Adding GLP-1 RA Therapy to Lifestyle Counseling Drives Weight Loss, Improves Outcomes in IBD

Obesity is increasingly recognized as a modifiable risk factor in inflammatory bowel disease (IBD), associated with poor medication response, higher surgical rates, and diminished quality of life. However, effective, IBD-specific weight management strategies have remained largely unstudied.

New prospective data from a dedicated IBD-metabolic clinic suggest that glucagon-like peptide-1 receptor agonists (GLP-1RAs), combined with structured lifestyle counseling, can deliver substantial weight loss and meaningful symptomatic benefit in this population, without compromising IBD disease control. The findings were presented by Stephanie Gold, MD, a gastroenterologist at the Icahn School of Medicine at Mount Sinai, at Digestive Disease Week (DDW) 2026 in Chicago, IL.

"Obesity really impacts IBD outcomes," Gold told HCPLive. "Our patients who are overweight or have obesity respond poorly to medications, have increased surgical needs, and poor quality of life. It's super important that we're addressing it."

Study Design

The analysis included 95 patients with IBD and overweight or obesity, defined as BMI ≥25 kg/m², seen during the first 12 months of a multidisciplinary IBD-Metabolic Clinic. All patients received structured lifestyle counseling, including a plating-method dietary strategy, daily walking, and twice-weekly resistance training.

Of the 95 patients, 50 (53%) additionally initiated a GLP-1RA based on standard eligibility criteria (BMI ≥27 kg/m² with comorbidity or BMI ≥30) and insurance or self-pay access. Weight, stool frequency and consistency, fatigue, and IBD-related complications were assessed at baseline and at 3, 6, 9, and 12 months. Of note, vibration-controlled transient elastography revealed hepatic steatosis in 72% of patients at baseline, underscoring the metabolic burden of this population.

Efficacy and Safety Outcomes

Weight loss in the GLP-1RA group was notable and widened progressively over time. At 12 months, patients receiving GLP-1RA therapy achieved a median weight reduction of 20.9%, compared with a 3.0% gain in the lifestyle-only group (P <.01). Patients on GLP-1RAs were also significantly more likely to report improvements in stool frequency, stool consistency, and fatigue as early as 3 months. Rates of ER visits, hospitalizations, and changes in IBD therapy were similar between groups, with no severe adverse events recorded.

Gold highlighted constipation, a common GLP-1RA side effect in the general population, as an unexpected benefit in IBD patients with high baseline stool frequency.

"If they're having 4 or 5 loose stools per day, a little constipation is actually a nice benefit," she said.

A Multidisciplinary Model

Central to the program's success, Gold emphasized, is its multidisciplinary structure, bringing together a metabolic hepatologist, an IBD-trained dietitian, endobariatric and bariatric specialists, and endocrinology colleagues in a single clinical setting, reducing the delays and coordination challenges patients face when navigating multiple providers independently.

Looking ahead, Gold expressed hope that GLP-1RAs will become a routine part of IBD care, noting that gastroenterologists are often a patient's primary touchpoint with the healthcare system.

"We may be the only access point with the medical system for many of these patients," she said. "It's really important that we're identifying if they're overweight or obese and offering effective and safe strategies."

Editor's note: Gold reports no relevant disclosures.

References

1. Gold S, Tiao J, Collen A, et al. GLP-1RA Therapy Plus Lifestyle Counseling Significantly Improves Clinical and Patient-Reported Outcomes in Patients Living With IBD and Obesity. Presented at Digestive Disease Week (DDW) 2026; Chicago, IL; May 2–5, 2026.

2. Kaazan P, Seow W, Yong S, Heilbronn LK, Segal JP. The Impact of Obesity on Inflammatory Bowel Disease. Biomedicines. 2023;11(12):3256. Published 2023 Dec 8. doi:10.3390/biomedicines11123256