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Olson KL, Eccleston C. Reconsidering the Role of Weight Loss in Treatment for Chronic Pain: Knee Osteoarthritis as an Exemplar. THE JOURNAL OF PAIN 2024:104647. [PMID: 39103008 DOI: 10.1016/j.jpain.2024.104647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/07/2024]
Abstract
Chronic pain is prevalent among individuals with higher body weight and associated with greater impairment. As a result, weight loss is a common recommendation for pain management among those with higher body weight. Body weight is an appealing target because it is modifiable and evidence-based treatments to produce weight loss are well-established. In the last 2 decades, there has been a growing line of scientific work investigating the application of weight loss to individuals with chronic pain. This represents an important step to integrate the conceptualization of pain and body weight and there is preliminary work suggesting treatment effects are enhanced when weight loss treatment is combined with pain coping skills. However, weight loss outcomes are variable and difficult to sustain, and access to evidence-based treatment is limited. These concerns are set against the backdrop of growing public and academic concern about the weight-centric approach to health care that dominates western medicine. This is a timely moment to reconsider the conceptualization of weight and pain, and the role of weight loss in chronic pain treatment. Using osteoarthritis as an exemplar, we review the evidence for and clinical uptake of weight loss as a chronic pain management strategy and conclude with key areas for consideration to advance the scientific understanding of these comorbid conditions and how to optimize pain management for individuals of higher body weight. PERSPECTIVE: This focus article critically considers the role of weight loss in management of chronic pain among individuals of higher body. Using knee osteoarthritis as an exemplar, the evidence and clinical uptake of weight loss for pain management is reviewed. Limitations are considered to guide future research and clinical care.
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Affiliation(s)
- KayLoni L Olson
- Weight Control and Diabetes Research Center, Miriam Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island.
| | - Christopher Eccleston
- Research Department for Health, University of Bath, Bath, England; Centre for Pain Research, University of Bath, Bath, England
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Fabrig A, Schmidt R, Mansfeld T, Sander J, Seyfried F, Kaiser S, Stroh C, Dietrich A, Hilbert A. Depressive Symptoms among Bariatric Surgery Candidates: Associations with Stigmatization and Weight and Shape Concern. Nutrients 2024; 16:510. [PMID: 38398834 PMCID: PMC10891665 DOI: 10.3390/nu16040510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Bariatric surgery candidates (BSC) are a highly vulnerable group for mental health impairments. According to the theoretical model of weight stigma, weight-related experienced stigmatization (ES) negatively influences mental health through weight bias internalization (WBI). This study tested this model among BSC and investigated whether this association depends on a negative body image in terms of weight and shape concern as a potential moderator. As part of a German multicenter study, ES, WBI, weight and shape concern, and depressive symptoms were assessed via self-report questionnaires among n = 854 BSC. Simple and moderated mediation analyses were applied to analyze whether WBI influences the relationship between ES and depressive symptoms, and whether this influence depends on weight and shape concern. WBI significantly mediated the relationship between ES and depressive symptoms by partially reducing the association of ES with depressive symptoms. Weight and shape concern emerged as significant moderators in the overall model and specifically for associations between WBI and depressive symptoms. The results suggest that the association between ES and depressive symptoms among BSC is stronger in those with high WBI. This association is strengthened by weight and shape concern, especially at low and mean levels. Studies evaluating longitudinal associations between weight-related stigmatization and mental health are indicated, as well as intervention studies targeting WBI in order to reduce adverse effects of ES on mental health in BSC.
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Affiliation(s)
- Alexandra Fabrig
- Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig Medical Center, Stephanstrasse 9a, 04103 Leipzig, Germany; (A.F.)
| | - Ricarda Schmidt
- Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig Medical Center, Stephanstrasse 9a, 04103 Leipzig, Germany; (A.F.)
| | - Thomas Mansfeld
- Department of General Surgery, Asklepios Clinic, 22559 Hamburg, Germany
| | - Johannes Sander
- Schön Klinik Hamburg Eilbek, Obesity Clinic, 22081 Hamburg, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, 97080 Würzburg, Germany
| | - Stefan Kaiser
- Department of Visceral, Pediatric and Vascular Surgery, Hospital Konstanz, 78464 Konstanz, Germany
| | - Christine Stroh
- Department of Surgery, SRH Wald-Klinikum, Adipositas Zentrum, 07548 Gera, Germany
| | - Arne Dietrich
- Department of Surgery, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Anja Hilbert
- Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig Medical Center, Stephanstrasse 9a, 04103 Leipzig, Germany; (A.F.)
