Olson KayLoni, Hackett Ruth A, Scott Whitney
Weight Control and Diabetes Research Center, Miriam Hospital, USA; Department of Psychiatry and Human Behavior, Brown Medical School, USA.
Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
J Pain. 2025 Mar;28:104772. doi: 10.1016/j.jpain.2024.104772. Epub 2024 Dec 28.
Pain is common among individuals with high Body Mass Index (BMI). This study investigated weight discrimination as a mediator of the longitudinal relationship between BMI and the presence of moderate/severe pain among adults from the English Longitudinal Study of Ageing (ELSA) cohort. ELSA is a longitudinal study of middle-aged and older adults living in England. Data were taken from three consecutive waves. Demographics, BMI, and self-reported pain were collected at wave 4 (2008-2009), perceived weight discrimination at wave 5 (2010-2011,) and pain (no/mild vs moderate/severe) at wave 6 (2012-2013). Generalized linear models estimated the association of BMI at wave 4 (assessed continuously and dichotomized to obesity status BMI ≥30) with pain at wave 6, and weight discrimination at wave 5 as a mediator of this relationship. Models were adjusted for demographics and baseline pain. Complete data were available for n=5362 individuals. Continuous BMI was associated with future moderate/severe pain (b=1.05 SE=0.01, p<.01) and weight discrimination partially mediated this effect (b=1.00 SE=0.002, p=.05). Obesity status was also significant (b=1.43 SE=0.11, p<.01) but weight discrimination did not mediate the relationship (p=.13). Post hoc analyses were conducted among individuals with no/mild pain at baseline (n=3979.) BMI and obesity status were both associated with pain and weight discrimination mediated both pathways (ps<.05.) Weight discrimination partially mediated the relationship between BMI and future moderate/severe pain, especially among individuals with no/mild pain initially. Weight discrimination may be an overlooked contributor to the transition to more severe pain among individuals of higher body weight. PERSPECTIVE: Weight discrimination may be an overlooked contributor to pain among individuals of higher body weight, particularly transition from lower to higher impact states. Post hoc analyses indicate the effect may be specific, as other forms of discrimination did not mediate the relationship.
疼痛在体重指数（BMI）较高的人群中很常见。本研究调查了体重歧视作为英国老龄化纵向研究（ELSA）队列中成年人BMI与中度/重度疼痛之间纵向关系的中介因素。ELSA是一项针对居住在英国的中年及老年人的纵向研究。数据取自连续三个波次。在第4波（2008 - 2009年）收集人口统计学信息、BMI和自我报告的疼痛情况，在第5波（2010 - 2011年）收集感知到的体重歧视情况，在第6波（2012 - 2013年）收集疼痛情况（无/轻度与中度/重度）。广义线性模型估计了第4波时的BMI（连续评估并二分法分为肥胖状态BMI≥30）与第6波时的疼痛之间的关联，以及第5波时的体重歧视作为这种关系的中介因素。模型针对人口统计学和基线疼痛进行了调整。共有n = 5362名个体的完整数据可用。连续BMI与未来的中度/重度疼痛相关（b = 1.05，SE = 0.01，p <.01），体重歧视部分介导了这种效应（b = 1.00，SE = 0.002，p =.05）。肥胖状态也具有显著性（b = 1.43，SE = 0.11，p <.01），但体重歧视并未介导这种关系（p =.13）。在基线时无/轻度疼痛的个体（n = 3979）中进行了事后分析。BMI和肥胖状态均与疼痛相关，体重歧视介导了这两条途径（p <.05）。体重歧视部分介导了BMI与未来中度/重度疼痛之间的关系，尤其是在最初无/轻度疼痛的个体中。体重歧视可能是体重较高个体向更严重疼痛转变的一个被忽视的因素。观点：体重歧视可能是体重较高个体疼痛的一个被忽视的因素，特别是从低影响状态向高影响状态的转变。事后分析表明这种效应可能是特定的，因为其他形式的歧视并未介导这种关系。
