Multiple sclerosis (MS) is a progressive disease of the central nervous system that can cause symptoms throughout the body, including both physical and cognitive symptoms. Obesity in childhood and early adulthood raise the risk of developing multiple sclerosis,e60dc2a1-f33c-4a05-9b50-8e3e8e597629f8cf7b6f-e48b-48b1-a004-8c0ba58945bae60dc2a1-f33c-4a05-9b50-8e3e8e5976292ebd872b-9a4d-42a4-877c-0039b6f4122f but does obesity have an impact on people already diagnosed with MS? Here’s what you need to know about how obesity affects MS, from symptoms to progression.
Practical Downsides of Obesity in MS Practical Downsides of Obesity According to Le Hua, MD , director of the multiple sclerosis program at Cleveland Clinic’s Lou Ruvo Center for Brain Health in Las Vegas, obesity can worsen a number of health-related problems for people with MS. It can put additional stress on the body, leading to more severe MS symptoms and increased disability.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299d4b2707-0d85-4403-b617-713902b94d4b Lower Quality of Life, More Disability Obesity is associated with a lower health-related quality of life, higher levels of fatigue and pain, and lower overall health for people with MS.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299d4b2707-0d85-4403-b617-713902b94d4b People who are obese are more likely to have a higher score on the Expanded Disability Status Scale (EDSS), a clinical benchmark used by neurologists to measure the level of disability, including walking ability, in MS.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ba4ffca5-7a13-4ab7-99b4-6dc04f47a411 Increased Risk of Comorbidities Obesity also raises the risk of comorbidities, or coexisting conditions, including diabetes and cardiovascular disease. “Obesity is a risk factor for worsening vascular disease,” says Dr. Hua. “When you have increased vascular risk factors and vascular comorbidities, that has been clearly associated with worsening MS progression and disability.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f5febaa-e70d-45d7-8dd6-324ee6f9d203 We know that by reducing vascular risk factors, including obesity, patients have better outcomes. We need to optimize and treat those other comorbid conditions, so that the overall progression in MS is decreased.” Pain in the Muscles and Joints People with MS and obesity are more likely to experience pain, as both pain in the muscles and joints (arthritis) and nerve pain can be worsened by the added stress of carrying extra weight.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ba4ffca5-7a13-4ab7-99b4-6dc04f47a411 “Obesity certainly impacts joints and arthritis, so patients who have more arthritis will have mobility impairments in addition to their MS,” says Hua. “Lack of mobility is also associated with more pain because you’re kind of sitting around more, you’re not getting improved blood flow, and the pressure on joints can then increase.” Increased Inflammation Obesity is characterized by chronic, low-grade inflammation in the body.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fdc41e59-ddf9-4106-a73d-8836e60958c6 According to Hua, this is due to the fact that adipose tissue (fat) “secretes numerous inflammatory factors.” That increased inflammation may contribute to neurodegeneration (destruction of neurons) and worsened cognitive function in MS.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299d4b2707-0d85-4403-b617-713902b94d4b Additional Bladder Issues People with MS may already experience bladder issues , either problems storing urine or problems emptying the bladder. This occurs when MS damages areas in the brain or spinal cord that control bladder function.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296d356faa-6ec9-497b-b8de-c756e733cb7a Excess weight puts pressure on the pelvic floor, which can lead to stress incontinence, or unexpected leaks.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ba4ffca5-7a13-4ab7-99b4-6dc04f47a411 Worsened Mental Health Obesity can have adverse effects on mental health.e60dc2a1-f33c-4a05-9b50-8e3e8e597629708f40b3-4a9e-4856-bf05-707fe0d7ec3b It can contribute to low self-esteem, and the additional stress of reduced mobility, increased pain, and more pronounced MS symptoms can create a vicious cycle that impacts your ability to cope. It’s important to seek help to break the cycle for both your physical and mental health.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ba4ffca5-7a13-4ab7-99b4-6dc04f47a411 Delayed MS Diagnosis Hua notes that obesity may lead to later diagnosis for some people with MS. “A lot of the time due to obesity, early signs and symptoms of MS are missed, and then patients are told they just need to lose weight, and that could actually lead to delays in diagnosis of their underlying MS,” she says.e60dc2a1-f33c-4a05-9b50-8e3e8e59762924ba45b4-f071-4669-bcb8-aa8aba7421c6
