Obesity and Fibromyalgia

~ Research reveals overweight FMS patients experience more severe symptoms

September 5, 2019
by Julie Maurer
Contributing Writer, MedPage Today

While patients with fibromyalgia frequently battle pain, fatigue, and depression, some believe that those who are also obese may experience more severe symptoms.

This is a topic explored in a study published in the journal Nutrients, by María Correa-Rodríguez and colleagues.

“Given that a main goal in the management of FMS patients is the improvement of quality of life by ameliorating clinical symptomatology and previous work has shown a high prevalence of overweight and obesity among FMS women, therefore investigating the associations among obesity measurements and numerous FMS-related symptoms is of special interest,” Correa-Rodríguez and colleagues wrote.

They noted that previous studies show the prevalence of obesity in fibromyalgia patients ranging from 62% to 73%.

“Although increased BMI has been associated with multiple pain measures, symptom severity, disease activity, fatigue, anxiety, or quality of life in FMS patients, the results are still controversial,” the authors wrote.

Participants were comprised of 73 women with fibromyalgia and 73 healthy controls, who matched on weight.

“We used a body composition analyzer to measure fat mass, fat mass percentage, and visceral fat. Tender point count (TPC) was measured by algometry pressure. The disease severity was measured with the Fibromyalgia Impact Questionnaire (FIQ-R), and self-reported global pain was evaluated with the visual analog scale (VAS),” Correa-Rodríguez and colleagues wrote.

Thirty-eight percent of the fibromyalgia patients in the study were obese, and their scores varied more significantly than those without additional weight.

“Significant differences in FIQ-R.1 (16.82 ± 6.86 versus 20.66 ± 4.71, P=0.030), FIQ-R.3 (35.20 ± 89.02 versus 40.33 ± 5.60, P=0.033), and FIQ-R total score (63.87 ± 19.12 versus 75.94 ± 12.25, P=0.017) among normal-weight and overweight FMS were observed,” the researchers found.

They also noted that higher fat mass produced poorer sleep quality in obese patients both with and without fibromyalgia.

The researchers noted a lack of relationship between the pain score and BMI and body composition in fibromyalgia patients, although the women without the disease did report pain.

“It could be hypothesized that in patients with low-pressure pain thresholds and a high number of tender points, such as FMS patients, factors other than obesity could also play a relevant role,” Correa-Rodríguez and colleagues stated.

The researchers hope that more studies will be done on the topic.

“The promotion of an optimal BMI might contribute to ameliorate some of the FMS symptoms,” the authors wrote. “Thus, development and implementation of obesity prevention programs based on a balanced diet and increased physical activity to improve the severity of symptoms in FMS women are of special interest.”

Yvonne Lee, MD, rheumatologist at Northwestern Memorial Hospital in Chicago, noted that multiple studies have shown that fibromyalgia patients who are obese are more likely to experience pain and other symptoms, such as poor sleep, fatigue, cognitive difficulties, and depression.

“I advise all of my obese patients, not just those with fibromyalgia, to lose weight because it would decrease the risk of many poor health outcomes, including diabetes and heart disease. More studies are still needed to conclusively determine whether, and, if so, how much weight loss will impact pain,” she told MedPage Today in an e-mail.

Lee, however, pointed to a 2017 study in The Journal of Pain by Schrepf, et al. in which 123 obese fibromyalgia patients underwent a 12- to 16-week calorie restriction weight loss intervention. Pain, symptom severity, and depression were measured before and after weight loss.

“Those who lost at least 10 percent of body weight showed greater improvement than those who lost <10 percent. Levels of the regulatory cytokine interleukin-10 increased after the intervention,” the authors wrote. “Weight loss may improve diffuse pain and comorbid symptoms commonly seen in chronic pain participants.”

When counseling fibromyalgia patients to exercise, Lee recommends they start slow and build from there.

“Patients are likely already doing some things as a part of their daily activities that they can build on. For instance, if their office is on the 2nd floor of a building, they can try to use the stairs once a day instead of the elevator,” Lee said. “If they are walking to the end of their driveway to get the mail, they can walk down the street to their neighbor’s mailbox and back to increase the distance, and then slowly increase the distance even farther to the end of the street.”

Lee noted that many symptoms fibromyalgia patients experience, such as sleep problems and pain, can be attributed to both their disease and weight, but that isolating which condition is the cause is not what matters.

“We know that obesity is a risk factor for multiple poor outcomes, beyond pain. Thus, it is important to encourage weight loss. One of the primary strategies for losing weight is increasing physical activity, which is known to help symptoms of fibromyalgia,” Lee said.

She concluded that the link between pain and obesity is an exciting area of current research.

“Much still needs to be learned. Longitudinal, controlled studies would be extremely helpful in elucidating the mechanisms underlying the association between pain and obesity,” Lee said.