The Weighty Side of Heartburn

Losing weight is a popular New Year's resolution that is often broken by February; however, maintaining a healthy weight should be top of mind year round. Alarmingly, recent data from the Centers for Disease Control show that obesity has become an epidemic — over 45 million adults are considered obese in the U.S., with the percentage of overweight young people more than doubling over the past 20 years.¹ Individuals with a Body Mass Index above 25 (see the National Institute of Health's BMI Guidelines for information) are considered to be overweight; those with a BMI of 30 or above are considered to be obese.

Overweight individuals are more likely to progress to obesity, which further heightens one's risk for hypertension, type II diabetes, and other disorders including Gastroesophageal Reflux Disease or GERD.^2-4 One large-scale analysis of more than 12,000 persons showed that being overweight increased one's risk of being hospitalized for GERD.⁵ However, despite research linking obesity with GERD, the link between being overweight and having heartburn, an often chronic and less severe precursor to GERD, is less well studied.

Anecdotal evidence^* has associated heartburn with being overweight for some time, and in actual practice this appears to be valid. According to nurse practitioner Wendy L. Wright, MS, RN, from the Merrimack Village Family Practice in New Hampshire, 61% of the U.S. population is overweight (BMI ≥ 25), of which 20% to 30% of the children are also overweight for their age-based ranges. For Wright, about half of her patients (who are mostly female)^* are overweight, with roughly 35% of these persons experiencing heartburn — about 18% in all. Similar proportions were noted among patients seen by David A. Peura, MD, associate chief of gastroenterology and hepatology at the University of Virginia Health Sciences Center. Peura noted that roughly one-third of his patients⁺ are overweight, and about half of these have some degree of GERD — about 17%.

The saying "You are what you eat" is doubly true for heartburn sufferers, noted Peura. Heartburn is commonly caused by eating the wrong types of foods — those high in fat content or acidity — and it can also occur as a result of weight gain from overeating. Wright emphasized that small weight changes can precipitate heartburn. For example, one patient she treated began experiencing heartburn after gaining 12 pounds. However, both Peura and Wright maintain that losing weight is a factor in managing heartburn, and Peura noted that "heart healthy diets are also heartburn healthy, indicating that people can take control of their heartburn and weight by adjusting their lifestyle. As little as a 10% drop in weight can improve heartburn symptoms, said Wright, a goal that is reasonably attainable. She emphasized that many of her patients don't realize the connection between heartburn and weight, saying that patients should discuss any concerns about heartburn and/or weight with their health care provider.

It should be noted that some studies have shown that heartburn sufferers can continue to experience symptoms even after an impressive weight loss. With this in mind, heartburn sufferers should approach weight loss with the goal of overall health benefits in mind, knowing that they may experience the added benefit of improving heartburn symptoms.

Avoiding dietary fats, chocolate and alcohol, combined with routine exercise and reducing stress levels all lead to improved heartburn symptoms, not to mention lost weight and a healthier lifestyle. Although GERD cannot be treated with these interventions, heartburn can. But, if heartburn symptoms persist, see your health care provider. You can live up to your New Year's resolution; it's not as weighty a task as it seems.

* The anecdotal evidence presented is based on the experiences of NHBA Board members Dr. David A. Peura and Nurse Practitioner Wendy L. Wright.

+ The findings discussed here are for GERD sufferers only.

Suggested Reading

1. Physical Activity and Good Nutrition: Essential Elements to Prevent Chronic Diseases and Obesity. (Accessed 12-16-02): National Center for Chronic Disease Prevention and Health Promotion, 2002.
2. Halsted CH. Obesity: effects on the liver and gastrointestinal system. Curr Opin Clin Nutr Metab Care 1999; 2:425-9.
3. Barak N, Ehrenpreis ED, Harrison JR, Sitrin MD. Gastro-oesophageal reflux disease in obesity: pathophysiological and therapeutic considerations. Obes Rev 2002; 3:9-15.
4. Fisher BL, Pennathur A, Mutnick JL, Little AG. Obesity correlates with gastroesophageal reflux. Dig Dis Sci 1999; 44:2290-4.
5. Ruhl CE, Everhart JE. Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Followup Study. First National Health and Nutrition Examination Survey. Ann Epidemiol 1999; 9:424-35.