The Effect of Obesity on Pain
Food is a basic need of life. For most of human existence, the ability to obtain enough food to survive was a struggle. However, in the modern world, food has never been more readily available or affordable. This constant access to food has led to a relatively new problem: obesity. Obesity is now a chronic disease that is becoming more prevalent in the United States and around the world. In 2015, nearly 604 million adults and 108 million children were identified as obese. Since the 1980’s, this represents a doubling in the prevalence of this disease. The consequences of being overweight are vast and include a significant increase in mortality, along with other health risks including dyslipidemia, hypertension, type 2 diabetes, and coronary artery disease. In addition, there is increasing evidence of a relationship between obesity and chronic pain.
How Do You Define “Overweight”?
The term “overweight” refers to a weight above the “normal range.” This is defined using the body mass index (BMI), which is calculated by dividing weight (in kilograms) by height squared (in meters).
- Underweight =< 18.5
- Normal Weight = 18.5-24.9
- Overweight = 25-29.9
- Obesity = 30 or greater
The Pro-Inflammatory State of Obesity
Fat is an active tissue that has multiple functions. In addition to storing energy for the body, it also stores and releases inflammatory markers including C-reactive protein, interleukin 6, and tumor necrosis factor. Obese patients have higher levels of these inflammatory markers which interact with the nervous system to enhance the sensation of pain. A 2010 study found that weight loss can lower these inflammatory levels in the body thereby lessening overall pain and improving function.
Obesity and Mechanical Stress
Studies have also revealed that obesity leads to increased mechanical stresses on the body. In fact, it has been shown that higher BMI is associated with increased musculoskeletal pain, especially in the lower limbs (hip, knee, and ankle) and spine. The hypothesis is that overloading the joints in these regions leads to degeneration and eventually osteoarthritis. Interestingly, a 2005 study of overweight subjects with knee osteoarthritis found that losing 1 pound of weight resulted in 4 pounds of pressure being removed from the knees.
Ok, Then… What Can I Do?
Losing weight is notoriously a difficult thing to do. To make things more complicated, there is a multibillion-dollar dieting industry in the United States promoting diet books, weight loss programs, and magic pills. Despite all of the claims, there is no one magical secret to weight loss. Instead, losing weight instead requires a comprehensive lifestyle intervention including:
- Diet – This is the most important part of weight loss! There are many different types of diets. The most important predictor of weight loss is the ability to stick with it! Ultimately, the goal is to reduce energy intake to a level below energy expenditure.
- Exercise – Increasing energy expenditure is a predictor of weight loss maintenance. The CDC recommends that all adults perform 150 minutes of aerobic exercise a week, or more simply 30 minutes a day, most days of the week. Resistance training at least two times a week is also recommended.
- Behavioral Modification – The goal is to allow for long-term maintenance of weight loss by modifying food intake, performing physical activity, and controlling stimuli in the environment that trigger eating.
If you are suffering from chronic pain and are having difficulty losing weight, speak with your healthcare provider about resources that would be beneficial for you. Please also contact us at Desert Spine and Sports Physicians to set up an appointment where we offer comprehensive, evidence-based, non-surgical care for your musculoskeletal needs.