5 Ways Weight Loss Can Reduce Chronic Pain

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Would you like to reduce your risk of developing osteoarthritis? A longitudinal study of approximately 800 women found that by simply losing 11 pounds (5 kilograms), the risk of developing osteoarthritis dropped by 50%. Not only does weight loss reduce the risk of arthritis, but studies have also found weight loss reduces the experience of chronic pain.

We often think that chronic pain leads to reduced activity, and reduced activity leads to weight gain. The conversations I have with patients often center around their frustration with losing weight because of their chronic pain issues.

But what if the opposite was true? What if weight gain itself were a crucial contributor to the development and maintenance of chronic pain? While not all chronic pain sufferers are overweight, obesity is a known risk factor in the development of some chronic pain conditions such as fibromyalgia and low back pain.

With the increased study of chronic pain, scientists are putting together the puzzle of how obesity is linked to the perception of pain and inflammation throughout the body. The rapid increase in obesity makes this issue even more pressing. Since the early 1960s, only 13% of adults in the United States were obese; today, nearly 70% are either overweight or obese, with 43% of the adult population being obese.

The Obesity-Pain Connection

Here are five fundamental principles of how obesity contributes to increased pain through a combination of inflammatory processes, mechanical stresses, metabolic changes, psychological factors, and changes in behavior.

1. Neuroendocrine Interaction: Obesity creates a chronic low-grade inflammatory process. Adipocytes, the cells comprising fat tissue, continually release pro-inflammatory factors, contributing to a systemic state of inflammation characteristic of obesity. Obese individuals often have higher levels of inflammatory markers such as interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and C-reactive protein (CRP).
2. Metabolic Syndrome: Obesity is often associated with metabolic syndrome, a cluster of conditions including insulin resistance, high blood pressure, and abnormal cholesterol levels. These conditions can contribute to nerve damage (neuropathy) and increase the risk of developing chronic pain conditions.
3. Mechanical Stresses: Excess weight increases mechanical stresses on the body, particularly on weight-bearing joints like the knees, hips, and lower back. Over time, this can lead to wear and tear on the joints, causing pain and potentially leading to conditions like osteoarthritis.
4. Autonomic Nervous System Regulation: The sympathetic and parasympathetic nervous systems, which innervate fat tissue, play roles in regulating inflammation and pain perception. The inflammation can sensitize nociceptors, the neurons responsible for detecting potentially damaging stimuli, leading to heightened pain perception.
5. Psychological Factors: Obesity is associated with an increased risk of depression and other mood disorders, which can amplify the perception of pain. Additionally, the stigma and discrimination faced by obese individuals can contribute to psychological distress, exacerbating pain symptoms.

The Pain Cycle

The relationship between obesity and chronic pain is complex. What is not complicated is the reality that pain and obesity make each condition more difficult to manage. To help patients face this challenge, I have found the pain cycle illustration helpful.

The pain cycle begins with the onset of pain. Pain is an unpleasant experience and triggers our stress response. The stress response increases muscle tension and changes blood flow, which can contribute to increased pain.

Pain and stress negatively impact mood. A depressed mood lowers motivation to be engaged in enjoyable activities and increases the likelihood of emotional eating. Mood changes also affect the quality of sleep, leading to exhaustion and worsening depression.

As fatigue, depression, and pain increase, the desire to be physically active decreases. As physical activity decreases, the muscles, joints, tendons, and ligaments become dysfunctional. These physical changes mean that even a small amount of movement and activity becomes painful, leading to a more sedentary lifestyle that increases weight and amplifies pain.

Where to Begin

If you find yourself trapped in the pain cycle, here are three key principles to keep in mind as you move toward a healthier lifestyle:

• Focus less on trying to avoid pain and more on moving forward with your life toward health. As you move toward health in all areas of your life, you move away from problems that lead to chronic pain and obesity.
• Based on studies of successful weight loss, we know that a healthy diet is key to initial success, but exercise and physical activity are necessary for maintaining a healthy weight in the long term.
• Remember that pain does not equal harm. Just because you are uncomfortable moving does not mean you are doing damage.

Connect with a physical therapist, learn safe ways to move, and never stop once you get going.