Weight Discrimination Partially Mediates the Prospective Relationship Between Body Mass Index and Pain in the Health and Retirement Study Cohort

In a sample of adults ≥50 years old in England, weight discrimination partially mediated the prospective relationship between high body weight and severity of physical pain. This study replicates these prospective analyses in the US-based Health and Retirement Study of adults ≥50 years old. It extends prior work by evaluating pain interference and the unique contribution of weight- compared with other- types of discrimination. Generalized linear models were used to estimate the direct effect of BMI/obesity status at wave-2004 on pain severity (no/mild or moderate/severe) and pain interference (yes/no) at wave-2010, and the indirect effect via weight discrimination at wave-2006/08. 6909 individuals provided complete data (59% female, 74.5% non-Hispanic white, 63.4±9.98 years old, BMI 28.7±5.7 kg/m2, 35% had obesity). Approximately 24% reported moderate/severe pain, 21% reported interference, and 14% perceived weight discrimination. BMI predicted future pain severity and interference (both p<.01.) but not via weight discrimination. Obesity predicted pain severity (b=1.49 SE=0.09, p<.01) and interference (b=1.04 SE=0.01, p<.01.), partially mediated by weight discrimination (severity p=.08, accounting for 13% of the total effect; interference at p<.01, accounting for >30% of the total effect). A chi-square test (X2 (3, 6906)=46.3, p<.01) revealed that individuals who reported weight discrimination (35%) or weight in addition to other types of discrimination (38%) were more likely to report moderate/severe pain than those who reported no (26%) or discrimination for non-weight reasons (27%). Results were similar for pain interference (X2 (3, 6906)=84.2, p<.01). Findings suggest a potential and unique role of weight discrimination in the obesity-pain relationship.