Your Pain is Not Because You’re “Fat”

Your Pain is Not Because You’re “Fat”

What do I know about the struggle to lose weight? Not much and I don’t pretend to. That is a genetic “crap shoot” that I came out on the lucky side of.

What I DO know is that pain does not happen to overweight people alone.

The other thing I know and hear about more often than I should, is how doctors of all specialties commonly and unabashedly display extreme prejudice against people who are overweight.  Numerous patients of mine tell me similar stories about reaching out for help with their pain and being met with a host of physician encounters that leave them feeling judged and ashamed.  So many doctors are quick to blame the weight and slow to investigate past the fat.

Anyone in this day and age knows about the correlation between obesity and disease and mortality.  I’ll go out on a limb here and suggest that the majority of overweight patients know that it’s not ideal to be on the heavy side.  The last thing they need to hear is that everything wrong with them is because of their weight. First of all, that’s just not always true and more importantly, blaming their weight is certainly not something they need a doctor’s help doing.

When has fat-shaming ever helped anyone make positive lasting change? Being judged by careless strangers is one thing but by your own healthcare provider is quite another and shouldn’t be allowed.

If someone has been steadily on the heavy side for the majority of their lifetime and there hasn’t been a sudden recent change in weight, then the skeleton – while perhaps stressed in ways that lighter people aren’t – has had years to adapt.  Our bodies are pretty amazing that way and given years to slowly get used to something, we just do.  The likelihood that suddenly the weight is the main problem is unlikely for this sort of scenario.
I see plenty of lean and “fit” looking people who just wake up one day in pain and have no idea why.  We don’t say to those people: “Well it’s obviously because you’re too skinny.  Come back and see me when you’ve gained some weight.”

Here’s another problematic drawing of parallels that seems to happen quite a bit…

Any sized woman who experiences a 9 month gain of pregnancy weight should never be compared with someone who is chronically overweight.  It is completely different. Not only do most overweight people not gain that quickly but they also aren’t experiencing the unique destabilizing and mechanically disorienting effects of massive hormonal and blood volume changes.

If weight is legitimately suspected as the cause for pain, then the last thing you should do as a doc is dismiss the patient with a sweeping prescription for exercise and calorie restriction when the more likely chronic weight-related risk is cardiovascular.  If anything, this person needs to have a heart health check first.

When a patient feels alienated from their physician due to the shame over their weight, it creates a dangerous  barrier to receiving true healthcare solutions.

I hear first-hand from patients that they will simply not return for care when they feel unfairly judged and dismissed and this can be more dangerous than the weight itself.

We do need to be clear with our patients about the facts:

But facts can be shared without judgment and blame. Higher body fat percentage is a real health risk. Abdominal fat is the worst. It predisposes us to higher levels of chronic inflammation which can manifest in many ways – not just through pain.  Evidence shows that it’s inflammation that is the huge risk factor and linked with a host of diseases.

Doctors and patients alike need to be aware of the cold hard fact that body fat percentage can be dangerously high in underweight, average weight and overweight people.  This is why everyone of absolutely any size, needs to avoid being sedentary, eliminate inflammatory foods and care for their stress levels and stress coping – all of which have been shown to play a role with inflammation which is the ultimate killer.

It’s never just the weight alone.

When there is pain, the pain chemistry needs to be addressed first and foremost.  Yes, fat cells contribute to inflammation which can stack the deck against us and cause pain, but every person’s situation is unique.  Look at the mechanics.  Consider individual body chemistry.  Inquire about psycho-social factors.  These are the inroads to better, more compassionate self-care which is where weight loss can begin if indeed that is appropriate for that patient.

We are emotional creatures first.  The physical body is a reflection of who we are.  All bodies need to be greeted with kindness and respect first before change can be made.


image credit: By Peter Paul Rubens – The Prado in Google Earth: Home – 7th level of zoom, JPEG compression quality: Photoshop 10., Public Domain, https://commons.wikimedia.org/w/index.php?curid=22620913

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Do You Think Your Weight is Causing Your Back Pain? Not So Fast.

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If you are carrying a little more weight than you would like or than is considered technically ideal for your frame, then you probably already have enough guilt and shame around this.  If you’re overweight and you have back pain the last thing you want to hear and yet the first thing you’re ready to assume is that your back pain is because of your weight.

This assumption is a very common one because according to popular media, obesity is the reason for all of our problems.  I don’t deny that morbid obesity is called “morbid” for a reason.  It will tend to shorten your life according to the science.  But when it comes to back pain the connection isn’t as clear as you think if you’re just moderately overweight – and I use the term “overweight” loosely because standardized charts that tell us who is and isn’t “too heavy” do not take into account body density, composition and activity level.

