Would you like to reduce your risk of developing osteoarthritis? A longitudinal study of approximately 800 women found that by simply losing 11 pounds (5 kilograms), the risk of developing osteoarthritis dropped by 50%. Not only does weight loss reduce the risk of arthritis, but studies have also found weight loss reduces the experience of chronic pain.

We often think that chronic pain leads to reduced activity, and reduced activity leads to weight gain. The conversations I have with patients often center around their frustration with losing weight because of their chronic pain issues.

But what if the opposite was true? What if weight gain itself were a crucial contributor to the development and maintenance of chronic pain? While not all chronic pain sufferers are overweight, obesity is a known risk factor in the development of some chronic pain conditions such as fibromyalgia and low back pain.

With the increased study of chronic pain, scientists are putting together the puzzle of how obesity is linked to the perception of pain and inflammation throughout the body. The rapid increase in obesity makes this issue even more pressing. Since the early 1960s, only 13% of adults in the United States were obese; today, nearly 70% are either overweight or obese, with 43% of the adult population being obese.

Here are five fundamental principles of how obesity contributes to increased pain through a combination of inflammatory processes, mechanical stresses, metabolic changes, psychological factors, and changes in behavior.

The relationship between obesity and chronic pain is complex. What is not complicated is the reality that pain and obesity make each condition more difficult to manage. To help patients face this challenge, I have found the pain cycle illustration helpful.

The pain cycle begins with the onset of pain. Pain is an unpleasant experience and triggers our stress response. The stress response increases muscle tension and changes blood flow, which can contribute to increased pain.

Pain and stress negatively impact mood. A depressed mood lowers motivation to be engaged in enjoyable activities and increases the likelihood of emotional eating. Mood changes also affect the quality of sleep, leading to exhaustion and worsening depression.

As fatigue, depression, and pain increase, the desire to be physically active decreases. As physical activity decreases, the muscles, joints, tendons, and ligaments become dysfunctional. These physical changes mean that even a small amount of movement and activity becomes painful, leading to a more sedentary lifestyle that increases weight and amplifies pain.

If you find yourself trapped in the pain cycle, here are three key principles to keep in mind as you move toward a healthier lifestyle:

Connect with a physical therapist, learn safe ways to move, and never stop once you get going.