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Unfortunately obesity is becoming an endemic in the USA. During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. In 2010, no state had a prevalence of obesity less than 20 percent. Thirty-six states had a prevalence of 25 percent or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence of 30 percent or more.
In addition to cardiac problems, with obesity there are various disorders associated with the gastrointestinal tract.
Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women.
    Underweight = <18.5
    Normal weight = 18.5–24.9
    Overweight = 25–29.9
    Obesity = BMI of 30 or greater

 Various gastrointestinal tract disorders including esophageal disease, irritable bowel syndrome, biliary tract disorders, gallbladder disorders and gallstone pancreatitis, gastrointestinal cancer, inflammatory bowel disease, and liver and pancreatic transplant are all GI-health conditions impacted by obesity.
Gallstones are one of many serious health risks linked to obesity. Crash dieting and weight cycling can also increase the risk of developing gallstones.

What Are Gallstones?
Gallstones are clusters of solid material that form in the gallbladder; they are usually mostly made of cholesterol. They occur either as one large stone or many small ones. Gallstones vary in size and can be as large as a golf ball or as small as a grain of sand.

How Are Gallstones Linked to Obesity?
Obese individuals are more likely to develop gallstones than those who are at a healthier weight. For women, obesity is an even stronger risk factor for developing gallstones. Researchers have found that obese individuals tend to produce higher levels of cholesterol than normal. This leads to production of bile that contains more cholesterol than can be dissolved. When this happens, gallstones can form from the undissolved cholesterol.
Additionally, in the obese, gallbladders may not empty normally or completely.
Research has shown that those who have excess fat around their stomach (abdominal obesity) may be at a greater risk for developing gallstones than those who carry excess fat mainly around their hip and thigh areas.
As BMI increases, the risk for developing gallstones also rises. Women with a BMI greater than 32 may be as much as three times as likely to develop gallstones as those with a BMI of 24 or 25. The risk may be seven times higher in women with a BMI above 45 than in those with a BMI under 24.
It's important to note that rapid weight loss (more than three pounds per week) due to crash dieting or losing a large amount of weight too soon can actually increase your chances of developing gallstones, too. Slower weight loss of about one-half to two pounds a week is much less likely to cause gallstones.
Although losing weight may increase the risk of developing gallstones, obesity poses an even greater risk. Weight loss can lower the risk of developing gallstones and many other obesity-related illnesses. Just a 10 percent reduction of body weight can lower disease risk. Losing 10 percent of your current weight over the next six months is a realistic goal that can significantly improve your life and your overall health.

Obesity and gallstone pancreatitis:
Ninety-nine patients with acute pancreatitis in whom body mass index (BMI = weight (kg)/height2 (m2)) was measured were studied prospectively to determine the importance of obesity as a prognostic factor in this disease. Of 19 obese patients (BMI / 30 kg/m2), 12 developed severe pancreatitis; seven had abscesses, of whom five died, and two further patients died. In 80 non-obese patients, the incidence of severe pancreatitis (n =5), abscess formation (n = 4) and death (n = 4) was significantly less (P = 0.0007). The mean (s.d.) BMI of 17 patients with severe acute pancreatitis was significantly higher than that in 82 patients with mild acute disease (31.2(5.6) versus 23.3(5.6) kg/m2, P <0.001). As a single prognostic factor, obesity had a sensitivity of 63 per cent and a specificity of 95 per cent for predicting disease severity. When five obese women with gallstone pancreatitis were excluded, the sensitivity of obesity increased to 86 percent. Severe pancreatitis occurred in all eight obese patients with disease of an alcoholic etiology. These data suggest that increased fat deposits in the peripancreatic and retroperitoneal spaces in obese patients may increase the risk of peripancreatic fat necrosis, abscess and death. Consideration should be given to including obesity as a prognostic factor in acute pancreatitis.

GERD:
Relationship with obesity is not clear but most studies find a strong association. In the U.S obesity is accepted as an independent risk factor for the presence of GERD. Obesity is risk factor that can identify patients with GERD who are greatest risk for developing gastro esophageal junction adeno carcinoma.

Obesity and Irritable bowel syndrome:
Significant association between obesity and irritable bowel syndrome was found with various studies. Etiology of association with obesity was unclear. Obesity was associated with more frequent constipation, diarrhea, straining, and flatus whether or not subjects reported binge eating

Obesity and cancer:
Under the assumption that the relationship with obesity and cancer casual, more than 90,000 deaths per year from cancer might be avoided if every one in the adult population could maintain a BMI of under 25 throughout  their life.

Esophageal and gastric cancer:
Increased risk of adenocarcinoma of esophagus by factor of 2-3 with increased BMI. Increased risk of adenocarcinoma of gastric cardia especially in men. The etiology is not clear.

Gallbladder Cancer:
Elevated risk for gallbladder cancer in women with increased BMI >40 by a factor of two and is mostly associated secondary to cholilithiasis

Obesity and pancreatic cancer:
Is an established risk factor for pancreatic cancer.  A meta-analysis of 14 studies involving  6000 cases of pancreatic cancer estimated that the relative risk of developing pancreatic cancer was about 20 percent greater in patients with a BMI >30 compared to normal weight individuals
 There is clear association of increase risk of colon cancer in obese patients.
While most research has focused on its effects in the fields of cardiology, and endocrinology, growing knowledge has been directed to the gut and its important role in contributing, managing and eradicating obesity.


Dr. Seela moved to Orlando, Florida after finishing his fellowship in Gastroenterology at Yale University School of Medicine. His interests include advanced and therapeutic endoscopic procedures, colorectal cancer screening, Gastro Esophageal Reflux Disease (GERD), metabolic and other liver disorders.
Dr. Seela is board certified in both Internal Medicine and Gastroenterology. He is a member of the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE), the American Association for the Study of Liver Diseases (AASLD), and Crohn's Colitis Foundation (CCF).

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