“Mentally, I find it very difficult to motivate myself,” Knott says, adding that symptoms like fatigue also make it hard for him to go to the gym after work — he usually goes home to rest up instead.
Facing the Complications from Obesity
Knott is one of a growing number of people with inflammatory bowel disease (IBD) who are struggling with weight issues. A study published in February 2017 in the journal Nature Reviews Gastroenterology and Hepatology reported that 15 to 40 percent of people with IBD are overweight or obese. Diet and lifestyle changes over the past few decades have contributed to this shift. Certain drugs also play a role in weight gain. What’s worse, obesity can also complicate the management of an IBD. “Obese patients with IBD may experience a more complicated course, be more prone to hospitalization, and spend more days in the hospital,” says the study’s coauthor, Siddharth Singh, MD, a clinical assistant professor of medicine in the division of gastroenterology and a postdoctoral fellow in the division of biomedical informatics at the University of California in San Diego School of Medicine in La Jolla. “They may not respond to medication as robustly as nonobese patients, and may lose response to therapy quickly. They may need more surgeries, and in the case of surgery, obese patients are more likely to experience postoperative complications, particularly infections.” One important factor contributing to obesity in people with IBD is steroid use, says Dr. Singh. Roughly 10 to 20 percent of patients treated with steroids can gain 10 pounds or more, along with experiencing other complications. Brian Bosworth, MD, gastroenterologist at NYU Langone Medical Center and chief of medicine at Tisch Hospital in New York City, says that a big factor could be changes in people’s microbiomes, the communities of protective microbes, like bacteria, that exist in the body. “This has a greater impact on people who have obesity than in the general population,” Dr. Bosworth says. “We know that the bacterial diversity in Crohn’s patients is less diverse than in the general population. The issue is, is this a chicken or the egg kind of situation? Is the diversity reduced because these people have Crohn’s, or does less diversity in and of itself lead to Crohn’s? The same thinking can be applied to obesity.” Bosworth explains that Crohn’s patients who have obesity find themselves in a difficult position. He says there’s no clear answer for whether having obesity to begin with could change the course of the IBD — will it lessen symptoms or make them worse? More research needs to be done.
Finding Treatment for Overweight People With IBD
Among IBD patients with obesity, Bosworth says the approach to treatment varies. He stresses that diet is an important consideration, and that for people who are obese, “weight loss is beneficial for their overall health and treatment.” “Just a five percent weight loss can make a big impact on a patient’s therapeutic success,” Bosworth says. He explains that some people gain weight because their bodies are trying to control inflammation so well that the body actually adds fat to make up for the calories used to peel away inflammation. “When a person comes in and is given a new diagnosis, treatment really varies from patient-to-patient and diagnosis-to-diagnosis,” Bosworth adds. “A treatment for maintaining Crohn’s and losing weight at the same time could be right for one person but might not be right for everyone.” Bosworth laid out these helpful tips for people trying to manage their weight while also living with IBD: Make a change of diet. Bosworth says changes to your diet could help. For instance, a high iron–based diet could help speed up the metabolism and spur weight loss. Seek out surgery. “I have had patients who are morbidly obese who have tried different types of diets and not found them to be effective,” Bosworth says. “Sometimes surgery has been the best path for these patients. I have had some obese patients who have needed to seek out bariatric surgery, for instance — that’s what they needed to improve their overall health and weight.” Get out and exercise. As in any other case when a person needs to lose weight, exercise is crucial to staying healthy. Bosworth says that people with IBD who are also obese should try to exercise every day — one of the most tried-and-true methods for weight control. Consider alternate medication. Many steroids, like prednisone, that are known for treating IBD, lead to inflammation and weight gain. Bosworth stresses that all people with IBD should consult their doctors about alternative treatments to this kind of medication. Each case is different. For his part, Knott says he has been on a low-fiber diet. He is currently on Humira (adalimumab) for his Crohn’s symptoms after trying out several steroids in the past, which contributed to some weight gain and inflammation. Knott’s key to success with weight loss was regular exercise. And to help you stay motivated, he suggests making your workout a group activity. “I think it’s good to find an exercise partner,” Knott suggests. “Someone who you can talk to and enjoy working out with. Exercise can’t be a chore; it has to be something you enjoy.”
