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Obesity and IBD management FAQ
Obesity Management in Comprehensive IBD Care: Experts’ Insights to Your Frequently Asked Questions

Released: August 03, 2026

Stephanie L. Gold
Stephanie L. Gold, MD
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Key Takeaways
  • Obesity adversely affects patients with IBD and can lead to impaired treatment response, increased disease severity, and/or elevated complication risk.
  • OMMs like incretin-based therapies are safe to use in patients with IBD and obesity.
  • APPs are uniquely positioned to screen patients with IBD for obesity and initiate person-centered conversations on effective weight management as a part of comprehensive IBD care.

In this commentary, Stephanie L. Gold, MD, answers questions posed by healthcare professionals (HCPs) during a live symposium titled “Leveling Up Obesity Management in IBD: Patient-Centered Approaches and Pharmacotherapy Advances.” Learn about specific considerations for integrating obesity screening and management, including the effective use of patient-first language and obesity management medications (OMMs), within comprehensive inflammatory bowel disease (IBD) care.

How should HCPs reframe obesity as a chronic, treatable comorbidity within comprehensive IBD care?
Although historically associated with underweight and malabsorption, the prevalence of comorbid obesity is rising among patients with IBD. Therefore, it is critical that HCPs recognize obesity as a chronic, treatable disease that affects IBD outcomes, including treatment response, disease severity, and complication development. Recent studies have found that patients with IBD and visceral adiposity may experience impaired response to biologics and increased flare-up risk and surgical complications as well as present with more severe phenotypes. To combat this, HCPs must identify overweight and obesity and provide effective treatment interventions early in patients’ disease course, all of which are now considered integral to comprehensive IBD care. 

How can OMMs like incretin-based therapies be leveraged in IBD treatment plans?
Incretin-based therapies, including GLP-1 and dual GIP/GLP-1 receptor agonists, may be safely used in many patients with IBD. However, before prescribing these therapies, HCPs must first consider patients’ BMI, present comorbidities (eg, hypertension, diabetes, dyslipidemia, metabolic dysfunction–associated steatohepatitis, and obstructive sleep apnea), IBD location and activity, surgical history, hydration needs, and nutritional status. These factors will inform which therapy best suits each patient. Of note, the incretin-based therapies should not be used in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, those with pancreatitis, or those who are pregnant or breastfeeding. Although select gastrointestinal-related adverse effects are common and generally transient, HCPs should evaluate patients for more specific conditions, such as gastroparesis, severe and persistent nausea or constipation, and gastroesophageal reflux disease, which may make therapy more complicated. 

When starting an incretin-based therapy in patients with IBD, it is important to follow a slow dose-escalation schedule as outlined in each agent’s FDA-approved labeling. Concomitant lifestyle modifications are crucial and should include counseling on nutrition and physical activity. Furthermore, HCPs must ensure patients understand that they need to be adequately hydrated, increase their lean protein intake, and prioritize resistance training to prevent malnutrition and sarcopenia. Finally, a multidisciplinary approach with collaboration among gastroenterology, endocrinology, hepatology, and primary care is best. 

What baseline assessments should HCPs perform before recommending or initiating OMMs like incretin-based therapies in patients with IBD?
First, HCPs should perform a comprehensive baseline assessment to confirm the intended therapy is appropriate and establish a reference for monitoring. This includes a detailed evaluation of patients’ weight, height, present comorbidities, and health goals. Then an assessment of their baseline IBD status is necessary to understand their current disease activity, postsurgical anatomic changes, disease location, and present complications (ie, strictures and fistula).

HCPs should also evaluate patients for malnutrition and any weight-related comorbidities. As mentioned above, HCPs must rule out contraindications and assess patients based on the relevant warnings and precautions. Finally, gastrointestinal symptoms, such as stool frequency and consistency, abdominal pain, nausea, vomiting, and constipation, should be evaluated and documented at baseline. This is essential to help HCPs guide clinical care for IBD while patients are receiving an OMM.

How should HCPs counsel patients with IBD on obesity management without reinforcing stigma, blame, or unrealistic expectations?
It is crucial to provide unbiased, supportive care to patients with IBD and obesity. That means using person-first, nonjudgmental language and framing obesity as a chronic, relapsing, and multifactorial disease that is influenced by genetic, biological, and environmental factors. All conversations with patients should begin by asking for their permission to discuss their weight. Once HCPs have their permission, open-ended questions are great tools because they allow patients to guide the discussion.

For patients with IBD, in particular, HCPs should highlight the potential for improved IBD-related outcomes alongside the cardiometabolic benefits of weight loss. HCPs can do so by discussing the data on excess adiposity in patients with IBD as well as weight loss achieved with lifestyle modifications alone compared with OMMs, thereby presenting incretin-based therapies as tools to augment healthy lifestyle modifications.

In follow-up, HCPs can reinforce the idea that obesity is a chronic disease requiring long-term management and that treatment plans may evolve over time based on efficacy, tolerability, and patient preferences.

What monitoring strategies should HCPs employ after patients with IBD start an OMM?
Close monitoring of patients receiving an OMM is vital. Patients should be seen regularly via in-person follow-up to assess their weight, BMI, waist circumference, and symptoms. If patients have constipation, a bowel regimen can be started and monitored for improvement prior to starting the OMM. Dietary recall and physical activity review should be completed as well to ensure patients are meeting their nutritional and activity needs. Laboratory tests like complete blood count, metabolic panel, lipid, and hemoglobin A1C should be ordered based on patients’ clinical profile. If patients with IBD have an ileostomy, close monitoring of ostomy output and hydration status, including serum creatinine, should be performed regularly.

How are advanced practice providers (APPs) uniquely positioned to improve obesity management for patients with IBD?
APPs have a central role in integrating obesity management into routine and comprehensive IBD care. They can help evaluate patients for overweight or obesity, initiate person-centered conversations about weight management, and counsel on the negative impact visceral adiposity has on IBD outcomes. In addition, APPs can further screen patients for weight-related comorbidities, malnutrition, sarcopenia, and disordered eating.

These HCPs are also well positioned to help coordinate multidisciplinary care by facilitating referrals to gastroenterology, obesity medicine, endocrinology, nutrition, behavioral health, and bariatric surgery when appropriate. Through coordinated, long-term follow-up, APPs can monitor patients’ treatment response and tolerability, reinforce lifestyle modification recommendations, troubleshoot medication access with the pharmacy team, and help patients manage any adverse effects.

By aligning obesity management within IBD treatment goals and overall health priorities, APPs can help deliver coordinated, patient-centered care that optimizes both patients’ metabolic and gastrointestinal outcomes.

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