In a December 26th article in JAMA Oncology, researchers reported that overweight patients who receive immunotherapy for NSCLC (non-small cell lung cancer) enjoy better overall survival rates than patients at a healthy weight. Survival rates for overweight patients were 19% better than those at normal BMI, while obese patients demonstrated a whopping 30% gain over those at a healthy weight. The investigators, from the Flinders Centre for Innovation in Cancer in Bedford Park, Australia, generally cited the “obesity paradox” but offered no specific explanation for the startling discrepancies.

From a TCM point-of-view, overweight and obese patients present a Chinese medical pattern of phlegm-damp accumulation. For anyone who reaches middle age, it is all too obvious that we gain weight more easily as we get older. According to Chinese medicine, it is the decline of qi which is responsible for this phenomenon. The five primary bodily functions of qi are movement, transformation, protection, containment, and warming. As the digestive movement and transformation mechanism weakens with age, unprocessed residue accumulates as dampness and phlegm—what is referred to in Western medicine as adipose tissue.

Following the Chinese medical syllogism, the overweight and obese patients observed in this study all present patterns of phlegm-damp accumulation with varying degrees of underlying spleen qi vacuity. The immunotherapeutic agent administered—unlike more traditional oncological care which directly destroys cancer cells—harnesses the innate power of the immune system to eradicate tumors. From a traditional Chinese medical perspective, we would describe this approach as using the body’s own qi to fight cancer. The fact that overweight and obese subjects survive longer is attributable to the fact that the treatment suitably fits their Chinese pattern, providing qi where qi is conspicuously absent.

Chinese medicine has long utilized the effective strategy of fu zheng or “supporting the right” to manage cancer cases. Like innovative Western medical immunotherapy, the Chinese approach works by helping the body to help itself and, in doing so, improves baseline energy levels and stimulates bodily function. One curious difference between traditional Chinese fu zheng treatments and the primary drug, atezolizumab, featured in this study: while Chinese treatment energizes tired patients, the immunotherapeutic agent often causes shortness of breath, poor appetite, and fatigue—all indications of qi vacuity. It would seem that while Chinese herbal formulas boost qi systemically, this new drug selectively enhances the movement and transformation actions of qi while depleting qi in its other forms and functions.