Before we were all held captive by the COVID-19 pandemic, another pandemic was (and still is) dominating our world. With high prevalence rates, some consider obesity the ‘real’ pandemic of the 21st century. It is undeniable that new diseases like COVID-19 and Zika can have a devastating impact on someone’s health. Yet, the long-term and far-reaching impact of obesity should not be underestimated in the light of these more ‘visible’ diseases.
Like smoking, the problem of obesity lies partly in its dormant character. Besides some limitations in physical function, like for example having less aerobic capacities, a person who is obese might for many years not suffer from highly debilitating consequences related to obesity. Yet, the long-term impact of obesity should not be misjudged. To name some, the presence of obesity is related to an increased risk of death, morbidity, and accelerated aging. Moreover, having obesity increases the risk of having a more severe disease course for co-occurring other diseases, like also for COVID-19.
Similarly, in chronic pain management, the impact of obesity should not be ignored. Obesity is not only highly prevalent in chronic pain patients, the presence of overweight and obesity can also act as risk factor for pain development. For example, overweight people report about 20% more pain compared to normal-weight people, and for obese people this percentage even goes up to 68%. Moreover, pain intensity and pain-related disability are associated with Body Mass Index, waist circumference, percentage fat, and fat mass.
Luckily, there is also good news to report regarding this topic. Several studies in a variety of chronic pain populations show that body weight modification interventions (focusing on a change in diet and/or an increase in physical activity) not only result in a decrease in weight, but also improve pain, disability, depressive symptoms, anxiety, body satisfaction, and quality of life. Thus, demonstrating the importance of addressing overweight and obesity in pain management.
Ideally, weight management is integrated within pain management in a multidisciplinary approach, with for example a physiotherapist responsible for the increase in physical activity and a dietician responsible for the change in diet. Yet, also in a monodisciplinary setting physiotherapists can integrate weight management in their approach to pain. Logically, a physiotherapist would need additional training in aspects related to diet and healthy eating patterns, but their readily available experience in dealing with psychosocial factors – especially for those skilled in treating chronic pain – should not be underestimated. Moreover, evidence shows that patients find it appropriate for their physiotherapist to discuss weight (management). Yet, it goes without saying that one should also be aware of their limits in weight management skills and knowledge, and should – where needed – work together with other health care professionals (like dieticians, psychologists and/or other (para)medicals) within a multidisciplinary approach to strengthen the outcome of therapy.
After reading this blogpost, you might be convinced that overweight and obesity do play an important role in pain management and should not be overlooked. Yet, this blogpost does not provide clear guidance on how to implement this knowledge in clinical practice. Well…I can say, stay tuned and follow Pain in Motion on social media, because we have plans to publish such guidance and we will share this with you as soon as possible!
Anneleen Malfliet
Anneleen Malfliet is an assistant professor and postdoctoral researcher at Vrije Universiteit Brussel and is funded by the Research Foundation Flanders. After doing her PhD on chronic pain rehabilitation, she is specializing further in the impact of overweight, obesity, and nutritional interventions in chronic pain.
2021Pain in Motion
References and further reading:
Roth et al., 2004. The obesity pandemic: where have we been and where are we going? Obesity Research, 12(S11).
Villalobos, 2016. Obesity: the real pandemic of the 21st century
Hussain SM, Urquhart DM, Wang Y, et al. Fat mass and fat distribution are associated with low back pain intensity and disability: results from a cohort study. Arthritis research & therapy. 2017;19(1):26.
Paulis WD, Silva S, Koes BW, van Middelkoop M. Overweight and obesity are associated with musculoskeletal complaints as early as childhood: a systematic review. Obesity reviews : an official journal of the International Association for the Study of Obesity. 2014;15(1):52-67.
