Excess weight, particularly around the abdomen, is one of the most consistent risk factors for reflux. The mechanism is mostly mechanical: abdominal fat increases pressure inside the stomach, which pushes up against the LES and makes it more likely to open when it shouldn't. This pressure also increases the risk of a hiatal hernia, which independently worsens reflux. The relationship isn't just theoretical — weight loss is one of the few lifestyle changes with strong evidence for meaningfully reducing reflux symptoms, even a relatively modest amount. That said, reflux affects plenty of people at a healthy weight too, since LES weakness, hiatal hernia, and other factors operate independently of body weight. Weight is a contributing factor worth addressing where relevant, not the explanation for every case.
