Metabolic Abnormalities a Factor in Obesity-Related Pain

LAS VEGAS—Obesity is associated with worse outcomes in pain patients, but losing even modest weight loss can make a substantial difference, says Robert A. Bonakdar, MD, Assistant Clinical Professor in the Department of Family and Preventative Medicine at the University of California San Diego.

Studies show that a 5% weight loss is associated with about a 25% improvement in function and about a 30% reduction in pain, he told attendees.

Helping patients with pain and comorbid obesity requires clinicians to address possible underlying metabolic problems, sleep disturbances, and mental health issues, he said, noting that pain in obese patients is not just about mechanical overload.

Research has demonstrated an association between metabolic derangements and painful conditions. For example, a study of 900 patients looking at the link between diabetes and osteoarthritis demonstrated that dysfunctional glucose metabolism is an independent risk factor for advancing to worse joint disease and joint replacement.

Both depression and sleep problems in pain patients can affect their judgment such that they gravitate toward unhealthy foods such as those high in fat and calories, he said. Dr. Bonakdar noted that physical pain may trigger hedonic hunger (eating for pleasure) and binge eating. Additionally, patients may be subconsciously looking for specific foods to help deal with their pain.

Dr. Bonakdar also explained that clinicians need to move beyond body mass index (BMI) as a measure of obesity because it can be misleading. “We have patients with normal BMI who absolutely have a worse metabolic state than people who have elevated BMI,” he said.

Percent body fat and the distribution of the fat is more important, he said. Studies have shown that higher body fat percentages are associated with increases in insulin resistance.