Obesity in Inflammatory Bowel Disease (IBD): Recognizing a Critical Modifier In Modern Disease Management
DOI:
https://doi.org/10.58931/cibdt.2025.3141Abstract
The notion of obesity as a disease remains controversial. A recent consensus from the Lancet Diabetes & Endocrinology Commission reframes obesity by distinguishing between “preclinical obesity,” defined as a state of excess adiposity with preserved organ function, and “clinical obesity,” defined as a chronic, systemic illness caused by excess adiposity and characterized by measurable dysfunction in organ systems or limitations in daily living activities. This distinction provides a medically meaningful basis to identify when obesity constitutes a disease in its own right.
Historically, inflammatory bowel disease (IBD) was associated with undernutrition and weight loss, a reflection of both disease activity and malabsorption. However, with shifting demographics, improved therapeutic options, and global lifestyle changes, obesity has emerged as an increasingly relevant coexisting condition in patients with IBD. While the current prevalence of overweight and obesity among Canadians with IBD remains unknown, population-level data from Statistics Canada show that 35.8% of adults in urban centers are classified as overweight, and 29.0% as obese.
This epidemiologic shift has important clinical ramifications. Obesity contributes to systemic inflammation and is associated with increased healthcare utilization and reduced quality of life (QoL), which are burdens already faced by patients with IBD. The intersection of these two chronic conditions introduces complex challenges for disease management, health outcomes, and healthcare systems. This review explores the clinical impact of obesity in patients with IBD, including its influence on disease phenotype, treatment response, surgical outcomes, and QoL.
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