Approximately 20–40% of patients with inflammatory bowel disease (IBD) are obese. Obesity is associated with inferior outcomes in patients with IBD, with lower rates of achieving remission, poor quality of life, and higher burden of unplanned healthcare utilization. Multiple cohort studies in patients with immune-mediated inflammatory diseases, including IBD, treated with biologic agents like tumor necrosis factor-α antagonists have suggested that obesity is associated with inferior response to biologic therapy. This may be related to the negative impact of obesity on the pharmacokinetics of biologic agents. Pharmacokinetic studies of multiple biologic agents have demonstrated that high body weight is associated with more rapid clearance and a higher volume of distribution of biologic agents, which leads to low trough concentrations. Randomized trials in patients with psoriasis and psoriatic arthritis treated with biologic agents suggest that diet- or lifestyle-induced weight loss is associated with improved response to therapy. This provides an opportunity to explore intentional weight loss as adjunctive therapy in obese patients with IBD. However, diet and lifestyle interventions for weight loss are hard to implement in patients with IBD; hence, long-term therapy with weight-loss agents (such as with phentermine–topiramate, naltrexone–bupropion) is attractive as adjunctive therapy in obese patients with IBD.

大约 20-40% 的炎症性肠病 (IBD) 患者肥胖。肥胖与 IBD 患者的不良预后相关，缓解率较低、生活质量差以及计划外医疗保健利用的负担较高。对免疫介导的炎症性疾病（包括 IBD）患者进行的多项队列研究表明，肥胖与生物治疗反应较差有关。这可能与肥胖对生物制剂药代动力学的负面影响有关。多种生物制剂的药代动力学研究表明，高体重与更快的清除速度和更高的生物制剂分布容积相关，从而导致低谷浓度。在接受生物制剂治疗的银屑病和银屑病关节炎患者中进行的随机试验表明，饮食或生活方式引起的体重减轻与治疗反应改善有关。这提供了一个机会来探索有意减肥作为 IBD 肥胖患者的辅助治疗。然而，IBD 患者很难通过饮食和生活方式干预来减轻体重；因此，长期使用减肥药（如芬特明-托吡酯、纳曲酮-安非他酮）作为肥胖 IBD 患者的辅助治疗很有吸引力。这提供了一个机会来探索有意减肥作为 IBD 肥胖患者的辅助治疗。然而，IBD 患者很难通过饮食和生活方式干预来减轻体重；因此，长期使用减肥药（如芬特明-托吡酯、纳曲酮-安非他酮）作为肥胖 IBD 患者的辅助治疗很有吸引力。这提供了一个机会来探索有意减肥作为 IBD 肥胖患者的辅助治疗。然而，IBD 患者很难通过饮食和生活方式干预来减轻体重；因此，长期使用减肥药（如芬特明-托吡酯、纳曲酮-安非他酮）作为肥胖 IBD 患者的辅助治疗很有吸引力。