Obesity and Celiac DiseaseFriday, March 16, 2012
Yesterday, I was in Medicine Hat (Southern Alberta), speaking at a Nutrition and Metabolism Workshop, hosted by the Palliser Primary Care Network.
While I spoke on obesity management in primary care, I was very much intrigued by a presentation on celiac disease given by Daniel Leffler from the Beth Israel Deaconess Medical Center in Boston, USA.
Leffler gave a most engaging talk on how to diagnose and manage celiac disease.
In his talk he referred to the interesting observation that patients who are successfully managed for their celiac disease often gain weight – not seldom, catching up in obesity rates with their non-celiac peers.
Thus, in a recent paper published in Alimentary Pharmacology and Therapeutics, Leffler and colleagues report on the weight increase in patients treated for celiac disease.
In their retrospective study of 679 patients with biopsy confirmed coeliac disease with at least two recorded BMIs, over a mean follow-up of 39.5 months, they noted that at baseline, the coeliac cohort was significantly less likely to be overweight or obese (32% vs. 59%) than the general population.
However, on beginning and maintaining a gluten-free diet, mean BMI increased significantly with about 22% of patients increasing their BMI by more than 2 BMI points, with about 16% of patients moving from a normal or low BMI class into an overweight BMI class.
Obviously, given the substantial morbidity and increased mortality associated with celiac disease, the fear of weight gain should not stop anyone with celiac disease from eliminating gluten from their diet. Nevertheless, as pointed out by Leffler in his talk, counselling regarding the prevention of excessive weight gain on commencement of a gluten-free diet may need to initiated, especially in those patients who are already carrying excess weight.
Kabbani TA, Goldberg A, Kelly CP, Pallav K, Tariq S, Peer A, Hansen J, Dennis M, & Leffler DA (2012). Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet. Alimentary pharmacology & therapeutics, 35 (6), 723-9 PMID: 22316503