Weight discrimination linked to chronic pain, but researchers say it’s more complex than that

A 2025 study published in The Journal of Pain found that people ages 50 and up with chronic pain have also experienced “greater discrimination than people without pain in a community-based sample.” 

The researchers wrote that people with higher body mass index (BMI) at the beginning of the study “[were] associated with greater likelihood of reporting moderate or severe pain approximately 4 years later. Findings are consistent with hypotheses and aligned with the existing literature documenting an association between BMI and pain.”

They wrote that discrimination of any form “is a chronic form of stress that may contribute to prolonged physiological dysregulation. Given evidence that systemic low-grade inflammation may precipitate chronic pain, this may be one explanatory pathway. [Also], experiencing perceived weight discrimination is consistently associated with factors linked to chronic pain such as psychological distress including depression and anxiety, as well as avoidance of health promoting behaviors such as exercise.”

Lead researcher Dr. KayLoni Olson from the Department of Psychiatry and Human Behavior at Brown Medical School said that historically, chronic pain among overweight people are based on biological factors, such as extra weight increases load on joints or alters movement mechanics.

“There is a growing evidence base suggesting that weight discrimination plays at least a partial role in the weight-pain relationship, so better understanding this was our goal,” she said in an interview with Massage & Fitness. “Individuals who have a higher body weight are at increased risk for experiencing pain in daily life and chronic pain conditions. Yet discrimination is recognized as a factor that can contribute to pain and weight-related discrimination is very common in Western cultures.”

With Dr. Ruth Hackett and Dr. Whitney Scott from King’s College London, Olson gathered data from the English Longitudinal Study of Ageing (ELSA)—a national, ongoing study following adults age 50 and older in England. They analyzed three consecutive waves of data to compare whether people with higher BMI were more likely to report pain later, and whether weight discrimination played a role.

“[ELSA] was started in the early 1990s to study adults living in England (not the entire U.K.) who are middle-age or older and to observe their health and well-being over time. The overarching goal was to illuminate and better understand aging,” Olson said.

In wave 4 (2008–2009), they collected demographic data (e.g. age, gender, ethnicity, wealth, marital status), BMI, and self-reported pain.

In wave 5 (2010–2011), they assessed perceived weight discrimination; and in wave 6 (2012–2013), they reassessed self-reported pain to track changes over time.

Participants were included if they had complete data for BMI, pain, discrimination, and demographics.

What they found

Out of more than 11,000 participants, 5,362 answered all the questions. Olson et al. noted that those who had completed had higher BMI, were less likely to be married, were more likely to be white, were of higher socioeconomic status and were less likely to report moderate/severe pain at baseline than those who dropped out or had missing information. 

Overall, about 37% of those who never experienced weight discrimination developed moderate or severe pain compared to 52% of people who had experienced such discrimination. Thus, weight discrimination increases the likelihood of experiencing chronic pain by about 41%.

Olson clarified that this sample “was only among those who had obesity at the start of the study.”

They reported 4% of the participants (217 people) said they experienced weight discrimination at wave 5, 29% (1,543 people) reported moderate or severe pain at wave 6. People with higher BMI or were obese at wave 4 were more likely to report moderate or severe pain later in wave 6.

However, Olson et al. reported that weight discrimination partly explained the link between BMI and future pain.

“In our prior work and the work done by others, it was common to look at body weight, pain, and weight discrimination all at the same time point,” Olson said. “This makes it difficult to figure out if one of the variables is causing the other or if they might all just happen to coexist.”

Olson gave an example where people with higher body weight often have more pain and weight-related mistreatment. 

“The ELSA study followed the same individuals over many years, and this allows us to look at BMI, pain, and weight discrimination over time in the same group,” she said. “This allows us to begin teasing apart how the factors are related. Because of this difference in how we study the variables, we can begin more seriously considering that weight discrimination isn’t just a side effect but possibly plays a role in driving or causing the weight-pain relationship.”

Although the ELSA study uses middle-age to older adults, Olson said that their findings could be applied to younger people. “This will be an important area for future study,” she said.

Some of the study’s limitations include a lack of: 

• Details on pain duration and its daily impact on function
• Psychometric validation, which did not allow the researchers to determine whether the findings apply to the chronic pain prediction
• Racial and ethnic diversity
• Younger age groups

Olson added that weight discrimination has varying degrees across cultures and the results may be similar to those of Western cultures. 

“A counterargument is that we don’t really know why weight discrimination seems to be playing a role in the BMI to pain relationship,” she said. “We have many hypotheses (e.g., disrupts access to screening and treatment for pain in medical settings or impacts lifestyle factors that potentiate pain or physiological pathways like inflammation due to chronic stress). As we learn more, it will illuminate whether or not these relationships are likely to be consistent across cultures.”

Future studies, bigger picture

Olson said that she and her colleagues are using the Health and Retirement Study (HRS) to replicate the analyses that were conducted in the ELSA study.

“The HRS study is the U.S.-counterpart to the ELSA study so the same variables were collected among a large cohort of adults 50 years and older who live in the U.S.,” she said. “We will also expand our analyses to see if the relationships between BMI, weight discrimination, and pain are the same among subgroups of individuals who are at risk for experiencing discrimination for other reasons, [such as] age, sex, or race/ethnicity.”

Regarding how studies involving weight discrimination and pain development affect public policies, Olson said that the current research is “premature.” However, she said that their research adds to a growing literature that recognizes weight discrimination is a risk factor for negative health outcomes. 

“Medical settings are one of the most common settings for weight discrimination, so even though this line of research requires more work, I think it’s fair to encourage all providers to be mindful of the potential for bias and discrimination related to weight and pain,” Olson said. 

Further reading: People in pain report more frequent perceived discrimination than those without pain