How Do You Manage Both?
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In the United States, obesity has become more prevalent among people with Crohn’s disease and ulcerative colitis — two conditions associated with inflammatory bowel disease (IBD). Several studies have reported that about 15 to 40 percent of people with IBD are obese.
As it does with other chronic health conditions (such as heart disease, diabetes, and cancer), excessive weight can worsen symptoms and contribute to complications in those with IBD.
“Obesity is associated with more severe inflammatory bowel disease,” says Christopher Damman, MD, a clinical associate professor of medicine in the division of gastroenterology at the University of Washington. “Yet while there does seem to be a correlation between the two, it is not possible to say with the current data whether obesity causes greater severity or the other way around [more severe IBD causes obesity].”
How Obesity May Compound Health Troubles
Some data shows that excessive weight may intensify IBD symptoms, making treatments less effective and creating difficulties if surgery is needed.
Increased Inflammation
In general, obesity is linked with chronic low-grade inflammation, according to a study published in 2020 in Circulation Research. For people with IBD, heightened inflammation may lead to more serious symptoms, such as severe abdominal pain and diarrhea. A paper published in 2023 in the World Journal of Gastroenterology, reviewing a range of research on this topic, reported that worsening inflammation related to obesity in Crohn’s disease patients may further induce the formation of fistulas and strictures (a narrowing of the intestine due to scarring).
The same review cited evidence showing that every five-measure increase in body mass index above normal pushed the risk of Crohn’s disease up by 16 percent.
Less Effective Medications
For people who are obese or overweight, medications may not work as well. In a 2020 review in Clinical Gastroenterology and Hepatology, Siddharth Singh, MD, a gastroenterologist with UC San Diego Health, and his coauthors suggest that people who are obese may not respond to medication as robustly as nonobese people, and they may lose response to therapy quickly.
Longer Hospital Stays
In a comprehensive review published in 2021 of more than 61,000 inpatient admissions — primarily for ulcerative colitis — obesity was associated with longer hospital stays. Researchers wrote that the “proinflammatory process induced by obesity may complicate the clinical picture of people with ulcerative colitis, interfere with biological treatment dosing, or worsen some of the side effects of systematic steroid use.”
“Obese patients with IBD may be more prone to hospitalization and spend more days in the hospital,” says Dr. Singh.
More Risks Related to Surgery
If surgery is required to treat IBD, obese patients are more likely to experience postoperative complications.
“Operations just tend to be a lot more difficult with obese patients — complication rates go way up,” says Dr. Damman. “That’s why surgeons will always ask their patients to lose weight before surgery, because it makes for better outcomes.”
Damman warns that some of the complications include infection at the site of surgery and incisions not healing well. People who are obese may also have problems during surgery related to heart disease, higher rates of respiratory infection, and higher rates of blood clots.
But for some individuals who are severely obese and have had no success with diet, exercise, or medication, surgery may be the only option.
Exploring Medication Options
While there are more options than ever when it comes to IBD medications, Damman notes that some meds may contribute more to weight gain than others. Make sure to speak with your healthcare provider, who can advise you on treatments based on your weight, disease activity, and other factors.
Oral corticosteroids (such as prednisone) are highly effective at inducing remission of IBD and have been the mainstay for the treatment of flare-ups since the 1950s. They can, however, alter your metabolism in such a way that you have a greater appetite and can gain weight.
Medications such as antitumor necrosis factor (TNF)-alpha inhibitors, which suppress part of the inflammatory response related to the protein TNF, may also contribute to weight gain. These treatments for moderate to severe IBD include adalimumab (Humira), certolizumab pegol (Cimzia), golimumab (Simponi), and infliximab (Remicade).
The weight gain risks may vary from drug to drug. Research has shown that body weight over time is more likely to rise among people receiving infliximab, compared with those receiving adalimumab, for instance.
In some cases, the weight increase will be a sign that the medications are having the desired effect and helping the body absorb nutrients. So, despite concerns about potential weight gain, people shouldn’t rule out taking IBD medications. Under a doctor’s guidance, any unhealthy gains due to medications may be managed and resolved, and today there are many drug options for treatment.
Recently, more people have been turning to drugs such as Ozempic (approved for people with type 2 diabetes) and Wegovy (approved for people who are obese or those who are overweight and have health problems related to excess weight) for weight loss.
Both medications are GLP-1 (glucagon-like peptide-1 receptor) agonists and contain the same active ingredient (semaglutide).
Research on how well these drugs work to treat IBD is still in the early stages. However, a study published in 2021 in eClinical Medicine looked at more than 3,700 people with IBD and type 2 diabetes who were taking a GLP-1 and concluded that these therapies may improve the disease course of IBD. The scientists observed a decreased risk of hospitalization and the need for oral steroid treatment (a common therapy for IBD) among those taking a GLP-1. Their study also reported that GLP-1 receptor agonists may reduce systemic inflammation indirectly through improved glucose regulation and weight loss.
Lifestyle Approaches to Help Improve IBD and Obesity
While drugs to treat IBD are often essential for controlling symptoms, lifestyle changes can help people reduce symptoms and maintain a healthy weight.
Find time to be physically active. Aiming for 30 minutes of moderate exercise each day can make a difference. Exercises such as walking, jogging, and lifting weights not only help fight obesity — they may also help reduce stress, lower inflammation, decrease disease activity, improve skin, reverse muscle weakness, and strengthen bones and the immune system.
Follow a healthy diet that works for you. IBD flare-ups can be triggered by certain foods, but following a healthy eating plan, such as the Mediterranean diet, is beneficial, and it can help control weight as well. The Crohn’s & Colitis Foundation details a number of diets that have been proven to be successful, depending on the patient’s specific symptoms.
For example, the IBD anti-inflammatory diet is designed to restore balance between helpful and harmful bacteria, while promoting good nutrition. The eating strategy includes probiotics with live good bacteria (such as plain yogurt, kefir, and kimchi) and foods that maintain good intestinal bacteria (such as oats, bananas, garlic, and onions). However, scientific evidence to support whether this specific diet maintains remission and prevents the relapse of IBD is limited.
There’s also the specific carbohydrate diet, which may ease the symptoms of IBD and promote weight loss by eliminating sugars and hard-to-digest carbs like grains and grain products.
Work toward building a better gut microbiome. Exercise and a healthy diet can also help promote a diverse gut microbiome (the ecosystem of bacteria and other microbes that live in your intestines). Both obesity and IBD have been linked to having a less diverse mix of microbes in the gut. This lack of diversity could affect the natural production of molecules that help control obesity and IBD, such as the fatty acid butyrate.
“Molecules that make butyrate could actually play a role in preventing obesity and potentially inflammatory bowel disease as well,” says Damman.
Manage your sleep and stress. Research has revealed that poor sleep is associated with disease activity and obesity. Stress can also fuel both obesity and IBD symptoms.
“In addition to medications and therapies for their specific condition, lifestyle habits are the most important factors,” says Damman, who is also the author of the gut health blog Gut Bites. “Eating well, exercise, sleeping well, and managing stress can all make a difference.”
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