Now, according to a meta-analysis published in January 2020 in the Annals of Pharmacotherapy, obese UC patients had a higher failure rate of anti-TNF therapy (biologics) than non-obese patients. The same did not hold true for patients with Crohn’s disease on this form of therapy. The reason this occurs is unclear, but scientists believe it has to do with a person’s own fat cells setting off a complex inflammatory reaction that disrupts metabolism and weakens the immune system. “There’s evidence to suggest that fat tissue has pro-inflammatory properties in the body through increases in molecules such as cytokines and adipokines involved in the inflammatory cascade,” says Benjamin Cohen, MD, the clinical director for inflammatory bowel disease at Cleveland Clinic in Ohio, who was not involved with the study.
Obese UC Patients May Need a Higher Dose of Anti-TNF Therapy
For the research, the authors analyzed data from six randomized controlled and 16 observational studies that investigated the outcome of anti-TNF treatment in adults with IBD according to body mass index or body weight. They found obesity increased the odds of treatment failure by 19 percent. Some of the studies also reported lower drug levels among those who were obese versus those who were not obese. While the study supports the notion that obesity may be related to increased risk of treatment failure, that doesn’t mean the study proves this association, notes Dr. Cohen. “Systematic reviews come up with answers by combining different studies together, so we should interpret these results with caution,” he says, adding, “The study is thought-provoking and shows we need more prospective studies designed specifically to assess the impact of body composition and body mass index on biologic treatment response.” Does this mean people who are obese should avoid using anti-TNF treatment? Cohen says no. But he does stress the importance of being proactive in monitoring treatment response. “Anti-TNF agents are one of our most effective therapies for treatment of IBD in both obese and non-obese patients,” he explains. “We just have to be mindful of various factors that can impact the success of these therapies — that means monitoring drug levels, particularly early in the treatment course, so you can quickly adjust doses and achieve the optimal effect.” Study authors recommend increasing the dose of anti-TNF treatment, but caution that attention should be paid to prevention and treatment of possible side effects.
Obesity and IBD Are a Growing Trend
Contrary to popular belief, not everyone with Crohn’s disease or ulcerative colitis is thin or malnourished. About 15 to 40 percent of people with IBD are overweight or obese, according to the aforementioned study in Nature Reviews Gastroenterology and Hepatology. Here are some tips for managing weight gain while living with IBD:
Change your diet. People with IBD often have trouble eating and digesting healthy foods such as fruits and vegetables. For some, having surgery or having part of the bowel removed can make eating such foods dangerous, causing blockage or bowel obstruction. While there is no single diet that works for everyone, people with IBD can reduce symptoms by eating small meals and sticking with foods such as low-fiber fruits like bananas and cantaloupe, lean protein, refined grains, and fully cooked, seedless, skinless, noncruciferous vegetables.Get active. It can be hard to exercise when you’re dealing with IBD symptoms such as bloating, cramping, and abdominal pain. But research shows exercise can help ease symptoms, maintain a healthy weight, improve circulation, and strengthen bones and the immune system. Just remember to talk with your doctor before starting a new exercise routine.Consider a different type of therapy. Certain drugs used to treat IBD, such as corticosteroids, lead to inflammation and weight gain. Talk with your doctor about alternatives to this kind of medication.
