Gut Check: When IBD and Obesity Collide

Inflammatory bowel disease (IBD) doesn’t discriminate, as witnessed in recent news of an actress being hospitalized. Even those with access to top medical care and healthy food face ongoing challenges of dealing with the miserable symptoms that accompany IBD. Managing it is a complex process due to periods of remission that may feel like it’s just gone away or cured itself. 

IBD is a chronic condition of digestive flare-ups and discomfort, yet diet is one of the most practical tools for management alongside medical oversight. Some people overlook early symptoms or dismiss dietary changes, but digestive issues like persistent diarrhea, abdominal pain, blood in the stool, and extreme fatigue shouldn’t be ignored.

The double whammy is that obesity appears to make the condition more complicated to manage. A growing body of research shows that individuals with excess weight often experience more severe symptoms and complications.¹ That’s likely because obesity is associated with chronic inflammation. Enlarged fat cells (called hypertrophic adipose tissue) attract immune cells that release pro-inflammatory signals – the very kind that can worsen conditions like IBD. Since IBD itself is an immune-mediated, inflammatory disease of the digestive tract, excess weight may amplify the body’s inflammatory load and make flare-ups more challenging to control.² 

Understanding what IBD is and how dietary elements can either trigger or tame your gut may help control symptoms better and improve your quality of life.

IBD vs IBS

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are often confused, but they are very different conditions.

IBD primarily includes two main conditions: Crohn’s disease (CD) and ulcerative colitis (UC). Both cause chronic inflammation of the digestive tract but affect different areas and layers of the intestines.

• Crohn’s disease can impact any part of the gastrointestinal tract from the mouth to the anus and often involves “patchy” areas of inflammation that penetrate deeply.
• Ulcerative colitis is limited to the colon and rectum and affects the lining of these organs more continuously.

Symptoms vary widely, and alongside abdominal pain, diarrhea (sometimes bloody), and fatigue, extra-intestinal symptoms can manifest as joint pain or skin conditions. Because symptoms can overlap with other digestive disorders, diagnosis requires careful clinical assessment involving a combination of imaging, endoscopy, and biopsy.

IBS, on the other hand, is a functional disorder, causing symptoms like abdominal pain, bloating, and changes in bowel habits, but without inflammation or visible damage to the intestines.

Diet Makes a Difference

Plant-Based Diets

A large cohort study (over 140,000 participants) found that healthy plant-based diets were associated with a lower risk of both Crohn’s disease and ulcerative colitis.³ Fruits and vegetables rich in fiber, antioxidants, and phytochemicals were regarded as protective. Conversely, diets high in unhealthy plant foods (e.g., refined grains, sugary beverages) were linked with increased risk.

Anti-Inflammatory Diets

Anti-inflammatory diets have shown promising results in reducing intestinal inflammation and improving daily functioning.^4-5 These diets prioritize foods that wind down inflammatory markers and the subsequent immune response:

• Fresh fruits and vegetables
• Whole grains
• Healthy fats (like olive oil)
• Lean proteins such as fish and poultry
• Avoidance of processed foods and additives

Research shows that an imbalance in gut bacteria also plays a role in IBD. In response, some anti-inflammatory diets have been developed to reduce inflammation by supporting healthier gut microbes. The idea is to limit foods like refined sugar, processed carbohydrates, and gluten-containing grains, ingredients that may feed harmful bacteria in the gut and worsen inflammation.⁵ 

Autoimmune Protocol (AIP) Diet

One small clinical study explored the autoimmune protocol (AIP) diet, a more restrictive extension of the paleo diet, that was designed to eliminate foods that may trigger immune activity or disrupt the gut microbiome. The diet begins with a strict elimination phase, cutting out grains, legumes, dairy, eggs, nuts, seeds, nightshade vegetables, processed sugars, food additives, NSAIDs, and more. It emphasizes fresh, nutrient-dense meals, fermented foods, probiotics, and bone broth, followed by a reintroduction phase to identify which foods might be contributing to symptoms.

Following the AIP diet, 73% of participants reached clinical remission by week six and maintained it through week eleven. Improvements were also seen in endoscopic scores and inflammatory markers. While promising, the sample size was minimal, indicating the need for further research to confirm long-term safety and effectiveness.⁶ 

Sweets and Processed Foods

Certain sweeteners and processed food additives may disrupt gut barrier integrity and worsen inflammation. 

Studies have shown that diets high in saturated fat, cholesterol, and refined sugars (common culprits in fast food) may increase the risk of developing inflammatory bowel diseases. Frequent fast food consumption has been linked to a higher likelihood of Crohn’s disease, while diets rich in animal fat are associated with ulcerative colitis. These eating patterns, particularly when low in fiber, may also contribute to an earlier onset of IBD, more severe symptoms, and a greater chance of needing surgery, especially in cases of UC.⁷ 

If you’ve battled excessive weight gain and obesity, it’s highly likely you’ve heard of some of these diets, or at least the reasoning behind them. The idea of eating healthy is to support your body with the right nutrients while minimizing foods that can trigger inflammation or other health issues.