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Vilugrón Aravena F, Cortés M, Valenzuela J, Rojas C, Gutiérrez P. [Obesity, weight-related stigma and its association with the perception of quality of life in Chilean university students]. NUTR HOSP 2023. [PMID: 37073745 DOI: 10.20960/nh.04338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION little attention has been paid to the effect of exposure to weight-related stigma on the quality of life of young Chileans with little obesity. OBJECTIVE to identify the prevalence of weight-related stigma and to analyze its association with obesity and the perception of quality of life in university students from Valparaíso, Chile. METHODS correlational type study and cross-sectional design. Two hundred and sixty-two university students participated, from 18 to 29 years old, matriculated in the Faculty of Health Sciences of a public university in Valparaíso, Chile. Quality of life was assessed with the WHOQOL-BREF scale, weight-related stigma with the Brief Stigmatizing Situations Inventory (SSI), and nutritional status with body mass index (BMI) classification. The application of the questionnaires was on-line and the answers were anonymous. Multiple logistic regression models were used to evaluate the association between the variables, adjusted for gender and age. RESULTS the prevalence of stigma related to weight was 13,2 % in eutrophic, 24,4 % in overweight and 68,0 % in obese. Weight-related stigma, rather than obesity itself, is associated with poorer perceived physical health (OR: 4.30; 95 % CI: 2.10-8.80), psychological health (OR: 4.51; 95 % CI: 2.20-9.26), social relationships (OR: 3.21; 95 % CI: 1.56-6.60) and environment (OR: 2.86; 95 % CI: 1.33-6.14). CONCLUSION students exposed to stigmatizing situations related to weight had a worse perception of their quality of life compared to those not stigmatized.
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Affiliation(s)
- Fabiola Vilugrón Aravena
- Departamento de Salud, Comunidad y Gestión. Facultad de Ciencias de la Salud. Universidad de Playa Ancha
| | - Milenko Cortés
- Nutrición y Dietética. Facultad de Ciencias de la Salud. Universidad de Playa Ancha
| | - Javiera Valenzuela
- Nutrición y Dietética. Facultad de Ciencias de la Salud. Universidad de Playa Ancha
| | - Camila Rojas
- Nutrición y Dietética. Facultad de Ciencias de la Salud. Universidad de Playa Ancha
| | - Paulina Gutiérrez
- Nutrición y Dietética. Facultad de Ciencias de la Salud. Universidad de Playa Ancha
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Sedney C, Cowher A, Turiano NA, Cox S, Dekeseredy P, Haggerty T. Understanding the Intersectional Relationship of Pain Stigma, Weight Bias Internalization, and Clinical Indicators in a Rural Population with Back Pain: A Survey-Based Study. World Neurosurg 2023; 171:e846-e851. [PMID: 36603648 DOI: 10.1016/j.wneu.2022.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Stigma is understood to be intersectional, meaning multiple characteristics can be stigmatizing, and they may be both overlapping and coconstitutive. Chronic pain and overweight are common complaints in the spinal surgery clinic. Since being overweight may relate to back pain in a complex fashion, we sought to understand if there is a moderating effect between weight bias and pain stigma. METHODS This study involves a survey-based, quantitative, cross-sectional, observational design using previously validated measures and demographic and clinical information. There were 192 participants. Statistical calculations were done with statistical package for the social sciences. RESULTS Pain stigma was not significantly correlated with BMI (body mass index), and weight bias was not significantly correlated with back pain. There was a strong positive correlation between weight bias and pain stigma. There was a strong positive correlation between weight bias and BMI when pain stigma was also high. CONCLUSIONS Given the relationship between weight stigma and pain, the intersection of weight and pain stigma is important because it indicates the vulnerability of patients with higher BMI to other forms of stigma, such as stigma for their pain complaints. Clinicians should be mindful of expressing pain stigma more significantly amongst patients with higher BMI.