Effect of Obesity on MS Progression Obesity and MS Progression In addition to being linked to worse health outcomes in general, obesity is associated with more disease progression, measured by a faster time to reach a higher EDSS, more new lesions seen on MRIs, and more rapid cognitive decline.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294e831fa6-405a-490b-898d-1743d92e44d4e60dc2a1-f33c-4a05-9b50-8e3e8e597629f9459e23-826f-4b37-9b3a-d59a08db9797 One of the reasons for this may be the increased risk of cardiovascular problems that come with obesity: High blood pressure High cholesterol Atherosclerosis, or hardening of the arteries Type 2 diabetes and insulin resistance Metabolic syndrome These conditions are associated with faster MS progression, brain shrinkage, and worse brain energy metabolism.e60dc2a1-f33c-4a05-9b50-8e3e8e59762925fb9069-136c-4111-8c00-a684eff8137e While treatments exist for the various cardiovascular diseases that can worsen MS progression, the potential for overlapping symptoms of obesity, MS, and other comorbidities can make treatment more complicated. As an example, Hua notes that both diabetes, which is often linked to obesity , and MS can cause numbness, tingling , and vision changes . It’s “important to sort out what is actually going on with that patient, rather than either only blaming MS or only blaming it on their obesity, when it may be one or the other, and further investigations need to be taken into account,” she says. Finally, obesity may have an impact on treatment effectiveness. Most MS treatments “use a standard adult dose, even though body size varies significantly from person to person,” Hua says. “We typically don’t adjust these doses based on weight, which raises important considerations: Could differences in body mass influence drug metabolism, side effects, or overall risk? These are factors that researchers continue to explore.”
Talking to Your Doctor About Obesity Talking to Your Doctor Weight management is an important part of MS treatment, and your doctor can help support you in reaching your weight and health goals.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d30f38f1-5aa8-470f-b6ec-9425827e66a1 That said, managing obesity isn’t about a number, says Hua. “When I talk to my patients, I don’t ever want to focus on a number,” she says. “I think we run into problems when we think about what the ideal weight is.” Instead, she says to focus on how you feel. If you can move better, you’ll feel healthier. Hua suggests working with your doctor to come up with a comprehensive care plan on how to address your needs from multiple angles. Your doctor may recommend these experts: A dietitian for nutrition support and help with meal planning A physical therapist, trainer, or exercise specialist for exercise help An occupational therapist to help you adapt your movements and daily activities based on your ability GLP-1 medications for appetite controle60dc2a1-f33c-4a05-9b50-8e3e8e59762961bb05ae-a01c-48e4-a5ae-e4bf00e48696 While obesity isn’t easily treated, it’s worth having a discussion with your doctor about what help is available. They can support you in setting realistic goals, sticking to a plan, and adjusting it as needed.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d9101d0d-7568-4120-841d-977fe8fe6297 Hua suggests encouraging your healthcare provider to look deeper than just diet and exercise. Someone “might eat an exceedingly healthy diet and exercise and still be larger, in which case we might need to then address other options to help them lose weight,” she says. It can help to come to your appointment with clear priorities as well as an understanding of the barriers you face in meeting your goals. For instance, you may want to focus on exercises to improve your balance and fatigue but face barriers like heat sensitivity , pain, and time constraints. Your doctor can help you work through these limitations to come up with realistic solutions.
The Takeaway Obesity in MS lowers quality of life by increasing fatigue and pain, and by contributing to difficulties with walking, balance, and coordination. Obesity itself is associated with increased disease progression and worse neurological outcomes by contributing to inflammation, and it additionally raises the risk of comorbidities such as cardiovascular disease and diabetes, which can further accelerate MS progression. If you have obesity, ask your doctor for help developing a personalized plan for addressing it, focusing on realistic goals that might include dietary strategies and physical therapy.
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