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Obesity is a strong risk factor for gallstones, especially among women. People who are obese are more likely to have gallstones than people who are at a healthy weight. Obesity in adults can be defined using the body mass index (BMI), a tool that measures weight in relation to height. The table below shows how the BMI calculation works. A BMI of 18.5 to 24.9 refers to a healthy weight, a BMI of 25 to 29.9 refers to overweight, and a BMI of 30 or higher refers to obesity.

As BMI increases, the risk for developing gallstones also rises. Studies have shown that risk may triple in women who have a BMI greater than 32 compared to those with a BMI of 24 to 25. The risk may be seven times higher in women with a BMI above 45 than in those with a BMI below 24.

Researchers have found that people who are obese may produce high levels of cholesterol. This leads to the production of bile containing more cholesterol than it can dissolve. When this happens, gallstones can form. People who are obese may also have large gallbladders that do not empty normally or completely. Some studies have shown that men and women who carry fat around their midsections may be at a greater risk for developing gallstones than those who carry fat around their hips and thighs.

Table 1. Body Mass Index

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Weight cycling, or losing and regaining weight repeatedly, may increase the risk of developing gallstones. People who weight cycle—especially with losses and gains of more than 10 pounds—have a higher risk for gallstones than people who lose weight and maintain their weight loss. Additionally, the more weight a person loses and regains during a cycle, the greater the risk of developing gallstones.

Why weight cycling is a risk factor for gallstones is unclear. The rise in cholesterol levels during the weight-loss phase of a weight cycle may be responsible. It is also thought that each cycle increases one’s risk for gallstones. However, further research is required to determine the exact link between weight loss and the risk for gallstones.

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Gallstones are common among people who undergo bariatric surgery to lose weight. Bariatric surgery to reduce the size of the stomach or bypass parts of the digestive system is a weight-loss method for people who have a BMI above 40. This procedure is also an option for people who have a BMI above 35 with comorbid conditions such as diabetes and high blood pressure. Experts estimate that about one-third of patients who have bariatric surgery develop gallstones. The gallstones usually develop in the first few months after surgery and are symptomatic.

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You can take several measures to decrease the risk of developing gallstones during weight loss. Losing weight gradually, instead of losing a large amount of weight quickly, lowers your risk. Depending on your starting weight, experts recommend losing weight at the rate of 1/2 to 2 pounds per week. Losing weight at this rate commonly occurs for up to 6 months. After 6 months, weight loss usually declines and weight stabilizes because individuals in lower weight groups use fewer calories (energy). You can also decrease the risk of gallstones associated with weight cycling by aiming for a modest weight loss that you can maintain. Even a loss of 5 to 10 percent of body weight over a period of 6 months or more can improve the health of an adult who is overweight or obese.

Your food choices can also affect your gallstone risk. Experts recommend including some fat in your diet to stimulate gallbladder contracting and emptying. Current recommendations indicate that 20 to 35 percent of your total calories should come from fat. Studies have also shown that diets high in fiber and calcium may reduce the risk of gallstone development.

Finally, regular physical activity is related to a lower risk for gallstones. Aim for approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week to manage your body weight and prevent unhealthy weight gain. To sustain weight loss, engage in at least 60 to 90 minutes of daily moderate-intensity physical activity.

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Silent gallstones are usually left alone and sometimes disappear on their own. Symptomatic gallstones are usually treated. The most common treatment is surgery to remove the gallbladder. This operation is called a cholecystectomy. In other cases, nonsurgical approaches—drugs—are used to dissolve the gallstones. Your health care professional can help determine which option is best for you.

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Although weight loss increases the risk of developing gallstones, obesity poses an even greater risk. In addition to gallstones, obesity is linked to many serious health problems, including:

• type 2 diabetes
• high blood pressure
• heart disease
• stroke
• certain types of cancer
• sleep apnea (when breathing stops for short periods during sleep)
• osteoarthritis (wearing away of the joints)
• fatty liver disease

For people who are obese, weight loss can lower the risk of developing some of these illnesses. Even a small weight loss of 10 percent of body weight over a period of 6 months can improve health and lower disease risk. In addition, weight loss may bring other benefits such as better mood, increased energy, and positive self-image.

If you are thinking about starting an eating and physical activity plan to lose weight, talk with your health care professional first. Together, you can discuss various eating and physical activity programs, your medical history, and the benefits and risks of losing weight, including the risk of developing gallstones.

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Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. September 1998. This National Heart, Lung, and Blood Institute report targets primary care practitioners and provides evidence for the effects of treatment on overweight and obesity.

Finding Your Way to a Healthier You: Based on the “Dietary Guidelines for Americans.” This brochure from the U.S. Department of Health and Human Services (DHHS) and the U.S. Department of Agriculture provides basic guidelines for eating a healthy diet and being physically active.

Gallstones. This fact sheet provides basic information about gallstones and treatment options. Published by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and available through the National Digestive Diseases Information Clearinghouse, 2 Information Way, Bethesda, MD, 20892–3570, Tel: 1–800–891–5389.

Bariatric Surgery for Severe Obesity. This fact sheet provides basic information about bariatric surgery, including benefits and risks. Published by NIDDK and available through the Weight-control Information Network (WIN), 1 WIN Way, Bethesda, MD, 20892–3665, Tel: 1–877–946–4627.

Prescription Medications for the Treatment of Obesity. Information, including potential benefits and side-effects of current Food and Drug Administration-approved prescription weight-loss medications, is provided in this fact sheet. Published by NIDDK and available through WIN.

Weight Cycling. This fact sheet provides general information about weight cycling and associated health risks. Published by NIDDK and available through WIN.

Weight Loss for Life. Information about healthful weight loss as well as weight-loss program options is provided in this brochure. Published by NIDDK and available through WIN.

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