Clinical Rheumatology

, Volume 31, Issue 11, pp 1591–1597 | Cite as

Effect of weight reduction on the quality of life in obese patients with fibromyalgia syndrome: a randomized controlled trial

  • Mohammed Kamal Senna
  • Rehab Abd-El Raouf Sallam
  • Hala Salah Ashour
  • Mohammed Elarman
Original Article


The aim of the study was to examine whether weight reduction can result in improvement of fibromyalgia impact questionnaire (FIQ) in the patients with fibromyalgia syndrome (FMS). This study was a randomized controlled trial. Obese patients with fibromyalgia were randomly assigned to 6-month dietary weight loss (n = 41) and no weight loss (n = 42) groups. Patients were assessed at baseline and at 6 months. The primary outcome measure was FIQ. Secondary measures included the tender point (TP) examination, Beck Depression Inventory-II, and Pittsburg Sleep Quality Index. Compared to the control group, patients who underwent weight reduction obtained significantly better FIQ (p = 0.007), lower mean TP count (p = 0.015), and lower mean TP pain rating in the lower body (p < 0.001). Patients who lost weight had less depression and better sleep quality than the controls. Patients who lost weight had significantly lower interleukin 6 and C-reactive protein levels than those in the control group (p = 0.034 and p = 0.007, respectively). Weight loss in obese patients with FMS leads to significant improvement in the quality of life as shown by the decrease in the FIQ score. Depression, sleep quality, and tender point count are also significantly improved by weight loss in obese patients with fibromyalgia. Our results suggest that weight reduction should be a part of fibromyalgia treatment.


