Obesity and reflux - the evidence

There is strong evidence linking the development of GORD with obesity though it appears to be only an indirect risk factor for the development of Barrett's oesophagus.

An evidence based review of 100 articles by researchers in Stanford, CA suggested that weight loss appears to be beneficial in reducing both symptoms and pH profiles. This has been tested prosepectively and even moderate amoounts of weight loss can be very beneficial: a study from Derby, UK suggested that 5% weight loss can improve symptoms by up to 75%. This study was in subjects who were not obese (mean BMI 23). Other work has cast doubt on the effectiveness of weight loss in obese patients despite even impressive amounts of weight reduction. It may be that these patients are beyond 'the point of no return' and that despite fat loss their hiatus remians open and lax.

In an extraordinary study from Holland patients were treated for their reflux by weight loss but half of them had regular balloon distension of their stomach and this group did not get the same benefit in terms of reduction in reflux episodes - indeed these episode increased. Again, the amount of fat lost correlated with the improvement in symptoms. The implication of this study is that weight loss by smaller meals (no gastric distension) is far more preferable to weight loss which is achieved in the setting of large meals. This reinforces the idea of a wholesale change in lfestyle as a treatment for reflux.

Ultimately the question is somewhat academic as there are of course many other health benefits from weight loss.....