Obesity is a leading cause of illness and death worldwide. It is a risk factor for many common gastrointestinal symptoms and digestive disorders, including many cancers. Disruption of mechanisms that regulate appetite and satiety are fundamental to the development of obesity. Knowledge of these issues that are discussed in this article will provide the basis to develop health strategies to prevent obesity-related diseases.
Obesity is a leading cause of illness and death worldwide. It is one of the greatest public health challenges of this century, with more than 1.6 billion adults classified as being overweight and 400 million as obese. From 1980 to 2002, rates of obesity more than doubled in the United States, reaching 32% in the adult population, thus achieving the highest rates of obesity in the developed world. Although overall obesity rates began to plateau in the 2000s, severe obesity in adults and children has continued to increase. The most dramatic increases have occurred in class III obesity (body mass index [BMI] ≥40), with an increase from 0.78% in 1990 to 2.2% in 2000.
As the rates of obesity have escalated, it is more than just waistbands that have expanded. Obesity is a risk factor for some of the most prevalent diseases in North America, including coronary artery disease, stroke, diabetes mellitus, hypertension, and osteoarthritis. Moreover, common digestive disorders, such as gastroesophageal reflux, esophagitis, nonalcoholic fatty liver, gallstones, and certain cancers, arise with greater frequency in obese individuals compared with normal-weight individuals ( Table 1 ).
| Magnitude of Increased Risk with Obesity (Compared with Normal or Low BMI) | Comments | |
|---|---|---|
| Esophagus | ||
| GERD symptoms | 50% | |
| Erosive esophagitis | 50%–100% | |
| Barrett esophagus | 2-fold | Abdominal obesity |
| Adenocarcinoma | 2-fold | |
| Gallbladder | ||
| Stones | 2- to 3-fold | More in women |
| Cancer | 35%–85% | More in women |
| Pancreas | ||
| Worse acute pancreatitis | 20%–50% | |
| Cancer | 35%–85% | Abdominal obesity |
| Colon | ||
| Adenoma | 50%–100% | |
| Cancer | 2-fold | Colon (not rectum), more in men, more with abdominal obesity, postmenopausal women |
| Liver | ||
| Nonalcoholic fatty liver disease | 2- to 4-fold | Abdominal obesity |
| Advanced HCV-related disease | 50% | |
| Cirrhosis | 30%–50% | |
| Hepatocellular carcinoma | 17%–89% | |
Obesity-related health care costs have also ballooned. Americans who are obese now make up a quarter of the population and are responsible for a 40 billion-dollar rise in annual medical spending. On average, an obese person spends more than 1400 dollars for his or her medical care annually, almost 42% more than is spent by a nonobese person. Although there are no current recommendations for testing in the absence of symptoms or preexisting laboratory abnormalities, weight loss is a recommended strategy to prevent the symptoms that are related to obesity-related gastrointestinal disorders and to decrease the risk of progression of diseases.
Gastrointestinal symptoms related to obesity and obesity treatments
Generally defined as a BMI of 30 kg/m 2 or more (less accurate in body builders and pregnant women), obesity has been linked to a wide range of gastrointestinal symptoms. Disruption of mechanisms that regulate appetite and satiety is fundamental to the development of obesity. Acid regurgitation, heartburn, and diarrhea are some symptoms that are reported with increased frequency in obese subjects compared with normal-weight subjects ( Table 2 ). Pharmacologic and surgical treatments of obesity, by altering gastrointestinal function through mechanisms that regulate hunger, food intake, or absorption of nutrients, influence the energy consumed and meal termination.
| Symptoms | Body Mass Index Category | |||
|---|---|---|---|---|
| Overweight | Obese | |||
| OR a | 95% CI | OR a | 95% CI | |
| Upper gastrointestinal symptoms | ||||
| Abdominal pain | 0.90 | (0.66, 1.23) | 1.29 | (0.93, 1.78) |
| Fullness | 0.90 | (0.55, 1.46) | 0.89 | (0.52, 1.53) |
| Food staying in the stomach | 1.37 | (0.91, 2.07) | 1.76 | (1.15, 2.7) |
| Bloating | 0.98 | (0.73, 1.33) | 1.07 | (0.77, 1.48) |
| Acid regurgitation | 2.00 | (1.39, 2.86) | 3.39 | (2.36, 4.87) |
| Heartburn | 1.64 | (1.16, 2.31) | 3.11 | (2.20, 4.39) |
| Nausea | 0.70 | (0.35, 1.40) | 1.46 | (0.77, 2.75) |
| Vomiting | 1.05 | (0.59, 1.87) | 1.70 | (0.96, 3.02) |
| Dysphagia | 0.53 | (0.30, 0.95) | 0.66 | (0.36, 1.18) |
| Lower gastrointestinal symptoms | ||||
| Anal blockage | 0.63 | (0.41, 0.99) | 0.74 | (0.46, 1.17) |
| Diarrhea | 1.35 | (0.97, 1.88) | 1.64 | (1.16, 2.32) |
| Constipation | 0.72 | (0.47, 1.11) | 0.50 | (0.30, 0.85) |
| Lumpy/hard stools | 0.99 | (0.72, 1.37) | 0.49 | (0.33, 0.75) |
| Loose/watery stools | 1.09 | (0.78, 1.53) | 1.63 | (1.15, 2.29) |
| Fecal urgency | 1.09 | (0.77, 1.54) | 1.46 | (1.03, 2.09) |
| Fecal incontinence | 0.98 | (0.66, 1.46) | 1.36 | (0.91, 2.04) |
Related posts:
Gastroesophageal Reflux Disease and Obesity
Prevalence and Epidemiology of Gastrointestinal Symptoms Among Normal Weight, Overweight, Obese and Extremely Obese Individuals
Postoperative Metabolic and Nutritional Complications of Bariatric Surgery
The Surgical Treatment of Metabolic Disease and Morbid Obesity
Gastroesophageal Reflux Disease and Obesity
Colonic Complications of Obesity
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