Dr. Starpoli blog on GI disorders

Obesity in Adolescents Leads to Adult Obesity: A Risk Factor for GERD

Written by Anthony A. Starpoli, MD | Nov 21, 2010 5:54:00 PM

The prevalence of obesity has increased in recent years. However, individuals who are obese early in life have not been studied over time to determine whether they develop severe obesity in adulthood, thus limiting effective interventions to reduce severe obesity incidence and its potentially life-threatening-associated conditions. According to a study in the Journal of the American Medical Association obesity in adolescence was significantly associated with increased risk of incident severe obesity in adulthood, with variations by gender and race/ethnicity.

It is important to remember that obesity is an independent risk factor for GERD or reflux.  Early intervention in the beginning of adulthood is essential may prevent long-term obesity and its complications.  As an adolescent, portion control and the avoidance of fatty and processed foods should be be enforced.  Obesity is an epidemic in the USA that seems to be on the rise.  The worldwide prevalence of GERD is about 18 percent.  The treatment of reflux is complicated, and the issue of weight is often overlooked by even the gastroenterologist. I know this firsthand from experience. As for many years I treated patients reflux without really attending to their overweight condition. As an independent risk, factor obesity directly influences the response of the body to different medication's that are used for controlling acid. Beyond acid, there is a mechanical aspect of reflux, which is directly influenced by being overweight. Essentially, having increased abdominal girth, puts pressure in the abdomen which pushes on the stomach and forces the retrograde or backwash of contents.  The management of weight issues is quite complex and involves genetics as well as behavioral and other physiological mechanisms. The approach begins with meeting with a registered dietitian to understand lifestyle and dietary habits. Then the doctor has the options to treat beyond lifestyle and dietary modification with medication, or perhaps procedures. They're a newer procedure, such as endoscopic sleeve, gastroplasty, known as E.S.G. that might be of benefit. 

Our approach to reflux has changed over the years to include proper weight management. We do everything we can to avoid long-term medication, used or invasive procedures. Of course, the most important thing is to prevent injury to the esophagus as chronic injury to the esophagus can lead to esophageal cancer.