Annie Bond, 37, was diagnosed with metastatic breast cancer in August 2015. Shortly after sharing her diagnosis, some of her friends sent miracle cures and wigs in the mail. 

“That was weird because I didn’t even know if I was going to lose my hair,” Bond says.

Bond has lived with metastatic breast cancer for over a decade and has lost friends who were not comfortable with the way her life has changed.

“The best thing anyone ever did was just stick around and stay open-minded. Just remember everything that’s true about your friend or your loved one is still true after they’re diagnosed,” she says.

When someone you love is diagnosed with metastatic or stage 4 breast cancer, you may struggle to find the right words or wonder what kind of support will actually help.

A stage 4 diagnosis will drastically change your loved one’s life. Before you try to help, remember that they are still a full, complete person, not just a cancer patient. Continuing to show up can make a meaningful difference as they navigate their life with metastatic disease. Focus on what you can do to help, rather than retreating from the relationship out of fear.

Do: Respect Boundaries

Every person with metastatic breast cancer is different; some people want to share updates, while others prefer to keep their journeys private.

Frances Malinis, 42, who was diagnosed with triple-negative metastatic breast cancer, says she was very selective about who to share information with initially. She knew some people would not handle it well, and others would try to make themselves part of the “drama.”

“Don’t try to get information out of [your loved one] that they’re not already wanting to give. Because what are your intentions? Are you just looking for entertainment?” Malinis says.

Try not to get offended if your loved one seems distant because they may not have the energy or emotional bandwidth to respond to every message you send. 

“One of the main things families can do is to be incredibly patient and understanding with the level of anxiety and fear that patients live with,” says Ian Sadler, PhD, an assistant professor of medical psychology at Columbia University Vagelos College of Physicians and Surgeons.

Do: Try to Educate Yourself About Breast Cancer

Metastatic breast cancer means the cancer has spread to the bones, lungs, liver, or other parts of the body. While it is not yet curable, it is manageable for many people.

“Modern developments in cancer treatment have turned metastatic breast cancer into a chronic disease for many patients,” says Swati Sikaria, MD, an oncologist at a Cedars-Sinai affiliate in Torrance, CA.

Prognosis varies person to person, but new treatments have significantly extended survival rates and quality of life for many people with metastatic breast cancer.

Malinis says some friends would ask how much time she had left, and others would send messages that felt like a eulogy. “I get that they wanted to express their care and love for me, but don’t write me off yet,” she says. 

Do: Provide Practical Support

People living with metastatic breast cancer have to fit frequent healthcare appointments into their schedules. Sometimes, it’s best to offer to help with specific chores or errands rather than saying, “Reach out if you need anything.” 

“As a patient, I don’t really know what I could ask for from people,” Malinis says.

Some useful things to suggest might be rides to and from the doctor’s office, pet or babysitting, house cleaning, meal prepping or grabbing groceries or other household items while running your errands.

Malinis says sending flowers, comfort food, or food delivery gift cards also shows you are thinking of your loved one. If you want to drop gifts off, leave them on the doorstop. Don’t expect to socialize if your loved one does not feel ready to welcome guests. 

Do: Honor Your Loved One’s Independence

If your friend or family member asks you to join them at a doctor’s appointment, show up in a way that honors their independence.

“The support of family and friends is pivotal in the life of someone with metastatic breast cancer, but it’s important to come in with the goal of supporting that individual and not trying to assume control or take over the situation,” Sikaria says. 

If you want to support your loved one, Sikaria says you can:

• Help them write down their questions prior to the appointment.
• Talk to them before the appointment to learn if they even want to ask the oncologist about their prognosis.
• Provide an extra set of ears and take notes during the appointment.
• Trust that the oncologist is developing the best care plan for the patient, rather than offering your own ideas on supplements or treatments.

Don’t: Offer Diet Advice 

You may be inclined to investigate whether diet or other lifestyle factors contributed to your loved one’s diagnosis, but this is not helpful. 

Breast cancer development is complex, and as many as 10% of breast cancer cases are hereditary. Age, being born female, dense breast tissue, and genetic factors all increase risk. While certain lifestyle factors also contribute to breast cancer risk, having a poor diet does not automatically mean someone will develop cancer. 

“All of us will blame ourselves first, so please do not do anything to help us blame ourselves,” Bond says.

Don’t: Pretend Like They Don’t Have Cancer

Metastatic breast cancer is a permanent part of your loved one’s life. You will have to balance acknowledging their disease while also respecting their boundaries.  

