Summary: Study reveals a link between obesity and chronic diarrhea, independent of lifestyle, diet, and other medical conditions. Those who are obese are 60% more likely to experience bouts of chronic diarrhea. A possible explanation could be the link between obesity and low-grade inflammation, which may trigger diarrhea more frequently.
Obesity affects approximately 40 percent of Americans, according to the Centers for Disease Control and Prevention (CDC). While obesity is known to be associated with increased risk of other health conditions – such as heart disease, diabetes, and gastrointestinal diseases – less is known about the relationship between obesity and abnormal bowel habits. In the most comprehensive analysis of the relationship between Body Mass Index (BMI) and bowel habits to date, published today in Alimentary Pharmacology & Therapeutics, a team of physician-researchers at Beth Israel Deaconess Medical Center (BIDMC) found a strong association between obesity and chronic diarrhea independent of an individual’s dietary, lifestyle, psychological factors or medical conditions. The findings could have important implications for how physicians might approach and treat symptoms of diarrhea in patients with obesity.
“While several previous studies have pointed to an association between obesity and bowel habits, all lacked data on whether dietary or other factors drive the connection,” said corresponding author Sarah Ballou, PhD, a health psychologist in the Division of Gastroenterology, Hepatology, and Nutrition at BIDMC. “Our research confirms a positive association between obesity and chronic diarrhea and reveals for the first time that this relationship is not driven by confounding factors such as diet or physical activity level.”
Using the 2009-2010 National Health and Nutrition Examination Survey (NHANES) – a program of studies administered by the CDC designed to assess the health and nutritional status of adults and children in the United States – Ballou and colleagues analyzed the bowel health questionnaire responses of 5,126 patients over the age of 20 years who did not report a history of irritable bowel syndrome, celiac disease or colon cancer. The team compared the reported bowel habits of patients who had a BMI associated with being underweight, normal weight, overweight, obese and severely obese.
After controlling for dietary, physical activity, diabetes, laxative use, and demographic factors, the team found that respondents who were obese or severely obese were 60 percent more likely to have experienced chronic diarrhea compared to those with normal bowel habits or constipation.
While the study reveals the association is not driven by compounding factors the team controlled for, questions still remain about what underlying causes may explain why obese individuals would be more likely than non-obese individuals to have diarrhea. One possible explanation may be related to the link between obesity and chronic low-grade inflammation, which may contribute to diarrhea. Future research clarifying this relationship and determining how obesity triggers inflammation could serve as a base for how physicians approach treating abnormal bowel habits with this patient population.
“The treatment of obesity and obesity-related medical conditions requires multidisciplinary management,” said senior author Anthony Lembo, MD, a gastroenterologist in the Division of Gastroenterology, Hepatology, and Nutrition at BIDMC. “Clinicians should be aware of the relationship between obesity and diarrhea, especially considering the potential negative impacts altered bowel habits can have on quality of life.”
In addition to Ballou and Lembo, co-authors include Prashant Singh, Vikram Rangan, Johanna Iturrino and Judy Nee, all of the Department of Medicine at BIDMC.
Funding: This work was supported by the National Institutes of Health (T32DK007760).
Chloe Meck – BIDMC
The image is in the public domain.
Original Research: Open access
“Obesity is associated with significantly increased risk for diarrhoea after controlling for demographic, dietary and medical factors: a cross‐sectional analysis of the 2009‐2010 National Health and Nutrition Examination Survey”. Sarah Ballou, Prashant Singh, Vikram Rangan, Johanna Iturrino, Judy Nee, Anthony Lembo.
Alimentary Pharmacology & Therapeutics doi:10.1111/apt.15500.
Obesity is associated with significantly increased risk for diarrhoea after controlling for demographic, dietary and medical factors: a cross‐sectional analysis of the 2009‐2010 National Health and Nutrition Examination Survey
Obesity is associated with increased risk for various gastrointestinal and liver diseases. However, the relationship between obesity and abnormal bowel habits is poorly understood.
To investigate the relationship between body mass index (BMI) and bowel habit, controlling for clinical, demographic and dietary factors, in a representative sample of the United States adult population
Data were extracted from the 2009‐2010 National Health and Nutrition Examination Survey. Survey responses were included in this study if respondents completed the bowel health questionnaire (BHQ), were ≥20 years of age, and did not report history of IBD, celiac disease or colon cancer. BMI was divided into the following categories: underweight, normal weight, overweight, obese and severely obese. Stepwise logistic regression provided risk ratios of constipation and diarrhoea controlling for confounding factors (dietary, life‐style, psychological and medical).
A total of 5126 respondents completed the BHQ, had BMI data available, and met eligibility criteria. Of these, 70 (1.40%) were underweight, 1350 (26.34%) were normal weight, 1731 (33.77%) were overweight, 1097 (21.40%) were obese and 878 (17.13%) were severely obese. Up to 8.5% of obese and 11.5% of severely obese individuals had chronic diarrhoea, compared to 4.5% of normal weight individuals. Stepwise regression revealed that severe obesity was independently associated with increased risk of diarrhoea.
Obesity is positively associated with chronic diarrhoea in a nationally representative US adult population after adjusting for several known confounding factors.