Medical Barriers: Gastrointestinal Disorders

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.


Dental Status

Elevated BMI is related to poor dental health status. Obesity is associated with increased prevalence of periodontal disease, particularly in younger individuals. Assessment of dental status is particularly important in obese patients, as food selection is affected by the number of teeth and occluding pairs of posterior teeth the patient has. Dental problems can limit a person’s ability to eat food with high-fibre content, such as cereals, fruits and vegetables, and may push them to consume energy-dense processed foods.

Reflux Disease

Obesity brings an increased risk of gastroesophageal reflux disease symptoms, erosive esophagitis, and esophageal adenocarcinoma. The risk for these disorders seems to increase with increasing weight. Obesity has been associated with increased intra-abdominal pressure, impaired gastric emptying, decreased lower esophageal sphincter pressure, and increased frequency of transient sphincter relaxation, all of which lead to increased esophageal acid exposure. Symptoms of reflux can be interpreted as hunger and are often relieved by eating. In this way, reflux can contribute to weight gain. There is some evidence to suggest that control of reflux disease can lead to weight loss.

Constipation and Irritable Bowel Syndrome

Decreased mobility and a diet low in fibre may predispose obese patients to constipation. Chronic constipation, together with increased intra-abdominal pressure, can increase the risk of diverticular disease as well as the incidence of hemorrhoids. Obesity can also contribute to the development of inguinal and umbilical hernias as well as recurrent herniation following repair. Abdominal symptoms including bloating, flatulence and other objective or subjective gastrointestinal symptoms can lead patients to avoid certain foods, thereby limiting their ability to follow a healthy diet.

It is not uncommon for obese patients to blame their weight gain on constipation. Such patients should be asked about laxative abuse. Successful treatment of constipation has not been shown to produce any substantive weight loss.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

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