Down the Hatch… Selectively

The gut lining is a critical barrier that protects us from harmful microbes while allowing for nutrient absorption. In IBD, this barrier is compromised by inflammation. Diet directly affects the gut environment, microbiome composition, and immune responses. When the gut lining is damaged, diet has a significantly greater impact on our overall health.

Certain foods may worsen symptoms or trigger flare-ups, while others help soothe inflammation and support healing. Emerging studies suggest that dietary patterns rich in anti-inflammatory foods can reduce systemic inflammation markers like C-reactive protein (CRP) and neutrophil counts, which are often elevated in IBD. 

Drawing from reviews and clinical guidance, here are common themes on foods to include and avoid to help manage IBD symptoms:

Foods to Emphasize

• Fruits and vegetables: Especially cooked or peeled to reduce fiber irritation during flare-ups.
• Whole grains: Such as oats, brown rice, and quinoa that are gluten-free.
• Lean proteins: Including fish, poultry, eggs, and plant proteins like tofu.
• Healthy fats: Olive oil, avocado, and nuts. (Be careful with seeds as they can lodge and lead to infection in pockets of the intestine that are already inflamed.)
• Probiotic-rich foods: Yogurt, kefir, or fermented vegetables to support gut microbiota.

Foods to Limit or Avoid

• High-fat, fried, or greasy foods.
• Dairy products.
• High-fiber raw vegetables, nuts, and seeds.
• Artificial sweeteners and processed foods.
• Alcohol and caffeine.

Tips for Success

• Keep a food diary to track what you eat and how symptoms respond.
• Consult a dietitian or gastroenterologist for a personalized plan.
• Stay hydrated, especially if diarrhea is frequent.
• Eat small, frequent meals to ease the digestive system.
• Consider taking vitamin and mineral supplements since deficiencies are common.

Diet isn’t a cure, but it plays an imperative role in managing symptoms and maintaining remission. If you notice digestive symptoms or have been diagnosed with IBD, don’t ignore the power of food. Alongside your medical treatment, simple dietary choices can help you regain control over your health.

As always, speak with your healthcare provider before making significant dietary changes. Nutritional deficiencies are common in IBD, as well as in obese and bariatric patients, and some restrictive diets may do more harm than good if not monitored properly. 

If you are experiencing weight loss roadblocks compounded by gut dysregulation and are considering bariatric surgery, partner with the team at VIPSurg. Our qualified medical team can help guide your choices safely and effectively.

1. Sun, J., Brooks, E. C., Houshyar, Y., Connor, S. J., Paven, G., Grimm, M. C., & Hold, G. L. (2025). Unravelling the Relationship Between Obesity and Inflammatory Bowel Disease. Inflammatory Bowel Diseases. https://doi.org/10.1093/ibd/izaf098. 
2. Kaazan, P., Seow, W., Yong, S., Heilbronn, L. K., & Segal, J. P. (2023). The Impact of Obesity on Inflammatory Bowel Disease. Biomedicines, 11(12), 3256. https://doi.org/10.3390/biomedicines11123256. 
3. Jin, Z., Zhou, T., Ye, K., Jiang, W., Liu, Z., Luo, L., Wang, Y., & Shen, Z. (2025). Healthy Plant‐Based Diet Is Associated With a Reduced Risk of Inflammatory Bowel Disease: A Large‐Scale Prospective Analysis. Molecular Nutrition & Food Research. https://doi.org/10.1002/mnfr.70151. 
4. de Castro, M. M., Pascoal, L. B., Steigleder, K. M., Siqueira, B. P., Corona, L. P., Ayrizono, M. L. S., Milanski, M., & Leal, R. F. (2021). Role of diet and nutrition in inflammatory bowel disease. World journal of experimental medicine, 11(1), 1–16. https://doi.org/10.5493/wjem.v11.i1.1. 
5. Shafiee, N. H., Manaf, Z. A., Mokhtar, N. M., & Raja Ali, R. A. (2021). Anti-inflammatory diet and inflammatory bowel disease: what clinicians and patients should know?. Intestinal research, 19(2), 171–185. https://doi.org/10.5217/ir.2020.00035. 
6. Chandrasekaran, A., Groven, S., Lewis, J. D., Levy, S. S., Diamant, C., Singh, E., & Konijeti, G. G. (2019). An Autoimmune Protocol Diet Improves Patient-Reported Quality of Life in Inflammatory Bowel Disease. Crohn’s & colitis 360, 1(3), otz019. https://doi.org/10.1093/crocol/otz019.
7. de Castro, M. M., Pascoal, L. B., Steigleder, K. M., Siqueira, B. P., Corona, L. P., Ayrizono, M. L. S., Milanski, M., & Leal, R. F. (2021). Role of diet and nutrition in inflammatory bowel disease. World journal of experimental medicine, 11(1), 1–16. https://doi.org/10.5493/wjem.v11.i1.1.