An association between overweight and gastro-oesophageal reflux disease (GORD) has long been suspected and observed in case series. Recently, this association has become established in large-scale analytical epidemiological research.^1,2 In a recent meta-analysis based on the available literature, it was concluded that there is a dose-dependent association between increasing body mass index (BMI) and GORD, usually assessed as typical reflux symptoms—that is, heartburn or regurgitation.³ The precise strength of this association is difficult to assess, but it seems that persons with a BMI >30 kg/m² are at an about twofold increased risk of GORD than persons of normal weight. Interestingly, it seems that any increase in BMI, even within the range of what is considered normal BMI, is associated with a gradually increased risk of reflux symptoms.² A similar finding has been observed with regard to the relation between increased BMI and adenocarcinoma of the oesophagus,⁴ a cancer closely linked with GORD.⁵

In the present issue of Gut, Corley et al⁶ (see page 756) present a large cohort study that not only evaluates BMI in relation to GORD, but also evaluates the role of objectively measured …