Increased visceral adipose tissue (VAT) is associated with systemic inflammation through amplified production of pro-inflammatory cytokines like TNF-α and interleukin-6. Higher visceral fat index (VFI), which is the ratio of VAT to subcutaneous adipose tissue (SAT) and reflects the degree of excess VAT in relation to SAT, is associated with complex IBD. However, its relevance to treatment response is unclear. We aim to evaluate the effect of VFI on treatment response and risk of surgery in IBD patients starting anti-TNF therapy.