Whether weight loss can resolve GERD symptoms in overweight or obese people has remained unclear, even though weight gain is an accepted risk factor for GERD. Now, Prateek Sharma and colleagues have shown that a structured weight-loss programme involving changes in diet, physical activity and behaviour can completely resolve GERD symptoms in most overweight and obese individuals.

332 individuals were enrolled in this prospective cohort study (mean weight 101 ±18 kg, BMI 35 ±5 kg/m2, waist circumference 103 ±13 cm). 37% of participants had GERD at baseline, 29% of whom had moderate-to-severe symptoms. Overall, regurgitation and heartburn were reported by 26% and 18% of participants.

97% of participants had lost an average of 13 ± 7.7 kg by the 6-month follow-up. At this time, there was a marked decrease in the prevalence of GERD (from 37% to 15%). In symptomatic individuals, the mean GERD symptom score decreased from 5.5 to 1.8, with the heartburn and regurgitation scores also decreasing substantially. The degree of weight loss and/or decrease in GERD symptom score did not differ considerably between the two types of weight-loss programme employed (phone versus clinic based).

Of those with GERD at baseline, 65% experienced complete resolution of symptoms and 15% had partial symptom resolution. The degree of weight loss also correlated positively with the change in the GERD symptom score and decrease in heartburn score (but not regurgitation score). Analysis of gender differences revealed that for GERD scores to change substantially, women needed to lose 5−10% of their body weight, whereas men needed to lose ≥10% of their body weight.