It is worth noting that your client is obese or extremely obese according to the information provided. Obesity is associated with Gastroesphageal Reflux Disease (GERD).  (Howard Hapel, M.D. MSc(Epi) and Hashem B. El-Serag, M.D., MPH META-ANALYSIS:  Obesity and the Risk for Gastroesophageal Reflux Disease and its Complications, Annals of Internal Medicine, Vol. 143 Number 3, 199-201, August 2, 2005.