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Affiliation(s)
- Cara Sedney
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
| | - Abigail Cowher
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Nicholas A Turiano
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Stephanie Cox
- Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | - Patricia Dekeseredy
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
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Olson KL, Panza E, Lillis J, Wing RR. Association of Weight-Related Stigmas With Daily Pain Symptoms Among Individuals With Obesity. Ann Behav Med 2022; 57:269-274. [PMID: 35738017 PMCID: PMC10074027 DOI: 10.1093/abm/kaac025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Individuals with obesity are disproportionately impacted by pain-related symptoms. PURPOSE This study evaluated experienced weight stigma and internalized weight bias (IWB) as predictors of pain symptoms in daily life among individuals with obesity. METHODS Adults with obesity (n = 39; 51% female, 67% White, 43.8 ± 11.6 years old, BMI = 36.8 ± 6.7 kg/m2) completed a baseline assessment (demographics, experienced weight stigma, IWB) and a 14-day Ecological Momentary Assessment (EMA) period involving five daily prompts of pain/aches/joint pain, muscle soreness, experienced weight stigma, and IWB. Generalized linear models were used to assess experienced weight stigma and IWB at baseline as prospective predictors of EMA pain/soreness symptoms. Multi-level models were used to test the association of momentary weight stigma experiences and IWB with pain/soreness at the same and subsequent EMA prompts. RESULTS IWB at baseline, but not experienced weight stigma, was associated with more frequent pain symptoms (p < .05) and muscle soreness (p < .01) during EMA. Momentary IWB (but not experienced stigma) was associated with more pain/aches/joint pain and muscle soreness at the same and subsequent prompt. CONCLUSIONS Internalized (but not experienced) weight bias was prospectively associated with pain symptoms in daily life among individuals with obesity. Results are consistent with growing evidence that weight-related stigmas represent psychosocial factors that contribute to weight-related morbidity typically attributed to body size.
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Affiliation(s)
- KayLoni L Olson
- The Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Emily Panza
- The Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Jason Lillis
- The Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Rena R Wing
- The Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
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Internalised weight stigma as a mediator of the relationship between experienced/perceived weight stigma and biopsychosocial outcomes: a systematic review. Int J Obes (Lond) 2022; 46:1-9. [PMID: 34628466 PMCID: PMC8501332 DOI: 10.1038/s41366-021-00982-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically review studies that have assessed the mediating role of internalised weight stigma on the relationship between experienced/perceived weight stigma and any biopsychosocial outcomes. METHODS PsycINFO, PsycExtra, Web of Science, CINAHL, Medline and Embase were systematically searched. Identified studies were double screened (HB and XPG). RESULTS Seventeen studies (across 16 articles) met our inclusion criteria (N = 21,172), and almost all studies measured only psychological outcomes (n = 15). Eight studies found consistent evidence for internalised weight stigma as a mediator of the relationship between experienced/perceived weight stigma and disordered eating outcomes. Preliminary evidence was found for the mediating role of internalised weight stigma on the relationship between experienced/perceived weight stigma and body shame, body dissatisfaction, exercise behaviour, healthcare experiences and behaviours, bodily pain and parental weight talk. However, the findings were inconsistent for depression and anxiety, although only two studies reported these. CONCLUSION This review provides preliminary evidence for internalised weight stigma as an intervening variable in the relationship between experienced/perceived weight stigma and adverse health outcomes. Results suggest that there are potential benefits of interventions addressing internalised weight stigma to improve health outcomes. However, these findings must be considered in the context of the psychometric limitations of the Weight Bias Internalisation Scale, which was used in all but one study.