“We didn’t ask to have this disease,” Bond says. “It doesn’t mean that we did something wrong, but the truth is the truth, which is that we have this disease forever.”

Even if your loved one is in remission or has no evidence of disease, like Bond, cancer still touches every aspect of their life. 

“I just wish that people would stop expecting us to forget about the cancer and be done with it when we’re metastatic,” Bond says. “Sorry, we don’t get that option.”

PEOPLE

Sleep, physical activity and diet are key lifestyle behaviours that influence the risk of cardiovascular disease and premature death.

Most cardiovascular prevention guidelines – such as recommendations to get at least 150 minutes a week of moderate‑intensity exercise or to follow a healthy dietary pattern like the DASH diet – have been built largely on evidence from studies in which these lifestyle behaviours were examined in isolation.

In real life, though, sleep, physical activity and nutrition are tightly interconnected, with changes in one often affecting the others.

Poor sleep, for example, can disrupt the secretion of appetite hormones, influencing food choices and calorie intake. Lack of sleep can also reduce the motivation to exercise as a result of fatigue.

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Diet, too, can influence sleep quality and energy for physical activity.

Now a new study, published March 26, investigated the relationship between all three lifestyle behaviours simultaneously and the risk of a major cardiovascular event, including heart attack, stroke and heart failure.

Turns out, you don’t need to completely overhaul your lifestyle to improve your cardiovascular health.

According to the findings, making small concurrent changes to daily sleep, physical activity and diet can have a surprisingly positive impact – one that’s at least as powerful as much larger changes to a single behaviour alone.

The latest research

The new study, published in the European Journal of Preventive Cardiology, set out to determine how combined variations in sleep, physical activity and diet influence the risk of heart attack, stroke and heart failure.

The researchers also aimed to identify the minimum combined improvements in these lifestyle behaviours associated with a clinically meaningful reduction in cardiovascular risk.

To do so, they analyzed data from 53,242 UK Biobank participants, average age 63, who were followed for eight years. The UK Biobank is a large-scale biomedical database and research resource containing health-related information from 503,317 participants across the U.K.

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Sleep (hours/day) and moderate- to vigorous- intensity physical activity (minutes/day) were measured using wearable devices.

Diet was assessed through a food frequency questionnaire; the data was then used to calculate participants’ diet quality scores.

The scoring system emphasized a higher intake of vegetables, fruit, whole grains, fish, dairy and healthy oils and a lower intake of refined grains, red and processed meats and sugary beverages.

Scores for each food category ranged from 0 (unhealthiest) to 10 (healthiest) for a total possible diet quality score of 100 points.

The findings

During the eight-year follow-up period, 2,034 major cardiovascular events occurred, which included 932 heart attacks, 584 strokes and 518 heart failure events.

A combined daily increase of as little as 11 minutes of sleep, 4.5 minutes of moderate- to vigorous-intensity physical activity and a modest increase of three diet quality score points (an additional one quarter-cup of vegetables) was tied to a 10 per cent lower risk of a major cardiovascular event.

This was in comparison to people with the lowest levels of sleep (5.5 hours/day), physical activity (7.9 minutes/day) and diet quality score (37 points).

The researchers also identified an “optimal” lifestyle behaviour combination that offered substantial cardiovascular risk reduction.

Compared to the least healthy levels, getting eight to nine hours of sleep per night, at least 42 minutes of moderate- to vigorous-intensity physical activity per day and having a moderate diet quality score was associated with 57 per cent lower risk of major cardiovascular events.

The findings held even after accounting for a wide range of factors, including age, sex, smoking, alcohol use, education, socioeconomic status, medication use and overall health.

Strengths, caveats

The study is credited for analyzing all three lifestyle behaviours together, reflecting how they interact in real life.

As well, sleep and physical activity were measured using wrist‑worn accelerometers, which provide much greater precision than self‑reported data.

By identifying the minimum combined changes in sleep, physical activity and diet linked to a clinically meaningful reduction in major cardiovascular events shifts the emphasis to feasible lifestyle improvements.

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The study’s main limitation was its observational design which can’t prove making these lifestyle changes will directly lower the risk of heart attack, stroke or heart failure.

The researchers noted that multibehaviour lifestyle intervention trials are needed to evaluate the effectiveness of small, achievable lifestyle changes for preventing major cardiovascular events.

Key takeaways

Even so, the new findings are relevant because they show that heart health isn’t all‑or‑nothing.

Small, doable changes in sleep, exercise and diet can add up, making cardiovascular prevention feel more achievable and less overwhelming for many people.

