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Obesity and Fibromyalgia



Readers may recall previous posts on the relationship between obesity and fibromyalgia, a chronic condition characterised by widespread pain, muscle tenderness, and decreased pain threshold to pressure and other stimuli.

Ursini and colleagues from Cantazaro, Italy, review the possible relationship between these two entities in a paper just published in Rheumatology International.

The authors review the epidemiological data showing that fibromyalgia patients have higher prevalence of obesity (40%) and overweight (30%) and discuss several mechanisms that may explain ‘the hidden link’ between these two conditions.

Proposed mechanisms include:

  • impaired physical activity
  • cognitive and sleep disturbances
  • psychiatric comorbidity and depression
  • thyroid dysfunction
  • dysfunction of the GH/IGF-1 axis
  • impairment of the endogenous opioid system

However, as they also note:

“…at this time is not possible to ascertain whether obesity is a cause or consequence of fibromyalgia.”

Nevertheless, the authors do suggest that the ‘causal’ relationship between the two conditions is supported by observations that fibromyalgia severity can be improved by weight loss.

This may be a good opportunity to remind readers that ‘causality’ is actually not always easy to demonstrate and it does take many levels of evidence to make any assumptions about causality convincing.

These include:

  • Biological plausibility (this is usually where basic science comes in)
  • Time course (this requires longitudinal studies)
  • Dose-effect relationship (can be seen in cross-sectional studies)
  • Strength of association (epidemiology)
  • Coherence (consistency across different studies)

Add to this positive list the negative criterium that there must also be no ‘reasonable’ alternative explanations for the finding, and one may be able to eventually make a case for ‘causality’.

Unfortunately, medicine is fraught with uncertainity, as data from different studies may be conflicting or inconclusive.

This does not mean science is wrong – it just means that answers become more or less likely depending on the amount and quality of data and our understanding of the underlying biology.

This is the difference between science and pseudoscience – when new data emerges, scientists change their opinion – pseudoscientists ignore it.

Unfortunately, many prefer the ‘certainty’ of ignorance than the ‘uncertainty’ of true knowlegde.

This is why the progress of the ‘pilgrim of science’ is such an exciting and ever-fascinating journey.

I, for one, am glad that so many of my readers are willing to bear with me and join me on this expedition.

AMS
Edmonton, Alberta

Ursini F, Naty S, & Grembiale RD (2011). Fibromyalgia and obesity: the hidden link. Rheumatology international PMID: 21476098

9 Comments

  1. many problems arise by obesity…. people who are suffering from this problem must watch it………

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  2. or perhaps they just have a common cause; sugars, grains and manufactured oils.

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  3. What a lovely post. Fibromyalgia is a perfect example of a self made condition. i have much compassion for sufferers, as the randomness of their pain and the variety of treatments often fail. It is as if their body is overreacting to environmental demands that don’t exist. They fail before they start.

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  4. I have a friend who suffered from fibromyalgia for many years. We’d grown up together; I was a fat kid and she was thin until her mid-twenties, when she started experiencing the symptoms. She put on weight while she was struggling with it.

    It came on during a very stressful time in her life, when she was separated from friends and family, was in a bad relationship, and was struggling to survive. She could barely make it through a work day, and any kind of physical activity was painful and exhausting for her. Since she feeling so run down, she may have been eating to try to boost her energy level, I don’t know. Anyway, she went from thin to around my size (a little over 200 pounds).

    In recent years, her fibromyalgia has improved and she’s gotten her life more together. She’s also a little thinner again – somewhere in between the size she was originally and her largest size. I suspect that she lost weight as her fibromyalgia symptoms abated, because when she was at her low point, she wasn’t able to lose any weight. Hell, she could barely make it through a normal day.

    I know that she was trying to lose weight when her fibromyalgia was at its worst, because she kept telling me about how she couldn’t, I kept telling her she’d feel better if she got more exercise. It was probably ignorant of me to say, but she was blaming how bad she felt partly on her weight, and there I was, the same size and without any of her problems. I didn’t understand the fibromyalgia, but I could see that I was a lot more physically active than she was, and I thought that might have been part of the reason why I felt fine and she felt horrible. Honestly though, I don’t think that she was able to take that advice until the fibromyalgia started fading on its own.

    It’s a really nasty condition, and the weight gain that’s associated with it is the least of it.

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  5. Hi Dr. Sharma,

    Are there any definitive markers for fibromyalgia? i.e. blood tests, eeg results, or?