Depression Fibromyalgia Obesity Weight loss 





  1. 1.
    White KP, Speechley M, Harth M, Ostbye T (1999) The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. J Rheumatol 26(7):1570–1576PubMedGoogle Scholar
  2. 2.
    Weir PT, Harlan GA, Nkoy FL, Jones SS, Hegmann KT, Gren LH, Lyon JL (2006) Incidence of fibromyalgia and its associated comorbidities. J Clin Rheumatol 12(3):124–128PubMedCrossRefGoogle Scholar
  3. 3.
    Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291(23):2847–2850PubMedCrossRefGoogle Scholar
  4. 4.
    Neumann L, Lerner E, Glazer Y, Bolotin A, Shefer A, Buskila D (2008) A cross-sectional study of the relationship between body mass index and clinical characteristics, tenderness measures, quality of life, and physical functioning in fibromyalgia patients. Clin Rheumatol 27(12):1543–1547PubMedCrossRefGoogle Scholar
  5. 5.
    Arendt-Nielsen L, Graven-Nielsen T (2003) Central sensitization in fibromyalgia and other musculoskeletal disorders. Curr Pain Headache Rep 7(5):355–361PubMedCrossRefGoogle Scholar
  6. 6.
    Okifuji A, Turk DC (2002) Stress and psychophysiological dysregulation in patients with fibromyalgia syndrome. Appl Psychophysiol Biofeedback 27(2):129–141PubMedCrossRefGoogle Scholar
  7. 7.
    Wallace DJ (2006) Is there a role for cytokine based therapies in fibromyalgia. Curr Pharm Des 12(1):17–22PubMedCrossRefGoogle Scholar
  8. 8.
    Bjorntorp P, Holm G, Rosmond R (1999) Hypothalamic arousal, insulin resistance and type 2 diabetes mellitus. Diabet Med 16(5):373–383PubMedCrossRefGoogle Scholar
  9. 9.
    Bluher M, Fasshauer M, Tonjes A, Kratzsch J, Schon MR, Paschke R (2005) Association of interleukin-6, C-reactive protein, interleukin-10 and adiponectin plasma concentrations with measures of obesity, insulin sensitivity and glucose metabolism. Exp Clin Endocrinol Diabetes 113(9):534–537PubMedCrossRefGoogle Scholar
  10. 10.
    Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L (2007) An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord 8:27PubMedCrossRefGoogle Scholar
  11. 11.
    Lauderdale DS, Knutson KL, Rathouz PJ, Yan LL, Hulley SB, Liu K (2009) Cross-sectional and longitudinal associations between objectively measured sleep duration and body mass index. Am J Epidemiol 170:805–813PubMedCrossRefGoogle Scholar
  12. 12.
    Okifuji A, Bradshaw DH, Olson C (2009) Evaluating obesity in fibromyalgia: neuroendocrine biomarkers, symptoms, and functions. Clin Rheumatol 28(4):475–478PubMedCrossRefGoogle Scholar
  13. 13.
    Kato K, Sullivan PF, Evengård B, Pedersen NL (2005) Importance of genetic influences on chronic widespread pain. Arthritis Rheum 54(5):1682–1686CrossRefGoogle Scholar
  14. 14.
    Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, Zitman FG (2010) Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 67:220–229PubMedCrossRefGoogle Scholar
  15. 15.
    Vogelzangs N, Kritchevsky SB, Beekman AT, Brenes GA, Newman AB, Satterfield S, Yaffe K, Harris TB, Penninx BW (2010) An onset of significant depressive symptoms: results from a prospective community-based cohort study of older men and women. J Clin Psychiatry 71:391–399PubMedCrossRefGoogle Scholar
  16. 16.
    Alschuler KN, Theisen-Goodvich ME, Haig AJ, Geisser ME (2008) A comparison of the relationship between depression, perceived disability, and physical performance in persons with chronic pain. Eur J Pain 12(6):757–764PubMedCrossRefGoogle Scholar
  17. 17.
    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Campbell SM, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA, Hamaty D, Lessard J, Lichtbroun AS, Masi AT, McCain GA et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33(2):160–172PubMedCrossRefGoogle Scholar
  18. 18.
    Flechtner-Mors M, Ditschuneit HH, Johnson TD, Suchard MA, Adler G (2000) Metabolic and weight loss effects of long-term dietary intervention in obese patients: four-year results. Obes Res 8(5):399–402PubMedCrossRefGoogle Scholar
  19. 19.
    Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gómez J, Lilienthal Heitmann B, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, M W J Schols A, Pichard C (2004) Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 23(6):1430–1453PubMedCrossRefGoogle Scholar
  20. 20.
    Bennett R (2005) The fibromyalgia impact questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol 23(5 Suppl 39):154–162Google Scholar
  21. 21.
    Okifuji A, Turk DC, Sinclair JD, Starz TW, Marcus DA (1997) A standardized manual tender point survey. I. Development and determination of a threshold point for the identification of positive tender points in fibromyalgia syndrome. J Rheumatol 24(2):377–383PubMedGoogle Scholar
  22. 22.
    Beck AT, Steer RA, Ball R, Ranieri W (1996) Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. J Pers Assess 67:588–597PubMedCrossRefGoogle Scholar
  23. 23.
    Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 8:77–100CrossRefGoogle Scholar
