Supporting Patients' Weight Resolutions

by Kelly McCormick

Losing weight is a common New Year’s resolution. In fact, nearly half of all those who make New Year’s resolutions say they want to lose weight or get in shape. Unfortunately, some 80 percent of all New Year’s resolutions fail – often by the second week of February.

Still, setting weight loss goals is essential. Obesity rates are skyrocketing in the United States: 42 percent of the nation’s adults are obese, and many of these people face obesity-related diseases. Maintaining a healthy weight can help people avoid the health consequences of obesity, such as hypertension, high cholesterol, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, and more.

GI Disorders and Food

Achieving and maintaining an ideal body weight is essential for good health. Almost everyone wants to appear slim and trim but, weight loss is just not that simple for most people. In fact, research suggests that as many as 80 percent of diets fail. Losing weight may be especially difficult for those with certain gastrointestinal (GI) disorders affected by what they eat. These include gastroesophageal reflux disease (GERD), inflammatory bowel disease, and celiac disease.

Recent research sheds more light on the association between body weight and many chronic GI disorders/conditions. The results of the studies makes it clear that gastroenterologists must start discussing weight with their patients if they are going to help them reach their health goals.

However, having the “weight talk” can make the office visit somewhat uncomfortable. This occurs even in situations where the patient asks the doctor for help with their New Year’s resolution. Maintaining a weight loss program is difficult for patients without digestive issues, but especially so for those who do. Fortunately, there are ways to make the conversation easier and more productive.

People with GI Conditions are Usually Underweight – Or are They?

Many people – including gastroenterologists – often assume that people with digestive problems are always underweight. Recent studies have found that patients with GI issues are often overweight at the time of their diagnosis. They also found that the excess weight can contribute to their conditions. Furthermore, treatment for digestive issues can lead to unwanted weight gain. For many patients with GI disorders, the weight can be especially tough to lose. Acknowledging the connection between excess weight and gastrointestinal disorders can facilitate the conversation about weight loss.

GERD

Research shows an association between body mass index (BMI) and GERD, for example. A 2006 study published in the New England Journal of Medicine confirmed that even modest weight gain among normal weight individuals could cause or exacerbate reflux symptoms. Other research confirms those findings, and suggests that as many as 37 percent over overweight people experience GERD; after losing weight, 81 percent of participants in this study had fewer symptoms of GERD.

While researchers have not yet established the exact reasons increased BMI causes GERD symptoms, they think excess weight around the waistline relaxes lower esophageal sphincter (LES) ring of muscle tissue between the esophagus and stomach.

IBD

Many patients with inflammatory bowel disease (IBD), such as Crohn’s disease and ulcerative colitis, are underweight because of appetite loss due to nausea and abdominal pain or because they avoid certain foods that trigger symptoms. However, 15 to 40 percent of IBD patients are obese, and their obesity may be a contributing factor in the development of IBD.

Celiac Disease

Celiac disease is another condition in which most patients are underweight at the time of their diagnosis. However, many can also be overweight. A 2010 study published in the Journal of Clinical Gastroenterology found that 15.2 percent of adults with celiac disease were overweight at the time of diagnosis, and 6.8 percent were obese. Some experts believe the number of overweight or obese people with celiac disease may be even higher.

Prior to treatment, patients with celiac may gain weight. This is through eating energy-rich and nutrient-poor comfort foods to avoid digestive upset from high-fiber and other foods. After treatment, patients often gain weight because many gluten-free are often high in calories. This is also because treatment improves the absorption of calories and nutrients from food. Relieved to be free from diarrhea, pain and gas after eating meals, celiac patients can also begin over-eating.

GI Conditions and Weight

The mere presence of GERD, IBD, celiac disease and some other chronic GI disorders/conditions can cause tremendous weight loss too. Prior to treatment or during flare-ups, patients often avoid eating altogether; the gastrointestinal conditions can prevent their digestive tracts from absorbing enough calories and nutrients from food to sustain healthy weight or muscle mass. These patients can also use the help of a gastroenterologist to reach their goals of gaining weight in the upcoming year.

GI conditions can derail a patient’s drive to lose or gain weight in other ways too. While physical activity is an important part of maintaining a healthy weight and building healthy muscle mass, for example, exercising can be challenging for people with GI conditions. Persistent discomfort, constant trips to the bathroom, and the lack of sleep they may cause can sap a patient’s strength to the point where they do not have the energy for fat-burning or muscle-building programs; the mental and emotional health challenges that often accompany digestive conditions can also make them unable or unwilling to exercise. To make matters worse, prednisone and medications for digestive conditions can affect metabolism and the storage of fat to trigger weight gain.

Clearly, many people with digestive orders could benefit from the help of their gastroenterologists to achieve their New Year’s resolution of weight loss or weight gain.

Female leg cautiously stepping on weight scale.

Talking to Your Patients about Their Weight Resolutions

Talking about weight is not easy for patient or providers, even when weight management is the patient’s New Year resolution. A great place to start is to recognize the patient’s resolution to gain or lose weight, and offer professional support. Discuss the health benefits they might expect, particularly as it pertains to their specific medical conditions.

The discussion often requires careful word choices. Research shows that patients have a preference order, preferring the word “weight” first and “BMI” second when talking about obesity. They dislike the “fatness,” “excess fat,” and “obesity.” With this in mind, a gastroenterologist might support the patient’s resolution by saying:

“I may be able to help you reach your goal of losing (or gaining) weight this year.”

Sustainable Weight Loss

Next, the clinician can ask questions about the patient’s eating and drinking habits, physical activity, and history of gaining or losing weight throughout the course of their disease. GI doctors can also help patients define their goals. They can then design a sustainable diet and exercise program to help them reach those goals.

To help patients stay on track, gastroenterologists can refer them for a consultation with a nutritionist or dietician, or suggest helpful websites, apps, and structured weight loss programs.

Gastroenterologists can be valuable assets to patients who want to lose weight or gain weight in the upcoming year. While it can be difficult to initiate the conversation between practitioner and patient, developing a partnership between them can help patients fulfill their New Year’s resolution.

Lynn Hetzler was a Medical Assistant for 20 years, working with clinicians in hospitals, universities and medical laboratories, and has been a leading writer in the medical field for another 20 years. She specializes in creating informative and engaging medical content for readers of all levels, from patients to researchers and everyone in between.