Bigger is NOT Better

There is a current ad in Australia about the 10,000 tonne woman. This woman has got a bit of weight to lose this year – she is asking for our help. She has been a weight loss consultant for years, so she has seen a lot of people try to lose weight, and the difference support makes. Why are we trying to do it by ourselves? She decided to lose weight with a friend, as a team. Then other people got on board, and then she noticed that the more people shared the weight, the easier it got for everyone.

That’s why she is asking the whole country to join in. Pledge some weight, support someone on their mission, and we’re going to lose 10,000 tonnes together.

biggerI have pledged 30kgs (about 66 pounds) – yes, it’s a lot but it is the amount of weight I have gained since being on antidepressants and FM medication. It is ironic that, although many of these medications cause us to gain weight, excess weight is known to aggravate FM symptoms – such as pain sensitivity and sleep disturbances – and reduce quality of life among patients.

New research now shows, the more severe the obesity, the more severe the FM symptoms, and those who have a body mass index, or BMI, of 35 or higher experience the worst symptoms.

“I’m not surprised,” says study co-author Terry H. Oh, MD, assistant professor of physical medicine and rehabilitation at the Mayo Clinic, in Rochester, Minn. She says that earlier studies have shown that obesity increases symptoms, but there hadn’t been concrete information before this study about whether different levels of obesity affected FM symptoms differently.

In other words, is all obesity the same when it comes to FM?

Help-with-ObesityThe answer is no: Bigger definitely is worse, leading to significantly more severe symptoms. “The severely obese seemed to have the most problems,” says Dr Oh.

The study, published online in the journal Arthritis Care & Research, divided 888 adults with FM into four groups: non-obese (BMI less than 25), overweight (BMI of 25 to 29.9), moderately obese (BMI of 30 to 34.9) and severely obese (BMI equal to or greater than 35). Patients were tracked for three years, underwent a physical evaluation and were asked to fill out health surveys and the Fibromyalgia Impact Questionnaire.

The researchers found – for most symptoms, but not all – that as the BMI category increased, so did the severity of the symptoms. But trends showed most symptoms worsened with higher BMI, but for the most part, the difference in the severity of symptoms was statistically significant for the highest BMI group compared with the other groups. Patients in the highest BMI group, for example, missed work more often because of symptoms and reported more pain, stiffness and fatigue compared with those who were not obese or less obese. Also, the study found that the severely obese patients had more tender points on their bodies and worse physical functioning than the non-obese and less obese.

Why is there a relationship between BMI and the severity of symptoms? Dr Oh and her team write that multiple factors may be at work, including a higher level of pain receptors in fat tissue, elevated levels of pro-inflammatory cytokines, loss of physical fitness and an increase in mechanical loads on the body. And the higher rate of obesity in FM patients “may be caused by a vicious circle of pain and physical inactivity.”

It is important that people with fibromyalgia find a way to stay active despite the chronic pain and fatigue that come with it.

obesity“Those who are severely obese may need more help for weight-loss management,” Dr Oh says. “The basic message is that they have to stay active and exercise by starting slowly and gradually in terms of duration, intensity and frequency. It’s more than saying ‘lose weight.’ They need specific recommendations or to see a dietitian or endocrinologist or get other treatment options.”

Akiko Okifuji, PhD, a psychologist at the Pain Research and Management Center and professor at the University of Utah, in Salt Lake City, conducted earlier research on FM and obesity, which found that obese patients had more pain, less physical strength and more sleep problems.

“Both obesity and fibromyalgia are very different persistent conditions that impact overall health, physical well-being as well as quality of life,” Okifuji says.

She believes people intuitively know what Dr Oh’s study showed – that severe obesity is bad for FM patients. “But it’s good to show it scientifically,” Okifuji says. “Patients need proper nutritional education. It is difficult when you don’t move much. Sometimes food becomes a comfort. They need education on how to deal with that and how to maximize calorie burning while minimizing intake. When dealing with chronic fatigue and chronic pain, it is very difficult to do weight management. The key issue for the scientific and clinical community is to come up with an effective [weight management plan] for people who can’t move that much. It’s a tricky thing.”

Want to check your BMI?

Mine is 39 and I have decided it is time to get myself together! Anyone else with me?