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Is Your Weight Giving You GERD?

The Links between Obesity and Heartburn
  -- By Megan Patrick, Staff Writer

It's common knowledge that eating spicy foods or even being pregnant can result in heartburn for many people. But when heartburn or acid reflux becomes a chronic problem—the cause is often something more than the buffalo wings you had a dinner. In some cases, being overweight may be to blame.

Some studies have shown that one of the major risk factors for chronic heartburn or gastroesophageal reflux disease (GERD) is having a body mass index greater than 30 (in the obese range). GERD occurs when the lower esophageal sphincter (LES), located at the bottom of the esophagus and just above the stomach, fails to close after you eat. This allows food and stomach acid back into your esophagus, which causes that familiar burning sensation, chest pain or difficulty swallowing known as heartburn. It can disrupt your sleep, leave you in pain and eventually lead to esophageal cancer, if left untreated.

A 2012 study published in the World Journal of Gastroenterology documented "that both the severity and frequency of heartburn had a positive correlation with BMI," meaning that the higher one's BMI was, the more severe and frequent their heartburn symptoms were. Another study published in the Journal of Clinical Gastroenterology showed that "in patients with GERD, high BMI was associated with more severe erosive esophagitis [irritation and swelling of the espophagus]," as well.

Despite these correlations between BMI and GERD symptoms, researchers aren't exactly sure how obesity plays a role or whether it directly causes GERD (in the absence of other risk factors). The theory is that overweight and obese individuals have excess body fat in the abdomen, which pushes against the stomach, forcing acid up into the esophagus and sometimes into the back of the throat, especially when people are trying to sleep. What we do know for sure is that obesity increases the risk of many other related conditions that can lead to heartburn. 

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Obesity-Related Conditions that Can Cause GERD

Hiatal Hernia
A hiatal hernia occurs when a portion of the stomach moves through the diaphragm allowing food and stomach acid to back up into the esophagus. The major risk factors for developing this type of hernia are age (being older than 50) and obesity. Common symptoms are heartburn, burping and difficulty swallowing. Small hernias can usually be managed with heartburn medications (H-2 receptor blockers like Tagamet or Pepcid or proton-pump inhibitors like Prevacid or Prilosec). A large hernia might require surgery. For people who are overweight, losing weight can decrease the symptoms associated with having a hiatal hernia.

Gastroparesis
One of the many possible complications of (uncontrolled) diabetes is one called gastroparesis, a condition in which your stomach takes too long to empty because high blood glucose levels have damaged the vagus nerve (which controls the muscles of the stomach). Common symptoms besides heartburn are nausea, feeling full after eating a small amount of food and vomiting undigested food. Eating six small meals a day can help control the symptom of this disorder but it's usually a chronic condition. Your doctor can help by adjusting your insulin and prescribing medications that improve gastric emptying like Reglan or Erythromycin. If overweight, losing weight can help you manage diabetes, making it easier for you and your doctor to control the resulting heartburn.

If you suspect one of them might be causing your heartburn, talk to your doctor immediately.

So, will losing weight cure your heartburn? The answer is maybe. If your GERD is caused or exacerbated by the pressure of excess fat in your abdomenal area, even losing a small amount of weight (5-10 percent of your body weight) could make a big difference. If you have a hiatal hernia, losing weight might help, but a large hernia would need to be surgically repaired to completely get rid of your GERD. And a serious condition like gastroparesis brought on by diabetes is something you'll have to manage your entire life. But losing weight has so many health benefits beyond heartburn control, so changing your diet and starting an exercise program for weight control could increase your quality of life in a lot of ways. Only a doctor can determine the right treatment plan for you, but the first step to stopping your recurrent heartburn is asking for help!

This article has been reviewed and approved by Becky Hand, Licensed and Registered Dietitian.
 
Sources
Mayo Clinic, "Hiatal Hernia," www.mayoclinic.com, accessed on April 25, 2013.

Mayo Clinic, "GERD," www.mayoclinic.com, accessed on April 25, 2013.

National Digestive Disease Information Clearinghouse, "Gastroparesis," www.digestive.niddk.nih.gov, accessed on April 25, 2013.

Sharma P, Vakil N, Monyak JT, Silberg DG. "Obesity Does Not Affect Treatment Outcomes with Proton Pump Inhibitors," Journal of Clinical Gastroenterology. 2013 Feb 24.

Shou-Wu Lee, Han-Chung Lien, Chi-Sen Chang, Yen-Chun Peng, Chung-Wang Ko, Ming-Chih Chou. "Impact of body mass index and gender on quality of life in patients with gastroesophageal reflux disease," World Journal of Gastroenterology, September 2012; 18(36):5090-5095.