Role of the Gastroenterologist in Managing Obesity

John K DiBaise; Amy E Foxx-Orenstein


Expert Rev Gastroenterol Hepatol. 2013;7(5):439-451. 

In This Article

Obesity and Its Association With GI Symptoms

Gastrointestinal symptoms occur commonly among the general population; however, at present, the relationship between obesity and GI symptoms remains poorly understood. A better understanding of the GI symptoms associated with obesity along with the physiology responsible for symptom generation in these patients may be important in the clinical evaluation and management of the obese patient. In the last few years, a number of published reports have found that multiple GI symptoms occur more commonly among obese compared to normal-weight individuals. A recent meta-analysis evaluated a number of GI symptoms with obesity and increasing BMI.[9] Significant associations were identified between increasing BMI and upper abdominal pain (OR: 2.65; 95% CI: 1.23–5.72), gastroesophageal reflux (1.89; 1.7–2.09), vomiting (1.76; 1.28–2.41), chest pain/heartburn (1.74; 1.49–2.04), diarrhea (1.45; 1.26–1.64), retching (1.33; 1.01–1.7 4) and incomplete evacuation (1.32; 1.03–1.71). No associations were found for all abdominal pain, lower abdominal pain, bloating, constipation, fecal incontinence, nausea and anal blockage. In a population-based study investigating associations among binge-eating behavior patterns, a disordered eating pattern that occurs commonly among obese individuals, and GI symptoms, after adjusting for BMI, age, gender, race, diabetes mellitus, socioeconomic status and physical activity level, binge-eating behavior was independently associated with the following upper and lower GI symptoms: acid regurgitation, heartburn, dysphagia, bloating, upper abdominal pain, diarrhea, urgency, constipation and feeling of anal blockage.[10] This highlights the complex relationships among obesity, eating patterns and GI symptoms and the need for further study.