we are here to support you.

Talk to us

If you or someone you know is affected by cancer, talking about how you feel and sharing your concerns can really help.

Macmillan Support Line

Our free, confidential phone line is open 7 days a week, 8am–8pm. Our cancer support specialists can:

- help with any medical questions you have about your cancer or treatment

- help you access benefits and give you financial advice

- be there to listen if you need someone to talk to

- tell you about services that can help you in your area.

Call us on 0808 808 00 00 or email us via our website, macmillan.org.uk/talktous

Information centres

Our information and support centres are based in hospitals, libraries and mobile centres. There, you can speak with someone face to face.

Visit one to get the information you need, or if you’d like a private chat, most centres have a room where you can speak with someone alone and in confidence.

Find your nearest centre at macmillan.org.uk/informationcentres or call us on 0808 808 00 00.

Talk to others

No one knows more about the impact cancer can have on your life than those who have been through it themselves. That’s why we help to bring people together in their communities and online.

Support groups

Whether you are someone living with cancer or a carer, we can help you find support in your local area, so you can speak face to face with people who understand. Find out about support groups in your area by calling us or by visiting macmillan.org.uk/selfhelpandsupport

Online community

Thousands of people use our online community to make friends, blog about their experiences and join groups to meet other people going through the same things. You can access it any time of day or night. Share your experiences, ask questions, or just read through people’s posts at community.macmillan.org.uk

The Macmillan healthcare team

Our nurses, doctors and other health and social care professionals give expert care and support to individuals and their families. Call us or ask your GP, consultant, district nurse or hospital ward sister if there are any Macmillan professionals near you.

Help with money worries

Having cancer can bring extra costs such as hospital parking, travel fares and higher heating bills. If you’ve been affected in this way, we can help.

Financial guidance

Our financial guidance team can give you advice on mortgages, pensions, insurance, borrowing and savings.

Help accessing benefits

Our benefits advisers can offer advice and information on benefits, tax credits, grants and loans. They can help you work out what financial help you could be entitled to. They can also help you complete your forms and apply for benefits.

Macmillan Grants

Macmillan offers one-off payments to people with cancer. A grant can be for anything from heating bills or extra clothing to a much-needed break.

Call us on 0808 808 00 00 to speak to a financial guide or benefits adviser, or to find out more about Macmillan Grants. We can also tell you about benefits advisers in your area.

Visit macmillan.org.uk/financialsupport to find out more about how we can help you with your finances.

Help with work and cancer

Whether you’re an employee, a carer, an employer or are self-employed, we can provide support and information to help you manage cancer at work. Visit macmillan.org.uk/work

Other useful organisations

There are lots of other organisations that can give you information or support.

Nutrition and diet information and support

British Dietetic Association (BDA)

Tel 0121 200 8080

Email info@bda.uk.com

www.bda.uk.com

Provides training and facilities for registered dietitians. The website includes food facts, and has information on the role of dietitians and how to find one.

British Nutrition Foundation

Tel 0207 557 7930

Email postbox@nutrition.org.uk

www.nutrition.org.uk

The website has information about healthy eating and lifestyle choices.

Exercise

Cancer Rehabilitation

Tel 0345 459 4618

www.canrehab.co.uk

Runs training workshops on developing exercise-based cancer rehabilitation programmes.

National walking groups

Walking for Health (England)

www.walkingforhealth.org.uk

Paths for All (Scotland)

Tel 0178 664 1851

Email info@pathsforall.org.uk

www.pathsforall.org.uk

Ramblers Cymru

Tel 0203 961 3310

Email cerddwyr@ramblers.org.uk

www.ramblers.org.uk/wales

Walk Northern Ireland

Tel 0289 030 3930

Email info@walkni.com

www.walkni.com

National stop-smoking services

Smokefree (England)

www.nhs.uk/smokefree

Quit Your Way Scotland

Tel 0800 84 84 84 (Mon to Fri, 9am to 5pm)

www.nhsinform.scot/care-support-and-rights/nhs-services/helplines/quit-your-way-scotland

Help Me Quit Wales

Tel 0808 278 6119

www.helpmequit.wales

Stop Smoking Northern Ireland

www.stopsmokingni.info

General cancer support organisations

Cancer Black Care

Tel 0208 961 4151

www.cancerblackcare.org.uk

Offers UK-wide information and support for people from Black and ethnic minority communities who have cancer. Also supports their friends, carers and families.

Cancer Focus Northern Ireland

Helpline 0800 783 3339 (Mon to Fri, 9am to 1pm)

Email nurseline@cancerfocusni.org

www.cancerfocusni.org

Offers a variety of services to people affected by cancer in Northern Ireland.

Cancer Support Scotland

Tel 0800 652 4531 (Mon to Fri, 9am to 5pm)

Email info@cancersupportscotland.org

www.cancersupportscotland.org

Runs cancer support groups throughout Scotland. Also offers free complementary therapies and counselling to anyone affected by cancer.

Macmillan Cancer Voices

www.macmillan.org.uk/cancervoices

A UK-wide network that enables people who have or have had cancer, and those close to them such as family and carers, to speak out about their experience of cancer.

