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Obesity Moderates the Effects of Motivational Interviewing Treatment Outcomes in Fibromyalgia

Kaleth, Anthony S. PhD; Slaven, James E. MS; Ang, Dennis C. MD, MS
The Clinical Journal of Pain: Post Acceptance: March 07, 2017
doi: 10.1097/AJP.0000000000000500
Original Article: PDF Only


Obesity is a common comorbid condition among patients with fibromyalgia (FM). Our objective was to assess if obesity moderates the treatment benefits of exercise-based motivational interviewing (MI) for FM.


This is a secondary data analysis of a completed clinical trial of 198 FM patients who were randomized to receive either MI or attention control (AC). Using body mass index (BMI) to divide participants into obese (BMI ≥30 kg/m2) and non-obese (BMI <30 kg m2) groups, mixed linear models were used to determine interaction between treatment arms and obesity status with regards to the primary outcome of global FM symptom severity (Fibromyalgia Impact Questionnaire, FIQ). Secondary measures included pain intensity (Brief Pain Inventory, BPI), 6-minute walk test, and self-reported physical activity (Community Health Activities Model Program for Seniors).


Of the 198 participants, 91 (46%) were non-obese and 107 (54%) were obese. On global FM symptom severity (FIQ), the interaction between treatment arms and obesity status was significant (P=0.02). In the non-obese group, MI was associated with a greater improvement in FIQ than AC. In the obese group, MI participants reported less improvement in FIQ compared to AC. The interaction analysis was also significant for BPI pain intensity (P=0.01), but not for the walk test and self-reported physical activity.


This is the first study to show that obesity negatively affects the treatment efficacy of MI in patients with FM. Our findings suggest that exercise-based MI may be more effective if initiated after weight loss is achieved.

Funding Support: National Institute of Arthritis & Musculoskeletal and Skin Diseases (1RO1AR054324-01A1). Identifier: NCT00573612.

Conflict of Interest: No professional relationships or conflicts of interest exist with any companies or manufacturers who will benefit from the results of the present study.

Reprints: Dennis Ang, MD, MS, Section of Rheumatology and Immunology, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157 (e-mail:

Received October 6, 2016

Accepted February 28, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.