Obesity Treatment/Obesity Comorbidity
Weight loss interventions for adults with
overweight/obesity and chronic musculoskeletal pain: a
mixed methods systematic review
L. Cooper
1,2
, C. G. Ryan
1,2
, L. J. Ells
1,2
, S. Hamilton
1,2
, G. Atkinson
1,2
, K. Cooper
3
, M. I. Johnson
4
,
J. P. Kirwan
5
and D. Martin
1,2
1
School of Health and Social Care, Teesside
University, UK,
2
Teesside Centre for Evidence
Informed Practice: A Joanna Briggs Institute
Centre of Excellence, UK,
3
The Scottish Centre
for Evidenced-Based, Multi-professional
Practice: A Joanna Briggs Institute Centre of
Excellence, School of Health Sciences, Robert
Gordon University, UK,
4
Centre for Pain
Research, School of Clinical and Applied
Sciences, Leeds Beckett University, UK, and
5
Lerner Research Institute, Cleveland Clinic,
Cleveland, OH, USA
Received 7 December 2017; accepted 14
February 2018
Address for correspondence: L Cooper, School
of Health and Social Care, Teesside University,
UK.
E-mail: l.cooper@tees.ac.uk
Summary
Worldwide prevalence of adult overweight and obesity is a growing public health
issue. Adults with overweight/obesity often have chronic musculoskeletal pain.
Using a mixed-methods review, we aimed to quantify the effectiveness and explore
the appropriateness of weight loss interventions for this population. Electronic
databases were searched for studies published between 01/01/90 and 01/07/16.
The review included 14 randomized controlled trials that reported weight and pain
outcomes and three qualitative studies that explored perceptions of adults with
co-existing overweight/obesity and chronic musculoskeletal pain. The random-
effects pooled mean weight loss was 4.9 kg (95%CI:2.9,6.8) greater for interven-
tion vs control. The pooled mean reduction in pain was 7.3/100 units
(95%CI:4.1,10.5) greater for intervention vs control. Study heterogeneity was sub-
stantial for weight loss (I
2
= 95%, tau = ±3.5 kg) and pain change (I
2
= 67%,
tau = ±4.1%). Meta-regression slopes for the predictors of study quality, mean
age and baseline mean weight on mean study weight reduction were shallow and
not statistically significant (P > 0.05). The meta-regression slope between mean
pain reduction and mean weight lost was shallow, and not statistically significant,
À0.09 kg per unit pain score change (95%CI:À0.21,0.40, P = 0.54). Meta-
synthesis of qualitative findings resulted in two synthesized findings; the impor-
tance of healthcare professionals understanding the effects of pain on ability to con-
trol weight and developing management/education programmes that address
comorbidity.
Keywords: Chronic, musculoskeletal pain, obese, weight loss.
Introduction
Excess weight (body mass index [BMI] ≥25 kg/m
2
) and
chronic musculoskeletal pain (CMP) are prevalent condi-
tions with widespread implications for the individual,
health care resources and the economy (1,2). These two
conditions frequently occur simultaneously, and the rela-
tionship appears to be bi-directional, adding to the com-
plexity of managing either condition independently.
Cohort, case–control studies and randomized controlled tri-
als (RCT) assessing the effectiveness of weight loss interven-
tions on individuals with co-existing CMP have shown that
weight reduction can be achieved and is associated with
lower pain scores (3–6). However, no systematic review
has been conducted to determine the effectiveness of weight
loss interventions in this specific patient group or partici-
pants’ perceptions of the appropriateness and sustainability
of interventions to inform clinical practice.
obesity reviews
doi: 10.1111/obr.12686
© 2018 World Obesity Federation Obesity Reviews 19, 989–1007, July 2018
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