  24. 24.
    Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213PubMedCrossRefGoogle Scholar
  25. 25.
    Booth-LaForce C, Thurston RC, Taylor MR (2007) A pilot study of a Hatha yoga treatment for menopausal symptoms. Maturitas 57(3):286–295PubMedCrossRefGoogle Scholar
  26. 26.
    Fischer CL, Gill C, Forrester MG, Nakamura R (1976) Quantitation of “acute-phase proteins” postoperatively. Value in detection and monitoring of complications. Am J Clin Pathol 66(5):840–846PubMedGoogle Scholar
  27. 27.
    Kim CH, Luedtke CA, Vincent A, Thompson JM, Oh TH (2011) The association of body mass index with symptom severity and quality of life in patients with fibromyalgia. Arthritis Care Res. doi: 10.1002/acr.20653 [Epub ahead of print]
  28. 28.
    Ursini F, Naty S, Grembiale RD (2011) Fibromyalgia and obesity: the hidden link. Rheumatol Int 31(11):1403–1408PubMedCrossRefGoogle Scholar
  29. 29.
    Shapiro JR, Anderson DA, Danoff-Burg S (2005) A pilot study of the effects of behavioral weight loss treatment on fibromyalgia symptoms. J Psychosom R 59(5):275–282CrossRefGoogle Scholar
  30. 30.
    Howren MB, Lamkin DM, Suls J (2009) Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med 71:171–186PubMedCrossRefGoogle Scholar
  31. 31.
    Miller AH, Maletic V, Raison CL (2009) Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry 65(9):732–741PubMedCrossRefGoogle Scholar
  32. 32.
    Wallace DJ, Linker-Israeli M, Hallegua D et al (2001) Cytokines play an aetiopathogenetic role in fibromyalgia: a hypothesis and pilot study. Rheumatology 40:743–749PubMedCrossRefGoogle Scholar
  33. 33.
    Tilg H, Moschen AR (2006) Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat Rev Immunol 6:772–783PubMedCrossRefGoogle Scholar
  34. 34.
    Hernandez ME, Becerril E, Perez M, Leff P, Anton B, Estrada S, Estrada I, Sarasa M, Serrano E, Pavon L (2010) Proinflammatory cytokine levels in fibromyalgia patients are independent of body mass index. BMC Res Notes 3(1):156PubMedCrossRefGoogle Scholar
  35. 35.
    Ortiz-Domínguez A, Hernández ME, Berlanga C, Gutiérrez-Mora D, Moreno J, Heinze G, Pavón L (2007) Immune variations in bipolar disorder: phasic differences. Bipolar Disord 9(6):596–602PubMedCrossRefGoogle Scholar
  36. 36.
    Ozdemir O, Gundogdu F, Karakelleoglu S, Sevimli S, Pirim I, Acikel M, Arslan S, Serdar S (2008) Comparison of serum levels of inflammatory markers and allelic variant of interleukin-6 in patients with acute coronary syndrome and stable angina pectoris. Coron Artery Dis 19(1):15–19PubMedCrossRefGoogle Scholar
  37. 37.
    Eliav E, Benoliel R, Herzberg U, Kalladka M, Tal M (2009) The role of IL-6 and IL-1beta in painful perineural inflammatory neuritis. Brain Behav Immun 23(4):474–484PubMedCrossRefGoogle Scholar
  38. 38.
    Bigal ME, Liberman JN, Lipton RB (2006) Obesity and migraine: a population study. Neurology 66(4):545–550PubMedCrossRefGoogle Scholar
  39. 39.
    Kawasaki Y, Zhang L, Cheng JK, Ji RR (2008) Cytokine mechanisms of central sensitization: distinct and overlapping role of interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha in regulating synaptic and neuronal activity in the superficial spinal cord. J Neurosci 28(20):5189–5194PubMedCrossRefGoogle Scholar
  40. 40.
    Kutlu S, Canpolat S, Sandal S, Ozcan M, Sarsilmaz M, Kelestimur H (2003) Effects of central and peripheral administration of leptin on pain threshold in rats and mice. Neuro Endocrinol Lett 24(3–4):193–196PubMedGoogle Scholar
  41. 41.
    Elert J, Kendall SA, Larsson B, Mansson B, Gerdle B (2001) Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders. J Rheumatol 28(6):1361–1368PubMedGoogle Scholar
  42. 42.
    Okifuji A, Donaldson GW, Barck L, Fine PG (2010) Relationship between fibromyalgia and obesity in pain, function, mood, and sleep. J Pain 11(12):1329–1337PubMedCrossRefGoogle Scholar
  43. 43.
    Bjorvatn B, Sagen IM, Oyane N, Waage S, Fetveit A, Pallesen S, Ursin R (2007) The association between sleep ration, body mass index and metabolic measures in the Hordaland Health Study. J Sleep Res 16(1):66–76PubMedCrossRefGoogle Scholar
  44. 44.
    Di Milia L, Mummery K (2009) The association between job related factors, short sleep and obesity. Ind Health 47(4):363–368PubMedCrossRefGoogle Scholar
  45. 45.
    Stamatakis KA, Brownson RC (2008) Sleep duration and obesity-related risk factors in the rural Midwest. Prev Med 46(5):439–444PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2012

Authors and Affiliations

  • Mohammed Kamal Senna
    • 1
  • Rehab Abd-El Raouf Sallam
    • 1
  • Hala Salah Ashour
    • 2
  • Mohammed Elarman
    • 3
  1. 1.Rheumatology and Rehabilitation DepartmentMansoura Faculty of MedicineMansouraEgypt
  2. 2.Psychiatry DepartmentMansoura Faculty of MedicineMansouraEgypt
  3. 3.Clinical Pathology DepartmentMansoura Faculty of MedicineMansouraEgypt

Personalised recommendations