If you have from fibromyalgia, you don’t need us to tell you how difficult it is to deal with the widespread pain, fatigue, and — depending on the severity of your condition — cognitive confusion and impairment. And while fibromyalgia managing symptoms can often feel like a full-time job, letting other areas of your health go — like nutrition, exercise, and weight — may make your fibro symptoms worse.

A recent study published in the journal Archives of Rheumatology compared the effects of obesity on fibromyalgia patients. Researchers looked at a group of fibromyalgia patients (42 were obese, 27 were overweight, and 32 were average weight) and recorded the participants’ pain, the severity of their symptoms, and other measures of their quality of life. What they found: All were worse among people who were considered obese than in people of an average weight.

These results aren’t terribly surprising, since many people in the fibro community know how complicated the relationship with their disease and their weight can be. Fibromyalgia patients are more likely to be overweight than healthy patients, multiple studies show. And while experts can’t say exactly why this is, there are several possible explanations.

The Fibromyalgia-Obesity Link

For one thing, having widespread, debilitating chronic pain that can make even getting out of bed or leaving your house difficult doesn’t make it easy for patients to exercise regularly; it can also affect patients’ ability to eat healthy meals. (Think of how challenging it can be to even stand in the kitchen chopping veggies, swirling smoothies, or boiling water for quinoa.)

Extra weight puts more pain on your joints and makes it harder to be active. Some research suggests that people who are overweight and obese are more sensitive to pain compared with average weight people. Visceral fat — the kind that accumulates deep in your body, around your organs, and is widespread in people who are obese — is active fat that releases inflammatory chemicals. Inflammation is something fibromyalgia patients need to control in order to lessen pain and other symptoms.

Sleep is another issue: It’s been well documented that people who get less sleep are more likely to be overweight. (Lack of sleep can mess with the hormones that affect hunger and fullness.) Fibromyalgia patients routinely report trouble sleeping because of their pain; in a vicious cycle, this lack of sleep can also make pain worse and make it harder for patients to exercise and eat well, which can also make pain worse.

There may be also factors unique to the disease state of fibromyalgia that make it harder for patients to lose weight. Fibromyalgia patients have lower metabolism than people of a normal weight, a study from the Fibromyalgia Research Foundation found, so it can take more effort to torch calories and make weight loss stick.

And some medications that people take to manage fibro symptoms, such as pregabalin, can increase appetite and contribute to weight gain.

What Can Fibromyalgia Patients Do to Lose Weight?

Recognizing that weight loss is important for your disease management — but that it can be difficult because of the very nature of having fibromyalgia (hello, irony) — is the first step.

“Not engaging in daily movements because of ongoing pain can worsen fibromyalgia symptoms due to muscle disuse or atrophy and increased fat content,” says physical therapist Evelyn Hecht, PT ATC, owner of EMH Physical Therapy in New York City and author of re.lieve Solutions for Chronic Pain. “Exercise not only helps muscles to function better, it stimulates the brain to send your body ‘happy chemicals’ like serotonin and dopamine, which help relieve pain.”

Indeed, doctors recognize that fibromyalgia can’t be treated with medication alone, MedPage Today reports. Daily physical activity and healthy eating choices are a key part of treatment, no matter how simply you start.

“It isn’t uncommon for fibromyalgia patients to tell me that they tried exercising a few times, but the pain was so unbearable that they stopped,” rheumatologist Ashira Blazer, MD, an instructor of medicine in the division of rheumatology at NYU Langone Medical Center, tells MedPage. “It is important to encourage patients during the initial periods, because this pain is not dangerous, and it does improve over time.”

Keep this advice in mind if you’re a fibro patient in need of some weight loss motivation:

Start small and simple: A 10- to 15-minute walk every day can do wonders for your health and mood, especially if you’ve been sedentary for awhile. “It is important not to get discouraged early, because where you are is not nearly where you will be with a little effort and discipline,” Blazer said.

Trouble sleeping? Ask your doctor about sleep apnea. Sleep apnea, a condition in which your breathing becomes obstructed multiple times throughout the night for very short periods of time, is more common among fibromyalgia patients. People who are overweight and obese are more likely to have sleep apnea too. Sleep apnea can make you feel tired during the day no matter how much you slept. Getting a sleep apnea diagnosis and treatment (such as with a CPAP machine that helps keep your airway open while you sleep) can improve sleep apnea symptoms, and in turn fibromyalgia pain.

Try a new exercise routine: If you’re someone who used to hop on the treadmill or elliptical for 30 minutes and call it a day, you might need to rethink your regimen when you’re coping with fibromyalgia pain. Consider swimming or taking water aerobics classes, for example. Water is incredibly soothing for chronic pain, both because a heated pool can help relieve pain and also because the activity doesn’t put additional strength on your joints.

Get a workout buddy: Depression is understandably common among people with fibromyalgia. In addition to taking medication if necessary, exercise can also help improve some of the mood issues fibro patients face. One way to tackle the isolation you may feel is asking a friend to help be a workout buddy and go on walks or drive to the gym together. You may find comfort knowing you have someone else there in case you feel particularly crappy. Having a workout buddy can also help you stay committed to a routine, especially in the beginning when you’re not yet in the habit.

Learn More About Living Well with Fibromyalgia


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