Environmental and lifestyle factors play an important role in the natural history of
Crohn's disease and
ulcerative colitis. A group of international experts from the International Organization for the Study of
Inflammatory Bowel Diseases voted on a series of consensus statements to inform the management of
inflammatory bowel disease (IBD). The recommendations include avoiding traditional cigarette smoking in patients with
Crohn's disease or
ulcerative colitis, screening for symptoms of depression, anxiety, and psychosocial stressors at diagnosis and during flares (with referral to mental health professionals when appropriate), and encouraging regular physical activity as tolerated. Patients using dietary approaches for treatment of their IBD should be encouraged to adopt diets that are best supported by evidence and involve monitoring for the objective resolution of
inflammation. We recommend formal assessment for
obesity and
nutritional deficiencies, and patients should be encouraged to maintain a normal body-mass index. A shared decision-making approach to
contraception should include the consideration of IBD-related factors, and risk factors for
venous thromboembolism. Long-term or frequent use of high-dose non-steroidal anti-inflammatory drugs should be avoided. For primary prevention of disease in the offspring of patients with IBD, we recommend avoiding passive exposure to tobacco, using
antibiotics judiciously, and considering breastfeeding when able.