Editor,—In a recent article, Lagergrenet al ( Gut 2000;47:26–9) reported no relation between body mass and gastro-oesophageal reflux in a Swedish population and concluded that reflux symptoms occur independently of body mass index. As the authors point out, the evidence on this subject is conflicting. A large recent US cross sectional study1 reported a strong positive association between body mass index and the prevalence of reflux symptoms (table 1). One possible explanation for the difference between the two studies is the younger age distribution of the US cohort. The prevalence of overweight has increased dramatically throughout Europe and North America in recent decades.2 As a consequence, the younger US cohort is likely to have accumulated more person years of overweight by any given age and the risk of reflux symptoms may be related to both the magnitude and years of overweight exposure. The authors also concluded, in the light of their findings, that weight reduction may not be justifiable as an antireflux therapy. Even if overweight is a poor predictor of reflux symptoms, …