A Heavy Burden: GERD and Obesity

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Excessive body weight is a well-known risk factor for a number of life-threatening diseases – diabetes, heart disease, and cancer have all been linked with obesity. Less well known is the direct relationship between obesity and gastroesophageal reflux disease (GERD).

What’s causing it?

In 2010 approximately 70 percent of the adult population was considered overweight.  Overweight individuals have two and a half times the likelihood of frequent GERD symptoms compared with those of normal weight.

To further understand obesity and its relationship to GERD, the term Body Mass Index or BMI must be discussed.  BMI is the most common measure of obesity and is calculated using a persons weight and height.  A healthy BMI is considered between 20-25, BMI greater than 25 is considered overweight, greater than 30 is obese, and greater than 40 is morbidly obese.

Because of increased body mass, obese patients tend to experience a “squeeze phenomenon” that can force stomach juices upward through the lower esophageal sphincter (LES) into the esophagus. There may also be a yet clarified hormonal influence contributing to GERD in the obese person.

Relationship between BMI and frequency of symptoms

Studies have shown that the frequency of reflux symptoms is directly related to BMI. The higher the BMI, the more likely a person is to experience heartburn more than once a week:

  • 5-10% of people with a BMI less than 25 have heartburn more than once a week.
  • 20-25% with BMI greater than 30 have heartburn more than once a week.
  • When actually tested for GERD by a pH study, almost 70% with a BMI over 30 tested positive for GERD!

There are all sorts of statistics such as this that lead to the same conclusions:

  • GERD is common and increasing
  • Obesity is common and increasing
  • GERD is especially common in obese people

Weighing Your Treatment Options

When looking at treatment plans, some big questions are raised – is it best to treat the obesity? Do we treat the GERD? Is there a way to treat both? It’s important that the patient understands that the obesity is the main cause of all of these problems, and probably their GERD-like symptoms as well.

Lifestyle changes

Lifestyle changes that result in weight loss will possibly improve or resolve all or many of the health problems associated with obesity, including GERD.  But for the obese person, significant weight loss, and maintaining it, is extremely difficult. Weight loss should be attempted, although it is usually unsuccessful in significantly improving GERD symptoms.  The obese GERD patient is a sub group of all GERD patients where lifestyle changes and weight loss tend not to be very effective.

Treat the GERD alone

The GERD alone can be treated.  This can be done through traditional GERD medications like Proton Pump Inhibitors (PPIs), but may require a patient to be dependent on the drug for the rest of their life. Antireflux surgery is somewhat more difficult in the obese patient compared to the non-obese, however the results are similar with the majority satisfied with the results. Treating the GERD alone ignores the chance to address the other very serious complications associated with obesity.

Bariatric surgery

In most obese and morbidly obese patients, the decision often comes down to whether they are willing to undergo bariatric surgery.  In recent years, bariatric surgery has become a reliable, long-term tool for obese patients to shed large amounts of excess body weight and to help control health problems like high blood pressure, diabetes, and GERD. While effective, weight loss surgery should only be considered after a serious attempt to lose weight through traditional means of exercise and diet has failed.

Lost weight = gained health

RefluxMD believes it’s important that patients understand the various treatments for addressing both GERD and obesity. Each has risks, side effects and success rates that one must be aware of. It’s increasingly clear that the loss of excess bodyweight is key to getting healthy and free of GERD. RefluxMD strongly recommends consulting a physician who is well qualified in GERD treatment for obese patients.

Reviewed by: Dr. Dengler, RefluxMD Medical Director

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