Overweight and obesity: A second functional burden that amplifies gait vulnerability in early multiple sclerosis

Overweight and obesity (OW/OB) are prevalent in patients with multiple sclerosis (PwMS) from disease onset and are associated with faster disease progression. While gait impairment is one of the most disabling symptoms of MS, the impact of OW/OB on gait in PwMS remains poorly understood.

To investigate the impact of OW/OB on gait parameters in PwMS with low disability.

In this exploratory prospective study, PwMS with low disability (EDSS < 4) were recruited during routine MS follow-up consultations between 2021 and 2025. Participants underwent a clinical assessment and three-dimensional gait analysis. Based on body mass index (BMI), participants were divided into two groups (BMI < 25 kg/m² or BMI ≥ 25 kg/m²). Spatiotemporal parameters were compared between groups. Kinematic and kinetic analyses used statistical parametric mapping.

Among 29 PwMS ultimately included (mean age: 40.1 years, median EDSS: 2, 27 females), 17 were allocated to the overweight/obesity group (BMI ≥ 25 kg/m²). No statistically significant differences were between groups in terms of clinical assessment, except for body mass. Gait speed, cadence, and step length did not differ between groups. However, PwMS with OW/OB exhibited increased step width and significant reorganization of the gait cycle. Kinematic and kinetic analyses revealed a more extended hip posture and altered hip and knee joint moments in PwMS with OW/OB, while ankle biomechanics remained unchanged.

OW/OB is associated with specific gait alterations in PwMS, which may potentially amplify functional vulnerability in early MS. Addressing this modifiable comorbidity may represent an important component of early, comprehensive MS care.