Management of Overweight and Obesity in Patients With Inflammatory Bowel Disease

Abstract

Increasing evidence has linked obesity to complications of inflammatory bowel disease (IBD); however, data are limited on the efficacy and impact of weight management strategies on the disease course. There are a strikingly limited number of interventional studies on weight management in patients with IBD, and the recent nutrition and IBD guidelines published in the United States do not mention weight management strategies. Overweight and obesity management in patients with IBD should follow a stepwise approach to assessment and treatment, including lifestyle modification, anti-obesity medications such as glucagon-like peptide-1 agonists, endobariatric procedures, and bariatric surgery (if deemed appropriate). This article reviews the management of overweight and obesity in patients with IBD, examines the efficacy of currently available interventions and their impact on the IBD course, and proposes a stepwise approach to the assessment and treatment of overweight or obesity for the IBD provider.

Keywords: Crohn’s disease; Inflammatory bowel disease; anti-obesity medications; endobariatrics; lifestyle modification; obesity; overweight; ulcerative colitis; weight management.

Figure 1.

Stepwise approach to management strategies for patients with IBD who are overweight or obese. BMI, body mass index; GIP, gastric inhibitory polypeptide; GLP-1, glucagon-like peptide-1; IBD, inflammatory bowel disease. ^aConsider endoscopic interventions and bariatric surgery in patients with IBD who do not have foregut disease.

Figure 2.

Endobariatric procedures for weight loss in patients with inflammatory bowel disease.

Figure 3.

Care of patients with IBD and overweight or obesity should include both assessment and treatment. Anthropometric testing including weight and height with calculation of BMI should be done for all IBD patients, and waist circumference should be measured in overweight patients. Malnutrition screening for restrictive and disordered eating as well as micronutrient deficiencies is important prior to starting obesity treatment. When possible, additional assessment of muscle mass should be performed with ultrasound, grip strength, cross-sectional imaging and/or bioelectrical impedance analysis. In terms of treatment, lifestyle modification should be seen as a component of all overweight and obesity management programs. This can be combined with pharmacotherapy, endobariatric procedures, or bariatric surgery. BMI, body mass index; IBD, inflammatory bowel disease; V=IR, voltage is equal to current multiplied by resistance (Ohm’s Law).