Mythbusters: Current Body Weight Will (or Won’t) Lead to Celiac Diagnosis

For years celiac disease (CD) was associated with infants and young children who failed to gain weight or who had what we now call “failure to thrive.” Only if a small child was not following a normal curve on the growth charts would an insightful doctor perhaps think to order a celiac blood test or endoscopy.

As knowledge about the disease progressed throughout the 20th century, adults with unexplained weight loss were tested more and more frequently. Yet the idea remained that nearly anyone with celiac disease should be underweight or experiencing significant weight loss.

Now that we are well into the 21st century, most gastroenterologists fortunately have better insight about celiac disease. They know on some level that it is standard to order a celiac blood test for patients who have otherwise unexplained gastrointestinal pain, diarrhea, constipation, anemia and other symptoms. Yet the idea still persists that “celiacs are skinny.”

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Can You Have Celiac and Be Overweight?

Overweight adults frequently report that their doctors have told them they “couldn’t possibly have celiac disease” because they’re not skinny or losing weight. Parents also complain about having trouble getting doctors to test their overweight children for the disease, despite the child presenting many of the symptoms of CD.

It simply does not occur to some doctors to test the overweight patient. Why? Because they are still conditioned by their training to think of it as a disease associated with children who are not growing properly.

Recent research, on the other hand, clearly shows that celiac disease is as much a concern for the overweight child or adult as those who are thin or experiencing weight loss. One study showed that 19% of children have above-normal body mass indexes (BMI) at the time of diagnosis, a far larger number than those who were underweight. A study of adults showed that 39% were overweight, including 13% who were obese. Celiac patients with normal or above-normal BMIs still may be suffering from disease-related malabsorption and its associated ailments such as anemia and fatigue despite not looking malnourished.

Today’s “typical celiac patient” has normal to high body mass index, as research studies are increasingly showing. In addition, celiacs who begin a gluten-free diet typically experience weight gain, regardless of whether they were underweight to begin with. Overweight patients are finding it easier to get their doctors to test them for the disease, though some still report encountering skepticism or surprise about their diagnosis from medical professionals treating them.

The profile of a celiac patient is changing, and the medical world and media are starting to learn what celiac patients have long known: There is no such thing as being “not skinny enough to have celiac disease.”