The findings don’t contradict established advice such as exercising regularly or following heart‑healthy eating patterns, though. Instead, they help explain why people may benefit even when they fall short of prescribed targets, and why partial adherence still matters.

What’s more, the findings align closely with guidance from the Canadian Heart and Stroke Foundation and the American Heart Association, which emphasizes that small, sustainable lifestyle changes add up over time and can meaningfully reduce cardiovascular risk.

Heart health improves through cumulative progress, not daily perfection.

The Globe and Mail

Weight-loss drugs are not the quick fix solution that many people believe, especially if you hope to keep the pounds off in the long-term.

Sarah Le Brocq has direct experience of the transformative effects of weight-loss drugs. She has lived with obesity for most of her adult life and tried numerous diets. “Anything that came out, I thought, ‘I’ll try that because that might work for me’.” Unfortunately, the weight always came back, she told the BBC’s Inside Health.

After taking weight-loss drugs for more than two years, she has lost almost eight stone (51kg/112lb). “All of a sudden I wasn’t thinking about food anymore,” she says. “I’ve just got more energy, I’m doing things I couldn’t do before… it’s kind of given me a new freedom in life again.”

Millions of people like Sarah are now accessing medications like semaglutide and tirzepatide, better known by their popular brand names Ozempic and Mounjaro. The numbers of people on weight-loss medication is only likely to increase as new drugs appear on the market too, including pills rather than the current jabs.

It’s clear that these drugs are opening up a new era in the treatment of obesity. The condition, is now a “mitigatable” issue, David Cummings, professor of medicine at the University of Washington tells me. “They are the closest thing I’ve seen to miracle drugs”. 

Other academics, however, warn that we risk losing sight of the need for behavioural change, especially as weight tends to be regained quickly when people stop taking the drugs.

So what should anyone planning to use weight-loss medication consider before they start?

How they work

Weight-loss drugs work by suppressing an individual’s appetite by mimicking hormones that tell our body when it is full. The most common are known as glucagon-like peptide 1, or GLP-1, and glucose-dependent insulinotropic polypeptide, or GIP.

The drugs bind to specialised molecules on the surface of our cells known as GLP-1 and GIP receptors, which play a key role in telling our body when it has had enough food.

Typically someone taking these drugs will begin to lose weight within the first few weeks. Although the drugs are only approved for weight loss in people with obesity, there is a rapidly growing private market for those not considered clinically obese.

Their popularity has been rising because they are extremely effective, with weight loss of between 14-20% in 72 weeks. But about 10-15% of people lose very little weight, so called “non-responders“.

GLP-1s are like “a chemical shield” that protects individuals against our “modern obesogenic environment, filled with cheap, calorie-dense foods”, says Naveed Sattar, a professor of cardiometabolic medicine at the University of Glasgow and leads the UK Government’s Obesity Healthcare Goals programme. He has also consulted on medical trials with several companies who produce weight-loss drugs but does not own any shares.

“There’s food everywhere,” he says – and within half an hour anyone “can pick up the phone and order 10,000 calories of food”.

If you stop, you’ll gain weight

If someone living with obesity starts to take weight-loss drugs, they need to consider that they may be on the drug long-term, says Cummings, who runs a weight management programme for individuals with obesity who have BMIs of 50 and above.

A common question he is asked by his patients before they start taking a weight-loss drug is how long they will be on it. Typically, they stop taking the drugs after about a year, he says. One analysis of scientific studies involving more than 9,000 patients indicated the average treatment duration was 39 weeks. People believe they can continue to lose weight using their willpower, he says, but the evidence suggests that is not the case.

People stop for various reasons, either due to the expense of treatment, their insurers stopping coverage or individuals not wishing to be on drugs for a prolonged period of time, Cummings has found.

And when people do stop the drugs, their weight tends to rebound. A recent study found that weight regain happens up to four times more quickly after stopping weight-loss drugs compared to someone ending a weight-loss programme that focuses on changing their behaviour.

Another study found that those on weight-loss drugs gained 1.5kg (3.3lbs) eight weeks after they stopped the medication, with their weight continuing to climb with the more time that passed. The same study also found that other health concerns, such as high blood pressure, also returns. New research has also found that people who stop taking weight-loss drugs gain back around 60% of the weight they lost a year later.

It returns quickly because of something researchers call “food noise“, which consists of persistent and intrusive thought around food, says Sattar.

