This is the third article of an eight-part series on acid reflux remedies and how to select the right GERD treatment and develop a plan to find relief. Body weight and the resulting body mass index (BMI) have proven to be very significant as an underlying cause of GERD, the triggering GERD symptoms, and the progression of GERD. As the numbers of overweight and obese adults have increased over the last decade, there has also been a substantial increase in the diagnosis of GERD.
In this article we will help you answer the question: “Is your weight optimal? As we will discuss, there is a relationship between body mass and GERD. Ideally, you will have found a GERD expert to confirm your GERD diagnosis (article 1) and determined your GERD stage (article 2). Each of these steps are important to finding the best GERD treatment plan for you.
In this article we will focus on the third of these eight questions:
- Do you really have GERD?
- What is your starting point?
- Is your weight optimal?
- Are you eating properly?
- Are you using the medications appropriately?
- Have you made the right lifestyle choices?
- Have you tried home remedies?
- Are you considering surgery?
Obesity facts and statistics
The data from the CDC describes a frightening trend; 79 million US adults, or over 1 out of every 3, are obese today. Not even one state has an obesity rate of less than 20% of adults, and 3 states report obesity in excess of 35%. The State of Obesity project, funded by the Robert Woods Foundation developed the following map to highlight obesity by state:
Adult Obesity Rate by State, 2014
Is obesity directly linked to GERD?
Jesper Lagergren MD, PhD summarized data in an article titled Influence of Obesity and the Risk of Esophageal Disorders: Obesity and GERD. Dr. Lagergren cited several studies including one from Norway that studied 3,113 adults with GERD and 39,872 without GERD. He found a positive relationship between BMI and GERD, and more importantly, “any increase in BMI was associated with an increase in the risk of GERD, even among individuals whose BMI was within the normal range.
In another study performed in the US, which included 10,545 women, “confirmed the finding that any increase in BMI in individuals of normal weight was associated with an increased risk of GERD, and even moderate weight gain among persons of normal weight might cause or exacerbate GERD.” In his conclusion to his research paper, Dr. Lagergren highlighted an important fact that should not be ignored by anyone suffering from GERD: “Obesity is proportionally associated with an increased risk of esophageal adenocarcinoma, Barrett esophagus and GERD. These three esophageal disorders are intimately related—GERD is the main cause of Barrett esophagus, which in turn is the main risk factor for esophageal adenocarcinoma.”
The role of excess fat at the waistline
In chapter 13 of RefluxMD’s Recipe for Relief, we discuss the role of belly fat as a potential causal factor for GERD. The persistent pull of gravity on the body fat stored around the stomach will drag the stomach downward, stretching the stomach beyond its normal range. As the stomach is dragged down, it can also pull at the lower esophageal sphincter (LES), the junction of the stomach and the esophagus. Over time and with enough pressure, the LES can become damaged and weakened, reducing its ability to be an effective barrier. Dr. Lagergren, who cited a US study consisting of over 27,000 women, also noted the relationship between waist circumference and GERD.
Weight loss: The most highly recommended GERD treatment of all
Maintaining a healthy BMI is almost always the top GERD treatment recommendation by GERD experts to their patients who are overweight or obese. It is also an important element of both the nationally acclaimed DASH diet and RefluxMD’s Recipe for Relief. The first step is to determine your BMI using the table below:
For any GERD treatment plan, the goal is to reduce your GERD symptoms and reduce the risks of disease progression. When the LES is compromised or damaged, we recommend that you should achieve and maintain a BMI of 24 or less, slightly less than the general standards noted above.. Therefore, step 2 is to use the table above to find your ideal weight that will result in a BMI equal to or less than 24. It should also be noted that according to NIH guidelines, those at risk of developing more serious health complications include anyone with a BMI of 30 or more, as well as those with a BMI between 25 and 29.9 combined with any of the following risk factors:
- High blood pressure (hypertension)
- High LDL cholesterol (bad cholesterol)
- Low HDL cholesterol (good cholesterol)
- High triglycerides
- High blood glucose (blood sugar)
- Family history of early heart disease
- Physical inactivity
- Cigarette smoking
In Recipe for Relief: A GERD-friendly food plan and diet program we created a complete program for those with a BMI of between 24.1 and 26.9 to shed pounds (burning more calories than consumed) in a safe and nutritious plan. If you want to manage your body weight down to a lower BMI, be sure to speak with your physician prior to starting any weight loss program and select a plan that is GERD-friendly to reduce the risk of triggering symptoms. For those that are excessively overweight (BMI = 27.0 to 29.9) and those obese (BMI of 30 or more), we recommend our more aggressive GERD-friendly weight loss program, Scale Down for Relief.
Exercise to reduce belly fat
If you have excess belly fat, than exercise should be another element of your GERD treatment plan. There are two types of exercises that can help to reduce weight and may also impact the fat found in the midsection. One is a cardiovascular workout – exercises that increase the heart rate and maintain it at a high, targeted level for a specific period of time. Repetitive and consistent cardiovascular workouts might include jogging, swimming, elliptical training, and walking at a brisk pace. This will burn calories and over time, fat will begin to disappear.
Other activities to reduce excess fat that may have more impact on the midsection are direct abdomen exercises that are designed to increase and strengthen the abdominal muscles. Many who embark on this exercise program can get frustrated because a stubborn layer of fat seems to hang on even after several weeks of workouts. Even though immediate results may not yield a “beach-body look,” the stronger abdomen muscles will result in less stomach sag and less pressure on the LES.
For those with an “inner tube” size layer of fat on the abdomen, more time and effort will be required to realize results. Many have succeeded in reducing their weight and impacting the largest “inner tube” by working with a personal trainer and setting realistic and achievable waistline goals. Before beginning any exercise program, it is wise to consult your doctor about your exercise plans. Most physicians will make certain that your overall health can support your goals and provide you with additional ideas as well.
Suggested resources to learn more
Here are some additional GERD treatment articles on diet and exercise at RefluxMD:
Why Diet Matters for Everyone with GERD – Dr. Para Chandrasoma
Five Easy Diet Tips to Help Relieve Acid Reflux – Kimberly Tessmer, RDN, LD
A Lifetime GERD Solution: RefluxMD’s Recipe for Relief
Below is a short list of other outside professional articles that we think are informative on this topic:
Diet Changes for GERD – IFFGD
Treating Acid Reflux Disease with Diet and Lifestyle Changes – WebMD
Weight Loss and Acid Reflux – Healthline
The next question
In Acid Reflux Remedies, Part IV we will ask the question, “Are you eating properly?” What you eat is as important as how much you eat. Eating the wrong foods will not only negate your weight loss program, but potentially trigger more GERD symptoms.
Acid Reflux Remedies Series