Research published in the journal Alimentary Pharmacology & Therapeutics found ulcerative colitis patients with higher BMIs had a greater likelihood of biologic treatment failure. Increases in BMI also were associated with a higher risk of surgery or hospitalization. The reasons might be related to endogenous steroid production, misuse of medical steroids, or underdosing of conventional medications which are not usually weight-based. Even weight based medications, like Remicade, do not take into account the volume of distribution of leaner vs high-BMI patients.