    In the late 80’s-early 90’s, I was diagnosed with fibromyalgia by my family doctor. In 1999, I was diagnosed with psoriatic arthritis by my rheumatologist. My GP still felt I had fibromyalgia as well.

    Certainly, whatever the diagnosis, the lack of the ability to do much physical exercise has definitely made it very easy for me to gain weight and difficult to lose and keep it off.

    However, with the help of Weight wise and modified exercise programs, (Step Forward and Waterworks) I am managing to lose at a very slow rate of about 1 pound a week. Frustratingly slow, but I’m doing it!

    Thanks for listening,
    Rosemary in Edmonton

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  6. Rosemary- Oh, that explains the weight gain. So, yeah. My friend with fibro had that happen too.

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  7. DeeLeigh, I live with fibro and I find what you said to be so true. I actually had my first recognizable flare-up of fibro when I had lost 175lbs and was the healthiest I’d been in years. I was exercising 3-4 times a week for 30mins to an hour.

    Then, I remember going to the doctor with the complaint that I ached all over and was so tired! I actually said, “I feel like I’ve been hit by a truck.” A lot of us sound alike when we describe it, so a lot of doctors know it when they hear it. Mom has it… I have it, too.

    Anyhow, I SO wanted to keep up my exercise and I was SO aware of what I’d accomplished in losing that weight! I just didn’t get a diagnosis for at least 3-4 years later and by that time, I was so fearful that I couldn’t keep my job. When I first got sick, I would work and then fall into bed exhausted and then wake up the next morning to go to work again. I had ambitions and hopes, but they were deferred due to my health. I didn’t know what was going on at all. I was so relieved to get a diagnosis because I could start trying to get my life back.

    I am about 25lbs shy of what I used to weigh. The medicines make it very hard to lose weight. I’m exercising 3-4 times a week now, but usually for 15mins or 20 minutes. My physical therapist sees that I’m quite driven. I do eat when I’m tired. Night eating after I take my sleep meds is a big issue for me. I used to overeat when I was in pain. I think I’m just physically overloaded, and when I’m fatigued I have less resistance! Just think how normal people feel after having a bit of insomnia.

    By the end of the work-week, I feel exhausted. I wish I could make more social commitments and do some of the things I used to do — go out walking with my heavy (professional-style) camera and take pictures of nature, or go shopping across town by foot/by bus and carry a ton of stuff home… I bought a mountain bike… Paid $300 for it… never used it. I’m doing a recumbent bike which I can set the resistance on. I found the weight of the mountain bike to be too much of an issue and wonder if a lighter-style bike is doable or not. ($300 later!!!!)

    There is much I want to do in life. My mother has fibro, too, and I feel for her. I hope research will find better treatments but thank goodness there are doctors out there who are doing what they can to help (and researchers, too!!!!!)

    Heather

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  8. I am researching websites to indeed find out if a large percentage of FM patients are obese as a result of having FM? I was diagnosed 25 years ago after going thru many years of seeing Internists and doctors. I finally found a doctor who was fresh out of medical school who pressed on the tell-tale pressure points after listening to my long list of symptoms. He presribed muscle relaxants and a low dose antidepressant for quality of sleep. I now also use Tramadol for the pain. Within the first year of “feeling like I was hit by a Mack truck” and constantly sleeping, I went from 145 pds. to 185 pds. I could no longer go dancing like I had, I could no longer take long walks with my young son. My whole life changed. All I could think about was coming home and going to bed. The only exercise I had was going from the house to the car and taking road trips with my son. I was too tired to make supper and had to resort to picking up fast food everynight. My son also gained weight. The second year I gained another 40-50 pounds. The last 25 years I have lived in a “fibro fog” and as I get older, my fibro has not gotten any better. I now weigh 325 pounds, have arthritis in my knees, torn right knee cartlidge, heel spurs, fibro pain all over and can no longer walk for any distance without a walker due to pain in my muscle calves. The only exercise I feel I can do and have started doing is walking for an hour in the pool. I have worked up until February of this year at which time my employer eliminated my position. I think my Fibromyalgia was brought on by extreme stress or a virus (Ebstein Barr Virus) was able to invade my immune system since it was weakened or compromised. I feel like a mess now and have applied for Disability. After researching, it does appear that there is some correlation between FM and excess weight. I am just happy that the medical field has recognized that this is a medical condition and not a psychological ailment.
    I pray for that magic pill for all who have FM.
    Debbie

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