Musculoskeletal pain in the obese: a comparison with a general population and long-term changes after conventional and surgical obesity treatment

Peltonen, Markku; Lindroos, Anna Karin; Torgerson, Jarl

doi:10.1016/s0304-3959(03)00091-5

Cited by 245 publications

(198 citation statements)

References 35 publications

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“…Schouten et al reported that disabilities could partly be due to cartilage loss, which is known to be strongly associated with knee OA and overweight (36) . Peltonen et al (37) concluded that obese subjects have more problems with work-restricting musculoskeletal pain than non-obese subjects. In a review Zamboni et al (38) found that body weight and BMI play a significant role in non-fatal physical disability in the elderly.…”

Section: Discussionmentioning

confidence: 99%

Overweight and health problems of the lower extremities: osteoarthritis, pain and disability

Tukker

Visscher

Picavet

2008

PHN

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Aim: To examine the association between overweight and health problems of the lower extremities, i.e. osteoarthritis (OA), pain and disability. Methods: Cross-sectional data from the Dutch population-based Musculoskeletal Conditions & Consequences Cohort (DMC3), comprising a random sample from the Dutch population aged .25 years (n 3664), were analysed using multivariate logistic regression. Overweight was defined as BMI $ 25?0 kg/m 2 , moderate overweight as 25?0 kg/m 2 # BMI , 30?0 kg/m 2 and obesity as BMI $ 30?0 kg/m 2 . Health problems of the lower extremities were: (i) self-reported OA of the hip or knee as told by a doctor; (ii) presence of self-reported chronic pain (.3 months) of the lower extremities; and (iii) disabilities in mobility as measured by the Euroqol questionnaire (EQ-5D). Results: Moderate overweight was associated with self-reported OA of the hip or knee (OR 5 1?7; 95 % CI 1?4, 2?1), chronic pain of the lower extremities at one or more location(s) (OR 5 1?6; 95 % CI 1?3, 1?9) and disability in mobility (OR 5 1.7; 95 % CI 1?4, 2?0). For obesity these odds were higher: 2?8 (95 % CI 2?1, 3?7), 2?5 (95 % CI 1?9, 3?2) and 3?0 (95 % CI 2?3, 3?9), respectively. Also, among those with OA, moderate overweight and obesity were associated with disability in mobility. Conclusion: There is a strong association between overweight/obesity and health problems of the lower extremities, i.e. OA, pain and disability. The increasing prevalence of overweight and obesity worldwide urges for public health action not only for diabetes and heart disease, but also OA.

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Section: Discussionmentioning

confidence: 99%

Overweight and health problems of the lower extremities: osteoarthritis, pain and disability

Tukker

Visscher

Picavet

2008

PHN

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“…The percent of patients with lumbosacral spine complaints decreased from 62 to 11%, hip pain from 11 to 2%, knee complaints from 57 to 14%, ankle problems from 34 to 2% and foot pain from 21 to 1%. 17 Peltonen et al 1 looked at work-restricting MSK symptoms in the general population and 2010 surgically treated obese subjects, aged 37-60 years, and 2037 age-and gender-matched obese subjects not undergoing surgery. Obese subjects had more work-restricting neck, low back, hip, knee and ankle pain and the prevalence increased with BMI.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Physician bias towards obese patients may contribute to the assumption that their painful musculoskeletal (MSK) symptoms are weight related. 3 However, the published literature does not support the association between weight and many MSK conditions.…”

Section: Introductionmentioning

confidence: 99%

“…Three previous studies in bariatric surgery populations addressed primarily lower extremity and lumbar spine pain, and demonstrated significant improvement following weight loss. 1,17,18 The purpose of this study was to determine the point prevalence of a wide range of MSK symptoms in obese individuals before and after bariatric surgery and to compare them to prevalence data published in the literature. This bariatric surgery group represents the extreme of an obese and older population, in which weight-related MSK conditions should be more readily identified and the response to significant weight loss readily detectable.…”

