Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

The Myth of Benign Obesity

There is no “benign obesity.” Now, what are we going to do about it?

They really are beautiful, and sexy, those women in the Cacique ads. Nothing appears wrong with them: How can beautiful and sexy be unhealthy? Well, the bottom line is that being overweight is not healthy. As cute as she might be, that full-figured gal is in reality a femme fatale, whose inability to count (and control) calories may lead to disease, potentially leaving her and her loved ones the direct and indirect victims of diabetes, arthritis, and heart disease.

This reality was brought home to readers of a recent article in “Annals of Internal Medicine,” which concluded that there is no such thing as healthy obesity. This declaration was based on a meta-analysis of eight studies, involving over 60,000 adults followed for over 10 years, the researchers analyzing the incidence of cardiovascular disease or all-cause mortality, and comparing outcomes for metabolically unhealthy (high blood sugar or high blood pressure, for example) and metabolically healthy individuals of various weights with outcomes for metabolically healthy individuals of normal weight.

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Metabolically healthy obese individuals were found to have almost a 25% higher risk of cardiovascular disease and death from any cause compared to metabolically healthy individuals of normal weight. And although clinically obvious poor health was not noted before 10 years, the researchers did find that excess weight is associated with early vascular disease, chronic inflammation, and thickening and calcification of the arteries. Of course, these vascular insults over time result in the manifestations of cardiovascular disease, including death. Shorter observation periods in similar studies led to the past, erroneous conclusions that there is such a thing as “healthy” obesity.

This study serves as a sort of second alarm ringing in the morning for those who persist in pressing the snooze button when it comes to maintaining a healthy body weight. Another large study, published last year in the journal “Obesity,” found that obesity and pain are often found in tandem—even if the obese individual is otherwise healthy.

So, why do pounds cause chronic pain?

We know that many conditions associated with pain are more common in the overweight and obese among us, including arthritis, depression, fibromyalgia, diabetes, and back pain. But the researchers found that there is pain associated with obesity, even when these potential causes of chronic pain are not present, and the correlation between pain and obesity becomes stronger with the more obese individuals.

Of course, no one has found the reason why fat causes pain. But there is a lot of probable cause out there: For example, fat cells are known to synthesize and release biochemicals that increase inflammation; and inflammation is associated with pain perception.

Who knows?

At least we know that there is no “benign obesity.” Now, what are we going to do about it?

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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