More Overweight Means More Are in Pain
May 12, 2005 — -- Dial Lewis used to weigh a trim 130. But once a "snake-like" pain started creeping along her hip and back area 15 years ago, she started taking medications to treat the problem. The medicines and the pain, she says, led to a weight gain of nearly 100 pounds.
The added weight then added more pain and it became a vicious cycle.
"I went from 135 to 140 to 160 to 220 -- before I knew it because steroids in the medications cause weight gain," the La Porte, Texas, resident said. "So you've got back pain and now you're carrying an extra 30 pounds.
"It's just a revolving door."
The number of overweight and obese Americans has risen at an alarming rate. According to the Centers for Disease Control and Prevention, more than 60 percent of Americans are overweight -- up from 23 percent in 1964. Studies have long linked weight gain to a slew of health problems from diabetes to coronary heart disease to gastric reflux and stroke, among others. In recent years, doctors specializing in chronic pain have also noted a growing number of overweight patients showing up in their offices, complaining of conditions like chronic back, hip, neck, leg and foot pain, even persistent, severe headaches.
John Foreyt, director of nutrition research at Baylor College of Medicine, for example, said that 20 years ago he rarely saw 300-pound patients. Today, he says they are common. Whether one condition leads to another, as in Lewis' case, doctors say the challenge lies in making sure the patient's weight is addressed when considering treatment for their pain.
"I think for many doctors there is a hesitancy to weigh their patients and talk about weight because of the social stigma associated with the obese," said Dawn Marcus, a chronic pain specialist in Pittsburgh. "But if doctors decline to evaluate their patients' weight, they miss a good opportunity to improve their health and get rid of their pain."
Extra Strain Means More Pain
Marcus' own work shows a clear link between being overweight and chronic pain. In a June 2004 study published in the Clinical Journal of Pain, Marcus evaluated the extent and effects of chronic pain among 372 of her patients. While she found the severity of pain was similar among all weight classes, those who were overweight and obese had a harder time recovering from their pain and their lives were more affected by it.
"The higher the people's weight, the more they tended to have pain-related disability," she said.
Why the link? Marcus says the correlation becomes obvious when considering the strain extra weight places on the body.
"It's like carrying a 30- to 40-pound bag on your back when hiking," she said. "After just an hour or two, you notice the weight and start feeling pain in your back and joints. The difference is if you're overweight, you can't take it off instantly and say, 'Ooh, I feel so much better now.'"
The problem isn't only mechanical. Being overweight can also place a strain on the body's circulatory system, which, in turn can lead to inflammation in the joints and headaches -- both common chronic pain complaints.
Marcelo Bigal, a neurologist at Yeshiva University's Albert Einstein College of Medicine in New York, recently measured the influence of weight on the frequency and severity of headaches. Among the more than 143,000 people reached and questioned by phone, he found 33 percent of obese people missed more than four days of work in one year because of a severe headache, compared with 27 percent of overweight people, 27 percent of normal weight people and 26 percent of those who were underweight.
"The findings suggest that people with obesity were more likely to report frequent, more painful and more debilitating headaches than other groups," Bigal said.
Surgical Solutions Can Create New Problems
David B. Allison, a biostatician at the University of Alabama at Birmingham, says for doctors examining overweight patients who are in chronic pain, part of their reluctance to discuss weight may be linked to the perception that they can do little about it.
"Sometimes it can be like beating their heads against a wall," Allison said. "We don't have good tools to treat obesity. Some pharmaceuticals are moderately effective. Counseling can help too, but that requires more time than the average physician can spend with their patients."
Even those treatments that have shown to clearly help patients lose weight carry their own complications.
Gastric bypass surgery has become increasingly popular in recent years as a favored treatment in the battle against fat. The number of weight-loss operations, including gastric bypasses, has jumped 400 percent since 1999 to more than 140,000 surgeries last year.
With the increase in surgeries, however, has been an increase in people dying or suffering from complications from the surgeries.
According to a health technology assessment published last year, 1 percent to 2 percent of patients die during or shortly after gastric bypass surgery, while an additional 10 percent to 20 percent develop complications. Some of these complications involve chronic pain -- something Lewis continues to experience after undergoing gastric bypass surgery two years ago.
"Since having the bypass, the lowest I've weighed is 220," Lewis said. "But the bypass has caused its own problems."
It may be the only way to stop the cycle of weight gain and chronic pain, Marcus says, is for doctors and patients to take the time to address both conditions through counseling as well as medications.
"We need to not be afraid to tell our patients that they're overweight," she said. "It's not like saying 'you're ugly' or 'I don't like you.' It's about telling them about a real medical condition. And it's the only way to begin to help."