The mediating effect of chronic pain on the relationship between obesity and physical function and disability in
Angela Fowler-Brown1, Christina C Wee1, Edward Marcantonio1,2
1Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Objectives:
To determine the extent to which bodily pain mediates the effect of obesity on disability and physical function.
Design:
Cross-sectional analysis.
Setting:
Population-based sample of residents in the greater Boston area.
Participants:
Community-dwelling adults aged 70 and older (N=736).
Measurements:
Body mass index (BMI), obtained from measured height and weight, was categorized as normal weight (19.0-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (≥30.0 kg/m2). Main outcome measures were the Physical Component Summary of the Medical Outcomes Study 12-item Short-Form Survey (PCS), activity of daily living (ADL) disability, and Short Physical Performance Battery (SPPB) score. Chronic pain was assessed according to the number of weight-bearing joint sites that had pain (hips, knees, feet and pain all over).
Results:
Older obese adults had greater ADL disability and lower SPPB and PCS scores than their nonobese counterparts, although in sex-stratified adjusted analyses, obesity was adversely associated with outcomes only in women. Obesity was associated with greater number of pain sites; and more pain sites were associated with greater odds of disability. Mediation analysis suggests that pain is a significant mediator (22-44%) of the adverse effect of obesity on disability and physical function in women.
Conclusion:
Bodily pain may be an important treatable mediator of the adverse effect of obesity on disability and physical function in women.
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