Obesity and Gastrointestinal Impact

Defining the Relationship of Weight and Gut Health

Obesity is a global pandemic rising at a rapid pace. Obesity is one of the significant drivers of preventable chronic diseases and healthcare costs in the United States, with an estimated range from $147 billion to $210 billion/year. Obesity, by definition, is considered a disease state with a chronic, progressive, and relapsing course. The illness can lead to body fat promoting adipose tissue dysfunction, which can cause unfavorable metabolic, biomechanical, and psychosocial health consequences. Individuals with Obesity are likely to have other illnesses that can affect multiple organs in the body, such as heart disease, obstructive sleep apnea, Type 2 Diabetes, High blood pressure, cancer, neurological disease, Gastrointestinal disorders, and many more. When these diseases happen in combination with Obesity, it may lead people to have poor health outcomes such as disability, poor quality of life, or even early death.

Weight gain also has a psychological impact on an individual as it has unfolded weight bias and stigma in Obesity, one of the significant challenges in healthcare. It prevents patients & clinicians from initiating discussions about weight. Patients cancel or delay medical appointments, including preventive screenings, which can lead to worse health outcomes. Therefore, it is essential to address Obesity as a disease and bring awareness about its impact on major organ systems in every healthcare setting, primary care, subspecialty clinic, or hospital. In this review, we will address the effects of Obesity on the gastrointestinal system.

Obesity and Esophageal Disease

An increase in abdominal pressure due to weight can cause a significant impact on both the upper and lower gastrointestinal (GI) tract. In upper GI, it can cause an increase in stomach acid and injure the esophagus. The constant heartburn due to the weakening of muscles can damage the lining of the stomach and esophagus and cause a condition called Gastroesophageal Reflux Disease (GERD). Common GERD symptoms include “indigestion,” throwing up food, coughing (especially at night), metallic taste in the mouth, soreness, hoarseness of voice, and belching. Approximately two of every ten people experience GERD symptoms regularly. The increased occurrence of GERD among individuals who are obese can lead to Barrett’s esophagus, a precancerous stage. Barrett’s esophagus finally causes esophageal adenocarcinoma, a likely mechanism explaining the association between abdominal fat mass and esophageal cancer.

Obesity and NAFLD

Obesity and insulin resistance are directly related to Non-Alcoholic Fatty Liver disease and, if untreated, can lead to a severe liver complication called cirrhosis.

Obesity and Gallbladder

The gallbladder is an organ present under the liver that stores and concentrates bile which is an essential digestive fluid made by the liver. When we consume fatty food, the gallbladder releases bile into the small intestine to help digest the dietary fats. If people consume processed foods, the risk of cholesterol rises, causing gallstones. Small-sized gallstones can remain without any symptoms. However, if they grow in size, they can cause severe pain and block the bile duct in some cases. Rapid weight loss by a very low-calorie diet can also increase the risk of Gallstones.

Obesity and Intestine

Our intestinal health has consequences beyond simple healthy digestion. Interestingly, our gut health may also control our mood (through a serotonin hormone), improve immune response, and prevent predisposition to weight gain. Since the total surface area of our gut covers a large extent, eating habits profoundly influence our health. In addition, epigenetics contains lifestyle changes that can hugely impact the integrity of the gut lining if it gets constantly exposed to irritants leading to chronic low-level inflammation.

Major and standard primary care visits are for bloating, gas, constipation, or diarrhea. These conditions are closely linked to gut and mental health and are called Irritable bowel syndrome. The intake of high amounts of processed food and dairy products can lead to this condition. An increase in abdominal pressure, either from Obesity itself or from straining due to constipation, can also lead to hemorrhoids which are enlarged or varicose veins of the anus and rectum.

In addition, increased intraluminal pressure in the intestine due to increased abdominal pressure or alteration in gut flora can cause colonic diverticula formation. Studies have also shown an increased risk of Crohn’s disease and Ulcerative colitis in patients with Obesity.

Obesity and Pancreas

Obesity might also play a role in causing inflammation of the pancreas called pancreatitis. Conditions that can lead to a higher risk of developing pancreatitis are gallstones, diabetes, high blood levels of triglycerides, obesity treatments such as bariatric surgery, and new medications GLP 1 agonist. The presence of adiposity increases the risk of developing gastrointestinal inflammation and is associated with more severe disease phenotypes and a lower response to treatments. Inflammation can lead to more unfavorable clinical outcomes and consequent clinical and economic burdens. Obesity can affect the multiorgan system, and treating obesity-related medical conditions requires a multidisciplinary team approach. The promising news is incorporating a healthy lifestyle by focusing on even a small weight change can still be hope in managing Obesity-related complications and go a long way in disease prevention.

Additional Resources

Obesity Medicine provides resources for clinicians to address obesity and its role in gastrointestinal disorders.

Continuing Education – OMA Academy Courses

• Slashing the Fat Out in NALFD (1 CME/CE)
• Update on Endoscopic Procedures (.75 CME/CE)

Obesity: A Disease – OMA Podcast

• Episode 8 | Article Review: Exercise and Fatty Liver Disease
• Episode 12 | Article Review: Saturated Fat and the Human Liver

Obesity Pillars Journal

• Nonalcoholic fatty liver disease and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022