Fibromyalgia is a complex chronic pain disorder that affects approximately 2-8% of the population. Obesity has been identified as a risk factor, with nearly 50% of fibromyalgia patients considered obese.
Fibromyalgia patients have higher prevalence of obesity and overweight in multiple studies compared with healthy patients.
This raises the question whether losing weight could make fibromyalgia go away or “cure” the condition. We reviewed the evidence on the impact of weight loss on fibromyalgia prognosis.
Weight Loss Effects on Fibromyalgia Symptoms
Research shows that gradual weight loss in fibromyalgia patients can:
- Reduce pain, fatigue, stiffness, and tenderness
- Improve sleep quality and duration
- Lessen symptoms of depression and anxiety
- Increase physical function and ability to exercise
However, most studies involve modest weight loss of 5-10% in overweight and obese subjects. This degree of weight loss only partially alleviates symptoms rather than putting fibromyalgia into remission.
Additionally, weight regain often leads to recurrence of fibromyalgia symptoms. So weight loss effects appear reversible rather than curative.
Potential Mechanisms Linking Weight Loss to Fibromyalgia
Some proposed mechanisms by which weight loss may improve fibromyalgia include:
- Reducing mechanical stress on muscles and joints
- Lowering inflammation associated with obesity
- Increasing conditioning and stamina for physical activity
- Enhancing self-esteem and body image
These changes likely modulate pain pathways, normalize neurotransmitter function, and influence psychosocial factors contributing to symptom perception and fibromyalgia severity.
What does the latest medical evidence says?
The research on this topic is mixed, with some studies suggesting weight loss can improve fibromyalgia symptoms but others finding no effect. Several studies found obesity and being overweight are common in people with fibromyalgia, with prevalence around 30-50% [1]Ursini F, Naty S, Grembiale RD. Fibromyalgia and obesity: the hidden link. Rheumatology international. 2011 Nov;31:1403-8.
Some research indicates weight loss may decrease fibromyalgia pain, fatigue, and disability. Shapiro (2005) found weight loss of about 10 pounds over 20 weeks significantly improved pain, pain interference, body satisfaction and quality of life in overweight women with fibromyalgia[2]Shapiro JR, Anderson DA, Danoff-Burg S. A pilot study of the effects of behavioral weight loss treatment on fibromyalgia symptoms. Journal of psychosomatic research. 2005 Nov 1;59(5):275-82..
Okifuji (2010) also found obesity was linked to greater pain sensitivity, worse sleep, less strength and flexibility in fibromyalgia patients. Aparicio (2013) found normal weight fibromyalgia patients had less pain, fatigue, morning tiredness and stiffness than overweight or obese patients. However, other research found no benefit of weight loss for fibromyalgia[3]Okifuji A, Donaldson GW, Barck L, Fine PG. Relationship between fibromyalgia and obesity in pain, function, mood, and sleep. The Journal of Pain. 2010 Dec 1;11(12):1329-37..
D’Onghia (2021) reviewed many studies and found inconsistent evidence for whether weight loss improves fibromyalgia symptoms. Rossi (2015) reviewed nutrition and fibromyalgia and found little evidence diet or supplements help, though weight control may provide some benefit[4]D’Onghia M, Ciaffi J, Lisi L, Mancarella L, Ricci S, Stefanelli N, Meliconi R, Ursini F. Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis. InSeminars in Arthritis … Continue reading.
Losing excess weight is unlikely to completely cure fibromyalgia but may be a useful part of an overall treatment plan for some patients, especially those who are obese or overweight.
Medical study evaluates relationship between fibromyalgia and obesity in pain
Okifuji and colleagues evaluated the relationship between patients with fibromyalgia and obesity.
- The study found a high prevalence of obesity among fibromyalgia patients, with 47% being obese (BMI ≥30) and an additional 30% overweight (BMI 25-29.9).
- Obese fibromyalgia patients exhibited significantly higher pain sensitivity as measured by tender point examination, especially in lower body areas like the gluteals, knees and hips.
- Pain sensitivity was positively correlated with BMI (r=0.277, p=0.002), suggesting a relationship between greater body weight and heightened pain.
- Obese patients showed reduced physical function including decreased strength as assessed by push-ups (p=0.018), phantom chair test (p=0.013) and bridging reps (p=0.020).
- Sleep was impacted in obesity, with shorter duration (p<0.001), lower efficiency (p=0.004), and greater sleep activity/restlessness (p=0.007).
- Depression scores were higher in obese patients (p=0.001) but other self-reported symptoms like pain and fatigue did not differ significantly.
- Proposed mechanisms linking obesity and fibromyalgia include mechanical loading on tissues, inflammation, endocrine alterations affecting pain processing, and dysfunction of endogenous opioid pathways.
- Weight loss through caloric restriction has been shown in other studies to improve fibromyalgia symptoms, pain, sleep, depression, and quality of life.
- The study concludes that obesity appears to worsen certain fibromyalgia symptoms like pain sensitivity and physical function, suggesting weight management should be incorporated into treatment.
Challenges of Maintaining Weight Loss
While weight loss can provide symptomatic relief, challenges with maintaining long-term weight reduction may limit its efficacy. Difficulties fibromyalgia patients face include:
- Adhering to strict dieting requirements needed for continued weight loss
- Persisting with exercise due to increased pain and fatigue
- The influence of medications that promote weight gain
- Struggling with ongoing stress, depression, and lack of motivation
Weight Loss and Fibromyalgia Remission
Despite the potential symptomatic improvements, there is currently no strong evidence that weight loss can lead to complete fibromyalgia remission or a “cure”.
- Most studies show only partial or temporary relief of symptoms with modest weight loss.
- However, there are some case reports of substantial weight loss inducing fibromyalgia remission.
Early weight intervention before significant fibromyalgia progression may have the best chance of positively impacting prognosis.
Conclusion
In summary, weight loss alone rarely results in full fibromyalgia remission, but can help improve symptoms like pain and fatigue. The amount of weight loss needed for optimal clinical impact is still unknown.
Gradual weight reduction through caloric restriction and exercise should be a component of fibromyalgia treatment. But weight loss by itself is unlikely to “cure” established fibromyalgia in most patients.
More research is needed to understand the complex relationship between obesity, weight loss, and fibromyalgia prognosis. Healthcare providers should have realistic expectations when recommending weight loss as part of a multifaceted fibromyalgia treatment approach.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.
References
| ↑1 | Ursini F, Naty S, Grembiale RD. Fibromyalgia and obesity: the hidden link. Rheumatology international. 2011 Nov;31:1403-8. |
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| ↑2 | Shapiro JR, Anderson DA, Danoff-Burg S. A pilot study of the effects of behavioral weight loss treatment on fibromyalgia symptoms. Journal of psychosomatic research. 2005 Nov 1;59(5):275-82. |
| ↑3 | Okifuji A, Donaldson GW, Barck L, Fine PG. Relationship between fibromyalgia and obesity in pain, function, mood, and sleep. The Journal of Pain. 2010 Dec 1;11(12):1329-37. |
| ↑4 | D’Onghia M, Ciaffi J, Lisi L, Mancarella L, Ricci S, Stefanelli N, Meliconi R, Ursini F. Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis. InSeminars in Arthritis and Rheumatism 2021 Apr 1 (Vol. 51, No. 2, pp. 409-424). WB Saunders. |