Obesity has become a major global public health problem and is associated with a range of comorbidities including sleep disturbance and chronic pain.1 There have been numerous studies on the associations between obesity, sleep, and pain, and on how and in which direction they influence each other.1,2 Sleep debt, chronic pain, weight gain, and significant hormonal changes have all been suggested as possible outcomes of these relationships.3–5 Results from a meta-analysis have shown that twins who are overweight are twice as likely to have low back pain compared to those of normal weight or below weight.6 An example of this complex interaction can be found in some individuals with chronic pain, who may be restricted in their movement and become less active, thereby contributing to weight gain which, in turn, has been shown to be associated with sleep restriction.
The literature shows that obesity can contribute to chronic pain through two main mechanisms: mechanical stress, with excess body weight causing stress on joints in the musculo-skeletal system; and systemic proinflammatory status, which is associated with obesity and can worsen pain.7 Conversely, chronic pain can contribute to obesity through limiting physical activity because of fear of movement.7 Other studies have shown body mass index (BMI) to be associated with pain, disability, depression, anxiety, reduced physical function,8 and lack of sleep.9
Several studies have demonstrated that sleep deprivation is associated with obesity in adults3,10 through modifying appetite-regulating hormones and increasing caloric intake. The mechanism can be explained by sleep deprivation causing an imbalance between leptin and ghrelin. Leptin and ghrelin are peripheral signals that interact with the hypothalamic arcuate nucleus and modulate orexin system activity to decrease or increase food intake.10 When there is sleep restriction, ghrelin increases whereas leptin decreases, therefore contributing to increased food intake. Previous studies have demonstrated that short sleep was also associated with unbalanced leptin and ghrelin and that these hormonal changes can result in increased BMI, which in turn can have negative effects on sleep.3
Therefore, we would like to highlight the mechanisms involved in obesity and the important relationship between obesity, sleep, and chronic pain. Modern lifestyles have tended to produce more sedentary populations who consume more food and sleep less,11 which has contributed to an increase in chronic diseases and less healthy populations. Thus, it is essential to implement awareness and prevention strategies that consider the relationships between all these factors in order to combat the risks to health. Changing behaviors is not easy, but it needs to be done given their current effect on health.
The authors are supported by grants from the Associacao Fundo de Incentivo à Pesquisa (AFIP) and the Sao Paulo Research Foundation. MLA and ST are CNPq fellowship recipients. PKM is supported by a grant from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). The authors report no conflicts of interest.
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