Hormones play a role too. When an individual tries to lose weight, it triggers a powerful hormonal response that tells your body to regain the weight you lost. Cummings explains that because of this, the brain interprets a calorie drop as an energy deficiency, so after stopping weight-loss drugs, hormones that stimulate appetite increase while the rate at which you burn energy – the metabolic rate – decreases. “If these biological defences are strong enough, they can blunt the drug’s effectiveness,” he says.

Lifestyle change

Sattar has observed that for a small proportion of people who make lifestyle changes, it may be possible to reduce the dose or use the drug intermittently instead. Some really do make “fundamental changes in their diet”, he says.

“Others might need it at a lower dose than they would when they started. But the majority will probably still need some dose of the drug because the [food] environment is still the same.”

There’s also increasing concern that individuals are taking weight-loss medication as a substitute for making life-style changes – even though evidence shows that modifying lifestyle in combination with weight-loss drugs is what will lead to greater weight loss.

Experts have recently cautioned in a scientific review of the evidence that when there’s a lack of behavioural and lifestyle support for those on weight-loss drugs, it can leave individuals vulnerable to nutritional deficiencies. “We need to make sure people are getting enough protein and are getting all the vitamins and minerals they need,” says Marie Spreckley a nutrition and behavioural scientist at Cambridge University and lead author of the report. “You don’t want to have longer-term unintended consequences, like frailty and muscle loss. We don’t want to replace one health concern with another.”

Because these medications cause a dramatic appetite reduction, patients tend to eat less overall, she and her colleagues note. This can lead to a “missed opportunity” if patients are not supported long-term and their food choices remain poor.

No quick fix

The World Health Organization has therefore stated that medication alone won’t “reverse the obesity challenge”. Early interventions, screening and creating healthier environments are also needed, the organisation has stated in its guidelines on using GLP-1 drugs.

This is easier when people are still taking the drugs, Sattar says. “You have more mental space to think about your diet.”

But behavioural change is extremely challenging, says Amanda Daley, a professor of behavioural medicine at Loughborough University in the UK. She says there needs to be better communication with patients about how quickly they can regain weight once they stop taking GLP-1 medication.

Obesity is a chronic, relapsing condition, she says, which means it cannot be “cured” with a drug alone. That’s why additional support and “wraparound care” is key to ensure patients make dietary changes as well as increasing their physical activity.

It’s unclear whether private providers are providing this crucial additional support, she says, which she finds concerning since so many people access the drugs privately and it is hard to monitor continuation of care.

Micro-nudges help change behaviour

To overcome some of this – researchers at Stanford have looked at how they can help support and encourage lifestyle changes. In one recent study, researchers tested whether small nudges – or “microsteps” – could help encourage healthy behavioural change for those taking GLP-1 medications.

The tiny changes focused on nutrition, physical activity, sleep and stress management. Crucially, the microsteps were small and manageable, such as swapping sugary drinks for water, no longer drinking coffee after lunch, taking a deep breath when stressed or popping outside for five minutes.

They found these helped improve behavioural expectations. It’s this “expectation” that’s a first necessary step for behavioural change, says Maya Adam, a clinical associate professor of paediatrics at Stanford School of Medicine, who was involved in the study.

“Achieving your best health involves a lot more than pharmacotherapy alone,” she says. “We found that giving people these little nudges may be very effective.” She calls these steps “too small to fail” because even small daily changes and habits make a real difference over time.

Side-effects

These kind of interventions are crucial to help give people the tools they need to enact change, Daley says, especially considering the known side effects. These include gastrointestinal issues. There has also been an observed increase in pancreatitis and gallstones. Muscle loss is another concern, especially among individuals who are not exercising. Recently a study found links to bone and joint conditions too.

While we now have several years of data on the effectiveness of GLP-1 drugs, we don’t yet know what the long-term outlook will be or whether the results will wear off over time. There is also a lack of data on how these drugs affect pregnancy outcomes or future generations, as the advice is not to take weight-loss drugs during pregnancy. 

But given the negative health outcomes for those living with obesity, the side effects pale in comparison, both Sattar and Cummings say. This is particularly the case for individuals with multiple weight-related conditions. Heart disease, cancer and stroke are the leading causes of death worldwide – and all are linked to obesity.

A changing landscape

What is clear is that the landscape for weight-loss medication is rapidly evolving.

There are other health benefits too beyond weight loss. In one major study involving two million people, the drugs were linked to better heart health, fewer infections, lower risk of drug abuse and lower incidences of dementia. It’s also been shown to improve sleep apnoea, arthritis and substance abuse. 

BBC