Purpose <p>Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have transformed obesity management, but their safety and efficacy in patients with inflammatory bowel disease (IBD) warrants further evaluation.</p> Methods <p>This retrospective cohort study included adults with obesity and a diagnosis of IBD who were treated with GLP-1 RA within a large healthcare network. Primary outcomes were ≥ 5% total weight loss (TWL) at 12-months post initiation, and IBD flares, comparing 12-months pre- and post-GLP-1 RA initiation. Secondary outcomes included ≥ 10% TWL, adverse events (AE), and discontinuation of GLP-1 RA. Secondary analysis assessed anti-TNF exposure and primary outcomes. Statistical analysis used paired t-test for continuous outcomes, and McNemar’s χ² test for dichotomous outcomes. Logistic regression was performed for multivariable analysis of the primary efficacy outcome.</p> Results <p>Of 272 patients included, 175 completed at least 12&#xa0;months of GLP-1 RA. Among these individuals, 61% achieved ≥ 5% TWL and 42% achieved ≥ 10% TWL. AEs occurred in 40%, and were primarily gastrointestinal (93%). GLP-1 RA were stopped in 24% of patients (48% for AE/tolerability and 18% for access/cost issues). There was no difference in the proportion of patients with IBD flares within 12&#xa0;months pre vs. post GLP-1 RA (17% vs. 13%, P = 0.40). Anti-TNF exposure did not affect the likelihood of achieving ≥ 5% TWL in comparison with other IBD therapies (66% vs. 58%, P = 0.33).</p> Conclusions <p>This study supports the safety, tolerability, and effectiveness of GLP-1 RA for treatment of obesity in patients with IBD.</p>