Abstract
BackgroundEveryday experiences with racial (RD) and weight discrimination (WD) are risk factors for chronic pain in ethnically diverse adults with obesity. However, the individual or combined effects of RD and WD on pain in adults with obesity is not well understood. There are gender differences and sexual dimorphisms in nociception and pain, but the effect of gender on relationships between RD, WD, and pain outcomes in ethnically diverse adults with obesity is unclear. Thus, the purposes of this study were to: 1) examine whether RD and WD are associated with pain intensity and interference, and 2) explore gender as a moderator of the associations between RD, WD, and pain.MethodsThis is a baseline data analysis from a randomized, controlled clinical trial of a lifestyle weight-management intervention. Eligible participants were English or Spanish-speaking (ages 18–69 years) and had either a body mass index of ≥30 kg/m2 or ≥ 25 kg/m2 with weight-related comorbidity. RD and WD were measured using questions derived from the Experiences of Discrimination questionnaire (EOD). Pain interference and intensity were measured using the PROMIS 29 adult profile V2.1. Linear regression models were performed to determine the associations between WD, RD, gender, and pain outcomes.ResultsParticipants (n = 483) reported mild pain interference (T-score: 52.65 ± 10.29) and moderate pain intensity (4.23 ± 3.15). RD was more strongly associated with pain interference in women (b = .47, SE = .08, p < 001), compared to men (b = .14, SE = .07, p = .06). Also, there were no significant interaction effects between RD and gender on pain intensity, or between WD and gender on pain interference or pain intensity.ConclusionsPain is highly prevalent in adults with obesity, and is impacted by the frequencies of experiences with RD and WD. Further, discrimination against adults with obesity and chronic pain could exacerbate existing racial disparities in pain and weight management. Asking ethnically diverse adults with obesity about their pain and their experiences of RD and WD could help clinicians make culturally informed assessment and intervention decisions that address barriers to pain relief and weight loss.Trial registrationNCT03006328
Highlights
Everyday experiences with racial (RD) and weight discrimination (WD) are risk factors for chronic pain in ethnically diverse adults with obesity
Gender identity moderates the association between pain interference, pain intensity, and racial discrimination (RD). These results suggest that men report more frequent experiences with RD, the associations between the frequency of experiences with RD, pain interference, and pain intensity are stronger in women, in a large cohort of Non-Hispanic Black (NHB) and Hispanic/Latino/a/x adults with obesity
Given the paucity of pain research that is inclusive of NHB and Hispanic/Latino/a/x individuals with obesity, our findings suggest that experiences with RD and WD are salient and clinically relevant features of the pain experience in these populations, and the mechanisms underlying the relationships between discrimination and pain outcomes warrant further investigation
Summary
Everyday experiences with racial (RD) and weight discrimination (WD) are risk factors for chronic pain in ethnically diverse adults with obesity. WD is a prevalent form of discrimination in the U.S [2, 14,15,16], and is associated with a wide variety of negative pain-related outcomes that include functional disability [17], psychiatric comorbidities [18], weight gain [19, 20], lower health-related quality of life [21], and higher mortality [22]. Little is known about the impact of WD on pain-related outcomes in NHB and Hispanic/Latino/a/x adults with obesity who tend to be significantly underrepresented in pain studies
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