 In the ABCs of health consequences of obesity, it looks like we're up to G, and G is for gallstones. The number one digestive reason people are hospitalized is because of a gallbladder attack. Every year, more than a million Americans are diagnosed with gallstones. About 700,000 have to get their gallbladder surgically removed. It's a relatively safe procedure. Gallstones rates tend to be under 5%, and the mortality rate is only about 1 in 1,000. But 1 in 10 may develop a post-colosusctomy syndrome of persistent gastrointestinal symptoms long after their gallbladder is removed. What are gallstones made of? In 80% to 90% of cases, the gallstones are mostly just crystallized cholesterol, forming like rock candy in your gallbladder when cholesterol gets too concentrated. This was used to explain why some small early studies found non-vegetarians at a higher incidence of gallstones, but their results from more recent larger studies are more equivocal with one study, suggesting protection from gallbladder disease, but another, showing higher rates among vegetarians independent of weight. The biggest purported cause-and-effect risk factor though may be obesity, increasing risk as much as 7-fold with a doubling of risk, even at the heavier side of normal. Ironically, rapid weight loss may also be a trigger. A half-pound a day has been deemed to be like the upper limit for medically safe weight loss based on gallstone formation. Ultrasound studies found that above that, the chance of new gallstones can go from less than 1 in 200 a week to closer to 1 in 40. To help prevent a gallstone attack, you can increase your fiber intake. But not only is dietary fiber intake associated with less gallbladder disease in the first place, those placed on high fiber foods during a weight loss regimen suffered significantly less gallbladder sludging than those losing the same weight without the extra fiber. G is also for GERD, gastroesophageal reflux disease. Fiber-rich food consumption also decreases the risk of acid reflux. Previously, I explored how chronically straining at stool may push part of the stomach up into the chest cavity. Well, the excess abdominal pressure due to obesity may have the same effect pushing acid up into the throat, causing heartburn and inflammation. The increased pressure on the abdominal organs associated with obesity may also explain why overweight women suffer from more vaginal prolapse, where organs such as the rectum push out into the vaginal cavity. The deadliest letter in the alphabet of obesity consequences, however, is H. H is for heart disease. Of the 4 million deaths attributed to excess body weight every year around the world, nearly 70% of the deaths are due to cardiovascular disease. Is it just because they're eating poorly? Mendelian randomization studies suggest that people randomize from conception to be heavier just based on genetics to indeed have high rates of heart disease and stroke regardless of what they eat. The question is, if you lose weight, does your risk drop? Enter the SOS trial, the first long-term control trial to compare the outcomes of thousands of bariatric surgery patients to match control subjects you started out at the same weight but went the non-surgical route. The control group maintained their weight, whereas the surgical group maintained about a 20% weight loss over the next 10 to 20 years. Over that time, the weight loss group not only developed 80% less diabetes, but suffered significantly fewer heart attacks and strokes. So not surprisingly significantly reduced their total mortality overall. You can see how 10 years out, the weight loss group appeared to cut their risk of fatal heart attacks and strokes in half.