Hey guys!! As you’re reading this, please understand that this is not meant to fat-shame people struggling with obesity. Losing weight can be incredibly difficult for anyone. If you are struggling with both chronic pain and obesity, please know that you are not to blame for either of these conditions. These are both medical conditions that can be successfully treated. I’m sorry for any disrespect you have received from healthcare providers due to your weight. Hang in there and know that there is hope for you.

• Rates of obesity are increasing in the United States. It’s estimated that 42% of adults are considered obese. (Cosio, 2023)

• It can be a high-risk factor for chronic pain.

• Weight loss can decrease chronic pain. (Cosio, 2023)

• It’s estimated that 20-45% of obese individuals report chronic pain (Cosio, 2023). Children and adolescents who are obese also have higher rates of chronic pain (Okifuji, 2015)

• Individuals with abdominal obesity are twice as likely to report chronic pain (Cosio, 2023)

• There are several mechanisms that may link chronic pain and obesity: (Cosio, 2023)

• Mechanical/structural factors

• Chemical mediators

• Depression

• Sleep

• Lifestyle

• Studies have shown that people with obesity are more likely to have low back pain, neck pain, osteoarthritis, foot pain, shoulder pain, fibromyalgia, and headaches (Cosio, 2023)

• The association between chronic pain and obesity is more common in women and those over the age of 40. (Cosio, 2023)

• Chronic pain can lead to obesity because frustration with their pain and lifestyle limitations can lead to overeating, a sedentary lifestyle, poor sleep, and some medications have weight gain as a side effect (Okifuji, 2015). 

• Eating more comfort food can be a coping mechanism for chronic pain (Chadha, 2023)

• Studies have shown that people who are obese have higher levels of sensitivity to pain (Okifuji, 2015)

How can both chronic pain and obesity be treated?

• Patient education (Cosio, 2023)

• Behavioral Medicine Approaches

• Physical therapy

• Medications

• Physical activity paired with dietary restrictions

• An increase in exercise intensity increases weight loss

• Weight loss through physical activity results in greater total fat loss and visceral fat reduction

Weight Management Programs

• These help people lose weight and decrease their pain (Okifuji, 2015).

• There are four pillars that should be addressed when treating obesity: nutrition, physical activity, behavior modification, and anti-obesity medications (Chadha, 2023)

• They usually involve both diet and exercise.

• They are even effective for people with advanced age

• A lot of people struggle with maintaining their weight after weight loss, especially after a bariatric surgery. Individuals who lose weight through behaviorally orientated weight management programs may have more success maintaining the weight loss. It is difficult to follow the new eating and exercise habits after a program is finished (Okifuji, 2015).

• Lifestyle modification programs may have more success with weight loss:

• Participants are encouraged to do moderate-intensity physical activity through increasing behavioral skills and by incorporating short bouts of physical activity into their daily routines (Okifuji, 2015)

• These activities can be walking, using the stairs, or doing household chores.

• Sedentary adults benefit from a lifestyle modification program more than they do from a structured physical exercise program (Okifuji, 2015)

Diet

• The basic principle is to eat food from each basic food group every day (Cosio, 2023)

• There is no standard guideline for a nutritional health plan that addresses both obesity and chronic pain

• There a lot of different types of diets: anti-inflammatory diets, high-protein diets, and assorted vegetarian diets

• If any of these diets work for you, go for it. Just know you’re not required to do one of these diets to improve your health. It’s about finding a diet that you can stick with long-term.

• A study done on a 3-month long vegan diet showed significant weight loss and symptom improvement, but weight and symptoms returned once participants resumed their regular diets (Okifuji, 2015)

Physical Activity

• The amount of exercise matters. The Department of Health and Human Services recommends at least 150 minutes of exercise per week (Cosio, 2023)

• Research shows that a person should exercise over 200 minutes per week to achieve weight loss (Cosio, 2023)

• Even if an exercise program does not result in weight loss, it can prevent weight gain.

• Regular physical activity has been shown to decrease pain severity, and improve sleep, standing, employment, and personal care behaviors (Cosio, 2023)

Barriers to Exercise

• Embarrassment, stigma, injury, fear of failure, worries related to pain, cardiac events, and joint damage

Stigma in the Healthcare System

• A lot of healthcare providers have stigmatizing attitudes towards those with chronic pain and fibromyalgia

• Certain types of medical advice can come off as patronizing to those who are obese

• People with obesity often feel as if their other medical conditions are ignored because healthcare providers tend to focus on their weight

• Patients who experience disrespect from healthcare providers may feel stress, distrust towards the provider, and they may avoid the healthcare system.

• There is training available for providers to reduce stigma (Cosio, 2023)

Written by Brianna Shortt RN, CEN

Chadha, A. (2023, April 5). Obesity and pain management: How to treat pain in patients with obesity. Obesity Medicine Association. https://obesitymedicine.org/blog/obesity-and-pain-management-how-to-treat-pain-in-patients-with-obesity/ 

Demyan, A., & Cosio, D. (2023, November 28). When obesity and chronic pain co-occur. MedCentral. https://www.medcentral.com/pain/when-obesity-and-chronic-pain-co-occur 

Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015;8:399-408. Published 2015 Jul 14. doi:10.2147/JPR.S55598