Obesity and Pain

September 11, 2018 Rachel Rodrigues

In 1940 the American fast food chain McDonald's was founded by the brothers Richard and Maurice McDonald. Today it serves roughly 70 million customers daily all around the world, making it of one of the largest fast food chains in the world. The inescapable offer of cheap food and fast service was definitely a success in the modern period as people became more busy and time more limited. The introduction of fast food chains is believed to be one of the major causes why obesity became a frequent condition among the population. Obesity was first recognized as a global epidemic in 1997 when the cases started to escalate rapidly. Of course it would be unfair to put the blame of a whole epidemic in the creation of fast food. It is important to understand that the food market as a whole contributed as it went through major changes, including the marketing and industrialization of its products. Genetics can also play an important role; once there is a history of obesity in the family, or even a tendency to gain weight easily, one needs to be extra careful not to develop such condition. Moreover, the discouragement of physical activity as a result of new technologies led to a higher rate of sedentarism, also contributing to the increase in obesity. Why walk to the supermarket if you can order everything online? Why play sports if you can play video games with your friends in the comfort of your house? Everything was simplified by technology, but the outcome of that created a problem bigger than expected.

According to the World Health Organization approximately 500 million adults are obese, with higher incidence among women between ages 50 and 60. In the United States, severe obesity is increasing in an alarming rate, exceeding the overall rate worldwide. There are several health issues that can arise as a result of obesity , including life threatening ones as heart attacks and diabetes. Psychological problems can too take place as the patient feels excluded from the society and shuts themselves inside their homes, not being able to overcome that challenge. After all, what characterizes one as obese? Obesity is defined by weight and height, which together are used to calculate the “Body Mass Index” (BMI), where a BMI greater than 30 kg/m2 reflects obesity. In this article I will talk about the connection between obesity and pain, where one can be triggered by the other.

Pain can become a paralyzing condition, limiting physical activity and encouraging sedentarism. This resultant inactivity can lead to weight gain and easily develop into obesity. Individuals that suffer from chronic pain are in even higher risk due to the possibility of depression as a result of its limitations. Depression is strongly linked to both pain and obesity as it is associated with disturbed sleep and emotional eating. The need to ingest high-caloric food is one of the main causes to weight gain as patients try to find comfort in food and lose control over their diet. The lack of motivation, also caused by the condition, not only renders the person inactive but can too act as a barrier for the road to recovery as there is no stimulus to get up and find help. Moreover the poor quality of sleep can play an important role in weight gain. Approximately 53% of patients experiencing chronic pain have high levels of insomnia and sleep apnea which is known to trigger obesity due to increased appetite and insulin resistance caused by sleep deprivation. Medication for pain and depression can also be an enemy as many can lead to side effects that contribute to obesity. We can explore the connection between chronic pain and obesity better by considering patients that suffer with fibromyalgia. It is estimated that 80% of people with this chronic pain disorder are overweight or obese. Fibromyalgia and obesity are both identified by the impairment of the communication system between glands and therefore can be targeted from the same source.

Conversely, overweight patients have higher risk of developing fibromyalgia and may even present worse symptoms than those in a normal weight range. It has been observed that individuals with a high BMI usually experience higher intensities of pain. It is a combination of factors that contribute to such incidence, including mechanical stress, chemical mediators that cause inflammation, lifestyle issues as well as depression and sleep deprivation. The mechanical stress caused by heavy weight affects mainly joints and the spine. Obesity completely alters the body mechanics, which leads to structural pain, cartilage damage and even increases the risk of developing arthritis as the joint becomes more strained with the weight. The predisposition of obese individuals developing arthritis is also linked to chemical mediators. The fat stored in the body is called adipose tissue and it is an active tissue that produces chemicals as well as discharging it around the body. Some of these chemicals released provoke inflammation which accentuates the perception of pain. Obesity is sometimes recognized as a chronic inflammatory state due to these chemicals.

The comorbidity of pain and obesity becomes clear when we consider how inactivity promotes obesity that in turn highlights pain, creating an even larger barrier for the practice of physical activity; running into a vicious cycle. Treatment should involve the targeting of both conditions, as the presence of one may intensify the other - there is no point in performing a bariatric surgery in an obese individual if they won’t be able to maintain a healthy lifestyle afterwards. In a real case scenario a 11 year old girl was a candidate for a bariatric surgery, but she also had severe pain in her legs causing them to bend due to her weight. After careful consideration it was decided to perform surgery in her legs first so that she would be able to walk normally before undergoing the bariatric surgery. It can be observed that in this situation the pain factor was targeted first so that the outcome of the weight loss through surgical intervention would be successful. Inversely losing weight through behavioral intervention may help in pain rehabilitation and the quality of life of such individual. It is however a demanding task to maintain eating and exercising habits for a long-term and it can become challenging to overcome this condition once you have the history. In order to defeat obesity and the pain related to it you need to be focused and aware of the benefits as well as developing a long-term strategy with a professional to maintain the accomplishments.

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