Body Mass Index and the Risk of Obesity in Coeliac Disease Treated With the Gluten-free Diet

T. A. Kabbani; A. Goldberg; C. P. Kelly; K. Pallav; S. Tariq; A. Peer; J. Hansen; M. Dennis & D. A. Leffler


Aliment Pharmacol Ther. 2012;35(6):723-729. 

In This Article

Abstract and Introduction


Background Coeliac disease is increasingly diagnosed and weight changes are common after adoption of a gluten-free diet (GFD), however data on body mass index (BMI) changes are limited.
Aim To assess changes in BMI after diagnosis in a large coeliac population.
Methods A total of 1018 patients with biopsy confirmed coeliac disease seen at our centre were studied retrospectively. Initial and follow-up BMIs were recorded, as was GFD adherence as assessed by an expert dietitian.
Results A total of 679 patients with at least two recorded BMIs and GFD adherence data were included in the study. Mean follow-up was 39.5 months. Compared to regional population data, the coeliac cohort was significantly less likely to be overweight or obese (32% vs. 59%, P < 0.0001). Mean BMI increased significantly after GFD initiation (24.0 to 24.6; P < 0.001). 21.8% of patients with normal or high BMI at study entry increased their BMI by more than two points.
Conclusions Individuals with coeliac disease have lower BMI than the regional population at diagnosis. BMI increases on the GFD, especially in those that adhere closely to the GFD. On the GFD, 15.8% of patients move from a normal or low BMI class into an overweight BMI class, and 22% of patients overweight at diagnosis gain weight. These results indicate that weight maintenance counselling should be an integral part of coeliac dietary education.


Coeliac disease (CD) is a systemic autoimmune disorder in which the primary lesion is an enteropathy triggered by gluten proteins found in wheat, rye and barley.[1] It was once considered rare in the US adult population, but more recent epidemiologic data show that the prevalence of CD may be approximately 1%.[2,3] Diagnosis of CD can be delayed by low suspicion in patients with a normal or high body mass index (BMI) on initial presentation. However, it is now well established that many CD patients have a high or normal BMI at diagnosis.[4–7]

Body mass index above the normal range is associated with multiple comorbidities including type II diabetes mellitus, cardiovascular disease and several forms of cancer.[8–10] Given the changes in diet and in the small intestinal absorptive function following the treatment of CD, significant changes in BMI may be expected.[11,12] As a growing proportion of individuals diagnosed with CD are not underweight, the risk of unintentional and adverse weight gain may have increased.

Data on changes in BMI after diagnosis of CD are limited due to small patient numbers and to divergent results of different studies. A prior study in the United Kingdom showed that patients with CD tend to gain weight after adhering to a gluten-free diet (GFD; 81% of the 188 patients gained weight). However, the sample size was small and the study was limited to adherent patients, as determined by serology testing alone.[5] A second study from Sweden did not look at changes in BMI after diagnosis,[4] but rather reported that being underweight significantly increased the risk of being diagnosed with CD. The most recent report from New York of 369 patients indicated normalisation of BMI in most patients who adopted a GFD, whether patients were underweight or overweight at diagnosis.[6]

Given the limitations of the prior studies, we performed this study to analyse changes in BMI in individuals after diagnosis of CD with particular attention to the potential effects of GFD adherence on weight change. In addition, and for comparison with the regional population, the BMI distributions at diagnosis and after treatment were compared to regional population data from the 2007 National Health Interview Survey (NHIS).[13]


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.