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Olson KL, Goldstein SP, Wing RR, Williams DM, Demos KE, Unick JL. Internalized weight bias is associated with perceived exertion and affect during exercise in a sample with higher body weight. Obes Sci Pract 2021; 7:405-414. [PMID: 34401199 PMCID: PMC8346369 DOI: 10.1002/osp4.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE For individuals with overweight/obesity, internalized weight bias (IWB) is linked to low physical activity (PA). This study used a laboratory-based paradigm to test the hypothesis that IWB moderates the association between heart rate (HR) and perceived exertion and affect during PA. METHODS Participants with overweight/obesity completed 30-min of supervised moderate-intensity treadmill walking (65%-75% of age-predicted maximal HR). Body Mass Index (BMI) and Weight Bias Internalization Scale were assessed at baseline. HR was monitored every minute; perceived exertion and affect were assessed every 5 min. Linear mixed models were employed with random effects of time and participant. RESULTS The sample (n = 59; 79.7% female, 91.5% white) had an average BMI = 32.1 kg/m2 (SD: 3.3), and age = 47.1 (SD: 10.3) years. There was a main effect of IWB on perceived exertion (greater IWB was associated with greater perceived exertion during exercise; p < 0.001). There was an interaction of IWB and HR on affect (B = -0.01, p < 0.01). For individuals with high IWB, HR elevations were associated with a negative affective response during exercise. For individuals with low IWB, HR elevations were associated with increased positive affect during PA. CONCLUSIONS Findings indicate that among individuals of higher body weight, IWB is associated with reporting higher perceived exertion during 30 min of moderate intensity PA. IWB moderated the relationship between increasing HR during exercise and affect. Among individuals with overweight/obesity who report IWB, the initial experience of PA may be harder and more unpleasant, with lasting implications for the adoption of PA.
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Affiliation(s)
- KayLoni L. Olson
- Department of Psychiatry and Human BehaviorBrown Medical SchoolProvidenceRhode IslandUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
| | - Stephanie P. Goldstein
- Department of Psychiatry and Human BehaviorBrown Medical SchoolProvidenceRhode IslandUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
| | - Rena R. Wing
- Department of Psychiatry and Human BehaviorBrown Medical SchoolProvidenceRhode IslandUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
| | | | - Kathryn E. Demos
- Department of Psychiatry and Human BehaviorBrown Medical SchoolProvidenceRhode IslandUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
| | - Jessica L. Unick
- Department of Psychiatry and Human BehaviorBrown Medical SchoolProvidenceRhode IslandUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
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Siqueira BB, Assumpção MC, Barroso SM, Japur CC, Penaforte FRDO. Weight stigma and health – Repercussions on the health of adolescents and adults: integrative review of the literature. JORNAL BRASILEIRO DE PSIQUIATRIA 2021. [DOI: 10.1590/0047-2085000000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To conduct an integrative review in order to understand the repercussions of the social stigma of overweight on the health of adults and adolescents. Methods The international protocol for systematic review and meta-analysis studies PRISMA was adopted to guide the writing of this review. The databases used were PubMed, Psycinfo, SciELO, Medline, Lilacs and Pepsic, considering studies published in the period from 2000 to 2020. Sixty-seven (67) articles were analyzed, and 4 categories emerged: repercussions on physical well-being; repercussions on social well-being; repercussions on mental well-being; and mixed category (physical and psychological impact). Results In the vast majority of studies analyzed, weight stigma had a negative impact on the different spheres that make up the health construct, that is, the physical, social and mental spheres. Conclusions The consequences of weight stigma are a source of intense suffering, with an impact that reduces the quality of life of individuals who experience stigmatization, involving physical, emotional and social aspects.
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Markey CH, Dunaev JL, August KJ. Body image experiences in the context of chronic pain: An examination of associations among perceptions of pain, body dissatisfaction, and positive body image. Body Image 2020; 32:103-110. [PMID: 31862524 DOI: 10.1016/j.bodyim.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 11/23/2019] [Accepted: 11/23/2019] [Indexed: 01/18/2023]
Abstract
Although body image research has recently begun to examine positive body image and ways to improve body image, it remains unclear the extent to which these findings generalize to individuals who experience chronic pain. With this in mind, this study examined individuals with chronic pain conditions (N = 278, Mage = 36.75, SD = 11.56), including their reports of their ability to control, manage, and accept their pain. Participants also completed assessments of four facets of body image: perceptions of body functionality, body appreciation, appearance evaluation, and body satisfaction. Results indicated that pain acceptance was the most consistent, unique predictor of these body image constructs, after controlling for the other pain facets, as well as body mass index, gender, and age. These findings have implications for improving body image among people with chronic pain; it appears that controlling or altering pain may be less relevant to body image than is how individuals cope with pain.
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