"It Is a Vicious Circle": Experiences of People Living With Obesity and Chronic Pain: A Qualitative Evidence Synthesis (QES).

Introduction: The relationship between obesity and chronic pain (CP) is complex. Obesity is associated with increased pain-related disability, pain intensity, worse physical functioning, and poorer psychological well-being.

Aims: The aim of this qualitative evidence synthesis (QES) was to systematically review and synthesize the qualitative literature reporting experiences of people living with obesity (PwO) and CP.

Methods: We registered (PROSPERO: CRD42023361391) and undertook a QES to answer the following question: "What are the first-person experiences of people living with obesity and chronic pain?" We searched five databases on February 9, 2023 and February 8, 2024 to identify primary qualitative studies investigating the experience of PwO and CP. Two authors independently screened search results for eligibility, extracted data, assessed methodological quality using the Critical Appraisal Skills Program (CASP), and undertook a thematic synthesis of the included studies.

Results: We included 10 studies (n = 153 participants) and identified eight findings under four main themes: (1) A Predominant Bio-Mechanical Understanding of Pain; (2) Catch 22: Vicious Cycle of Pain and Obesity; (3) The Stigmas Associated With Pain and Obesity; and (4) Food as a Complex and Frustrating Pathway to Health.

Conclusions: The lived experiences of CP and obesity include complex interactions of pain beliefs, challenges relating to healthcare provision, pain-associated and weight-related stigmas, altered self-image, self-blame, and altered food habits in response to pain. Our QES enhances understanding of experiences of PwO and CP and highlights the need for improved strategies for healthcare professionals to address weight-based stigma and provide holistic care for PwO and CP.