Focusing on and stressing about your weight is a sure fire way to put on more pounds and it won’t do a darn thing for your pain.

I’ve been seeing and treating back pain of all shapes and sizes for over twenty years and the only common thread is inflammation – not size, not shape, not weight.  Inflammation can reach critical mass anywhere in any body and when it does, our structurally and chemically vulnerable areas will be where we experience the discomfort of that inflammation…and sometimes that comes in the form of back pain.  The story of inflammation is extremely complex and deserves more than a blog post to do it justice, but the bottom line is that inflammation is triggered by three main things:

  1. mechanical stress or imbalance
  2. chemical stress or imbalance
  3. emotional stress or imbalance

These imbalances have to reach a critical mass before they cause any pain at all, so they often go on for years undetected and then when there finally is pain, we are reluctant to acknowledge these real causes and instead turn our attention to the easy target like body weight.  Each of these three things when out of balance, can be caused by excess body weight but are also caused by a multitude of other things that aren’t necessarily related to being overweight.  Plenty of skinny people have back pain.

Heavy and thin people alike put their spines under mechanical strain by sitting too much and developing poor body movement mechanics throughout life.  None of us will know it until we are in pain.  Then we can’t help but notice all the things we thought were okay to do suddenly hurt like crazy.

Heavy and thin people alike put their body under chemical stress by the foods they choose to eat or the toxins and allergens they are inadvertently exposed to.  Some have genetic predispositions to experience chemical stress more easily than others.

Heavy and thin people alike experience emotional stress with varying sensitivities and thresholds; all of which can add to the expression of inflammation.

It’s not your weight, but it might be your fat to muscle ratio…

…and this is something that the lean crowd should be sure not to overlook, because it’s easy to buy into the pervasive notion that someone is healthy just because they’re thin but no one is exempt from having a high fat to muscle ratio.

Fatty tissue is also called adipose.  Adipose produces a type of cell called an adipokine.  Adipokines are cell signaling proteins that help fatty cells communicate with the rest of the body.  Unfortunately these adipokines are pro-inflammatory and the more adipose you have the more inflammation your own body will produce.

On the up side, muscle cells – when active – secrete something called a myokine and for a reason that still eludes researchers, even though this myokine is in the same family as adipokines, it exerts an anti-inflammatory effect on the body!  What better motivation could there possibly be for getting your body moving?!  This is such a no-brainer.  Keep your muscle to fat ratio high and you’re much less likely to have back pain associated with chemically inflammatory adipose.

It’s not your weight alone, but it might be if it was a sudden gain…

What I’ve observed is that when there’s a sudden weight gain, like with pregnancy for example, there is a much greater probability that back pain is related to that weight gain because it’s a sudden change that the structures of the spine haven’t had time to adapt to.  When someone has had the same proportion of “extra” weight without much fluctuation throughout most of their life, then the back pain is less likely related to weight.

It’s not your weight, it’s the fact that you think  it’s your weight.

Now that you know it’s not necessarily your weight that is causing your pain, you can stop stressing about it. Just this simple decrease in stress is going to lower the inflammation in your body…and possibly make it easier for you to shake the pain.

The other problem with people who are stressed about their full figures, is that they will adopt the particularly stressful body habits of trying to suck in the gut and tucking the butt.  You can read more about why these are so bad for your back here, but for now do your best to eliminate that mechanically inflammatory habit!

For most moderately overweight bodies losing weight is not the answer to back pain.  Gaining strength and muscular balance is  the answer for all body types when dealing with back pain.  This is not to say that taking a few pounds off would not ease the load on any skeleton in pain but to focus on weight loss will backfire eventually and is not a good use of your energy.  To focus on strength building will cause an incidental weight loss that is much more sustainable and far reaching.

Even if you’re not in pain, please stop fixating solely on what and how much goes in your mouth, and start focusing on moving your body to make it stronger.

To read more about what is really behind your back pain go to Stop Everyday Pain.

 

References:

Advances in Medical Sciences 2009, 54(2): 150-157 Role of adipokines in complications related to obesity. A review. Gnacinska M et al.

Journal of Experimental Biology 2011; 214(337-346) Muscles and their myokines. Pedersen BK.

Science 1991 Oct 18;254(5030):421-3.Autocrine or paracrine inflammatory actions of corticotropin-releasing hormone in vivo. Karalis K, Sano H, Redwine J, Listwak S, Wilder RL, Chrousos GP.