Section: Introductionmentioning

confidence: 99%

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Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery

et al. 2006

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Objective: To determine the point prevalence of painful musculoskeletal (MSK) conditions in obese subjects before and after weight loss following bariatric surgery. Design: Longitudinal, interventional, unblended. Subjects: Forty-eight obese subjects (47 women, one man, mean age 4479 years; mean body mass index (BMI) 5178 kg/m 2 ) recruited from an academic medical center bariatric surgery program. Measurements: Comorbid medical conditions; MSK findings; BMI; Western Ontario McMaster Osteoarthritis Index (WOMAC) for pain, stiffness and function; and SF-36 s for quality of life. Methods: Consecutive subjects were recruited from the University Hospitals of Cleveland Bariatric Surgery Program. Musculoskeletal signs and symptoms and non-MSK comorbid conditions were documented at baseline and at follow-up. Subjects completed the SF-36 s and the WOMAC questionnaires. Analyses were carried out for each MSK site, fibromyalgia syndrome (FMS) and for the cumulative effect on the spine, upper and lower extremities. The impact of change in comorbid medical conditions, BMI, physical and mental health domains of the SF-36 s on the WOMAC pain subscale score was evaluated. SF-36 s outcomes were compared to normal published controls. Results: Forty-eight subjects were available for baseline and a follow-up assessment 6-12 months after gastric bypass surgery. They lost an average of 41715 kg and the mean BMI decreased from 5178 to 3677 kg/m 2 . Baseline comorbid medical conditions were present in 96% before surgery and 23% after weight loss. There was an increased prevalence of painful MSK conditions at baseline compared to general population frequencies. Musculoskeletal complaints had been present in 100% of obese subjects before, and 23% after weight loss. The greatest improvements occurred in the cervical and lumbar spine, the foot and in FMS (decreased by 90, 83, 83 and 92%, respectively). Seventy-nine percent had upper extremity MSK conditions before and 40% after weight loss. Before surgery, 100% had lower extremity MSK conditions and only 37% did after weight loss. The WOMAC subscale and composite scores all improved significantly, as did the SF-36 s . Change in BMI was the main factor impacting the WOMAC pain score. Conclusion: There was a higher frequency of multiple MSK complaints, including non-weight-bearing sites compared to historical controls, before surgery, which decreased significantly at most sites following weight loss and physical activity. These benefits may improve further, as weight loss may continue for up to 24 months. The benefits seen with weight loss indicate that prevention and treatment of obesity can improve MSK health and function.

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“…It has been demonstrated that weight reduction improves functional health, for example, surgically induced weight loss is associated with a marked relief in dyspnea and chest pain. 25,26 However, symptoms like these could also be interpreted as reactions to underlying mental stress, predisposing a life-style causing obesity, and consequently amplify the condition specific problems.…”

Section: Discussionmentioning

confidence: 99%

Severe obesity and personality: a comparative controlled study of personality traits

et al. 2003

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OBJECTIVE:The primary purpose was to assess personality trait differences between the severely obese seeking treatment and a mainly non-obese reference group. We also investigated gender differences and differences between obese patients and obese not seeking treatment. METHOD: Personality traits were assessed using 7 of 15 scales from the Karolinska Scales of Personality (KSP): Somatic Anxiety, Muscular Tension, Psychastenia, Psychic Anxiety, Monotony Avoidance, Impulsiveness, and Irritability. Patients from the Swedish Obese Subjects (SOS) intervention study (n ¼ 3270, ages 37-57, 71% women) and the SOS reference study (n ¼ 1135, 54% women) completed the survey. Data presented in this study were gathered prior to treatment. Significance tests and effects sizes were calculated. RESULTS: Although statistically significant differences were found between obese patients and reference subjects on nearly all personality traits, effect sizes were at most moderate. Of the three scales with moderate effects sizes, differences on Somatic Anxiety and Psychastenia could be traced to items tapping condition-specific symptoms, e.g., problems with sweating and breathing as indicators of Somatic Anxiety. Moderate differences on the Impulsiveness scale (men alone) could not be explained by item composition. Further, the obese patients differed from obese in the reference group, and both obese and reference women reported significantly higher levels on Somatic Anxiety, Muscular Tension and Psychic Anxiety compared to men (effect size: small). CONCLUSIONS: Our results provided no evidence of a general obese personality profile, instead considerable heterogeneity in personality traits was observed across our obese samples (treatment seekers vs non-seekers, men vs women) and generally only small differences were noted compared to a reference study population. Further research is needed to investigate if the somewhat elevated levels of Impulsiveness, particularly among male obese patients, is affected by weight loss. When assessing personality traits in diseased groups consideration should be given to possible confounding from, e.g., somatic symptoms.

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Musculoskeletal pain in the obese: a comparison with a general population and long-term changes after conventional and surgical obesity treatment

Cited by 245 publications

References 35 publications

Overweight and health problems of the lower extremities: osteoarthritis, pain and disability

Overweight and health problems of the lower extremities: osteoarthritis, pain and disability

Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery

Severe obesity and personality: a comparative controlled study of personality traits

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