This of course also applies to patients diagnosed with multiple sclerosis (MS), a progressively disabling disease of the central nervous system currently affecting an estimated 2·5 million people worldwide. Multiple sclerosis is also the most common non-traumatic cause of disability in young adults.
In addition, patients with multiple sclerosis also often have psychiatric comorbidities ranging from depression, anxiety and social phobias to sleep disorders and chronic pain, which can all further adversely affect ingestive behaviour.
In a paper by Ruth Ann Marrie and Ralph Horowitz from the University of Manitoba, Winnipeg, Canada, just published in Lancet Neurology, the authors discuss why recognising obesity and other chronic illnesses in patients with multiples sclerosis is so important.
Apart from promoting the obvious sequelae of hypertension, diabetes and heart disease, obesity is also associated with delayed diagnosis of multiple sclerosis and obese patients tend to have higher levels of immobility and disability at the time of diagnosis.
Conversely, the diagnosis of comorbidities could be delayed by mistakenly attributing neurological symptoms such as progressive inability to walk, pain, or seizures to the pre-existing diagnosis of MS.
Corticosteroids used for relapses, may also contribute to weight gain and worsening of diabetes.
As the authors point out in the discussion:
“Further work is needed to establish whether pre-existing comorbidities affect the risk and phenotype of multiples sclerosis and, if so, how. Data from some studies indicate that comorbidities and health behaviours also affect disease progression. These findings need to be verified, and a broader range of disability outcomes, such as upper extremity and cognitive function, need to be taken into account. From a therapeutic perspective, important questions include whether comorbidities affect treatment choice, response, tolerability, and adherence, and whether we should use different treatment strategies in the presence of a comorbidity.”
As in all patients with impaired mobility and other physical or mental comorbidities, weight management can be challenging and should probably start well before weight gain sets in.
Marrie RA, & Horwitz RI (2010). Emerging effects of comorbidities on multiple sclerosis. Lancet neurology, 9 (8), 820-8 PMID: 20650403