Maggie’s

Tel 0300 123 1801

Email enquiries@maggies.org

www.maggies.org

Has a network of centres in many locations throughout the UK. Provides free information about cancer and financial benefits. Also offers emotional and social support to people with cancer, their family, and friends.

Penny Brohn UK

Helpline 0303 300 0118 (Mon to Fri, 10am to 1pm)

Email helpline@pennybrohn.org.uk

www.pennybrohn.org.uk

Offers physical, emotional and spiritual support across the UK, using complementary therapies and self-help techniques.

General health information

Health and Social Care in Northern Ireland

www.hscni.net

Provides information about health and social care services in Northern Ireland.

NHS.UK

www.nhs.uk

The UK’s biggest health information website. Has service information for England.

NHS Direct Wales

www.nhsdirect.wales.nhs.uk

NHS health information site for Wales.

NHS Inform

Helpline 0800 22 44 88 (7 days a week, 8am to 10pm)

www.nhsinform.scot

NHS health information site for Scotland.

Counselling

British Association for Counselling and Psychotherapy (BACP)

Tel 0145 588 3300 (Mon to Thu, 10am to 4pm)

Email bacp@bacp.co.uk

www.bacp.co.uk

Promotes awareness of counselling and signposts people to appropriate services across the UK. You can search for a qualified counsellor.

Emotional and mental health support

Mind

Helpline 0300 123 3393 (Mon to Fri, 9am to 6pm)

Email info@mind.org.uk

www.mind.org.uk

Provides information, advice and support to anyone with a mental health problem through its helpline and website.

Samaritans

Helpline 116 123

Email jo@samaritans.org

www.samaritans.org

Provides confidential and non-judgemental emotional support, 24 hours a day, 365 days a year, for people experiencing feelings of distress or despair.

LGBT-specific support

LGBT Foundation

Tel 0345 330 3030 (Mon to Fri, 10am to 6pm)

Email info@lgbt.foundation

www.lgbt.foundation

Provides a range of services to the LGBT community, including a helpline, email advice and counselling. The website has information on various topics including sexual health, relationships, mental health, community groups and events.

Support for carers

Carers UK

Helpline (England, Scotland, Wales) 0808 808 7777 (Mon to Fri, 9am to 6pm)

Helpline (Northern Ireland) 0289 043 9843 (Mon to Fri, 9am to 5pm)

Email adviceinfo@carersuk.org

www.carersuk.org

Offers information and support to carers across the UK. Has an online forum and can put people in contact with local support groups for carers.

Disclaimer, thanks and sources

Disclaimer

We make every effort to ensure that the information we provide is accurate and up to date, but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Some photos are of models.

Thanks

This eBook has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been approved by Prof Tim Iveson, Consultant Medical Oncologist and Macmillan Chief Medical Editor.

With thanks to: Lindsey Allan, Macmillan Oncology Dietitian; Dr Shreerang Bhide, Consultant Clinical Oncologist; Carolyn Faulkner, Head & Neck Oncology Clinical Nurse Specialist; Loraine Gillespie, Specialist Oncology Dietitian; Catherine Green, Oncology Dietitian; Natasha Jones, Advanced Specialist Dietician; Monika Siemicka, Senior Specialist Haematology and TYA Dietician; Clare Stevinson, Senior Lecturer in Behavioural Aspects of Physical Activity and Health; Professor Robert Thomas, Consultant Oncologist and Professor of Exercise and Biological Science; Sarah Wheeldon, Macmillan Specialist Dietician; and Rachel White, Oncology Dietitian.

Thanks also to the people affected by cancer who reviewed this edition, and those who shared their stories.

We welcome feedback on our information. If you have any, please contact cancerinformationteam@macmillan.org.uk

Sources

Below is a sample of sources used in our managing weight gain information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

NICE guidelines. Preventing excess weight gain. 2015. www.nice.org.uk (accessed August 2018).

World Cancer Research Fund (WCRF). Diet, nutrition and physical activity: energy balance and body fatness – a literature review. 2017. www.wcrf-uk.org (accessed August 2018)

World Cancer Research Fund (WCRF). Healthy living after cancer. 2016. www.wcrf-uk.org (accessed August 2018).

Can you do something to help?

We hope this eBook has been useful to you. It’s just one of our many publications that are available free to anyone affected by cancer. They’re produced by our cancer information specialists who, along with our nurses, benefits advisers, campaigners and volunteers, are part of the Macmillan team. When people are facing the toughest fight of their lives, we’re there to support them every step of the way.

We want to make sure no one has to go through cancer alone, so we need more people to help us. When the time is right for you, here are some ways in which you can become a part of our team.

5 ways you can help someone with cancer

Share your cancer experience

Support people living with cancer by telling your story, online, in the media or face to face.

Campaign for change

We need your help to make sure everyone gets the right support. Take an action, big or small, for better cancer care.

Help someone in your community

A lift to an appointment. Help with the shopping. Or just a cup of tea and a chat. Could you lend a hand?

Raise money

Whatever you like doing you can raise money to help. Take part in one of our events or create your own.

Give money

Big or small, every penny helps.

Call us to find out more 0300 1000 200

macmillan.org.uk/getinvolved