Medical Review by Andrea Chadwick, M.D., M.Sc., FASA | Last Updated: December 2025
Key Takeaways
- Fibromyalgia has been shown in some studies to be associated with weight fluctuations or obesity; many people with fibro report weight gain or challenges maintaining weight. [1]
- Biological changes in hormones that regulate metabolism and stress—along with sleep disruption, pain, fatigue, decreased activity, and certain medications—can contribute to weight changes in fibro patients.
- Effective symptom management often requires a multi-pronged approach, including sleep and fatigue management, personalized movement and pacing, nutrition, and medication review under supervision.
- Emerging therapies like GLP‑1s show potential symptom reduction in some people with fibromyalgia, but evidence is still limited.
Why Weight Matters — How It Impacts Fibromyalgia Symptoms
Living with fibromyalgia affects far more than pain—it can also impact your weight in ways that are often misunderstood. Many people are told to “just lose weight” to feel better, but that advice oversimplifies what’s really going on.
Research does show that being overweight or obese when you have fibromyalgia can worsen many core symptoms of the condition. Here’s why:
- Increased pain sensitivity and tenderness: Fibromyalgia patients who are overweight or obese have been shown to have more tender points and higher pain sensitivity. [2]
- Worse sleep and fatigue: Obesity is associated with poorer sleep quality and more restless sleep in fibromyalgia patients. [2]
- Reduced mobility and strength: Movement is already difficult with fibromyalgia. Weight gain and worse sleep can make movement harder, increasing joint stress and reducing flexibility.
This can create a negative cycle: Poor sleep → increased fatigue → less activity → weight gain → worsened pain/sleep → repeat.
What Is the Connection between Fibromyalgia and Weight Gain?
A recent systematic review found that about 35.7% of people with fibromyalgia meet criteria for obesity (BMI ≥ 30). [1] That’s similar to the prevalence of obesity in the United States, typically around 40%. So while weight can impact symptoms, not everyone with fibromyalgia struggles with weight, and not everyone who is overweight has fibromyalgia symptoms.
So why would having fibromyalgia be connected with weight? Recent research can suggest some clues:
Hormonal and Metabolic Changes
Some studies suggest people with fibromyalgia may have disruptions in hormones related to energy balance and stress regulation, which can also affect weight:
- One small study compared 60 people with fibromyalgia to 42 healthy controls and found higher leptin and lower growth hormone (GH) in the fibro group. [3]
- Similar findings appear in broader analyses: a 2024 meta-analysis of 697 fibromyalgia patients vs 560 controls found in certain subgroups a significant increase in leptin and decrease in GH levels. [4]
Because leptin influences satiety and GH influences metabolism, these changes may contribute to reduced metabolic rate, increased fat storage and altered appetite regulation.
Sleep, Pain, Fatigue and Activity Reduction
Fibromyalgia frequently disrupts sleep, causes chronic pain and fatigue, and reduces tolerance for movement or exercise. Many patients become less active, either because of pain flares or fear of triggering symptoms.
This reduction in daily energy expenditure — combined with metabolic/hormonal changes — makes maintaining a healthy weight much harder.
Given that in fibromyalgia, obesity is associated with worse pain, poorer sleep, and decreased function, a vicious cycle can form: fibro → weight gain → worsened fibro. [2]
Medication Effects
Some medications used in fibromyalgia — including certain anticonvulsants, antidepressants, muscle relaxants, or off-label therapies — can have side effects that include weight gain, increased appetite, sedation (reducing activity) or fluid retention. Over time, these side effects may contribute to gradual weight increase.
Does Fibromyalgia Ever Cause Weight Loss Instead?
Not everyone with fibromyalgia gains weight. Some lose weight, often unintentionally, due to:
- Medication side effects (e.g., gastrointestinal disturbances, decreased appetite)
- Mood changes (e.g., anxiety, depression)
- Sensory sensitivities (some people become more sensitive to food textures/smells)
- Pain or fatigue interfering with regular eating
Could GLP‑1 Receptor Agonists Help Fibromyalgia Patients?
Given the challenges of weight management in fibromyalgia — and the association between obesity and worse fibro symptoms — it’s natural to ask whether newer weight-loss medications like GLP‑1 receptor agonists (GLP-1s) could help.
What Are GLP‑1s?
GLP-1 receptor agonists are a class of medications originally developed for diabetes, and increasingly used for weight management. They include Semaglutide (Ozempic, Wegovy, Rybelsus), Liraglutide (Victoza, Saxenda), Dulaglutide (Trulicity), and Tirzepatide (Mounjaro, Zepbound).
They work by:
- Slowing the emptying of the stomach (making you feel full longer).
- Reducing appetite and hunger signals in the brain (promoting satiety or fullness).
- Modulating metabolic and hormonal signals to favor fat loss.
Multiple clinical trials and meta-analyses in adults with obesity have found that GLP-1RAs are associated with significant weight loss — for example, one meta-analysis of 11,459 participants showed an average weight loss of ~ 7.1 kg (over 15 lbs) compared to control groups. [5]
Given these effects, GLP-1s could potentially help fibromyalgia patients who struggle with weight, especially if they meet clinical criteria (e.g., BMI, comorbidities).
Emerging Evidence for GLP-1s and Fibromyalgia
There is growing but still preliminary evidence suggesting GLP-1s might also have an impact on fibromyalgia symptoms specifically:
- A 2025 analysis of health-records from a large cohort of fibromyalgia patients found that GLP-1 users had lower documented pain and fatigue over 5 years compared with non-users.
- Some animal studies suggest GLP-1RAs may have anti‑inflammatory, neuroprotective, and analgesic effects, potentially reducing the central sensitization and pain signaling associated with fibromyalgia. [6]
Keep in mind that most evidence of GLP-1 benefit in fibromyalgia comes from observational data, not randomized controlled trials. This means we can observe associations but need more evidence to prove that GLP-1s caused the improvement.
What This Means for Patients
For fibromyalgia patients who are overweight or obese and struggling with weight, or whose fibro symptoms worsen with weight gain, GLP‑1 receptor agonists might represent a potential tool to support weight loss. Because weight loss can improve pain, sleep, mobility, and overall functioning, GLP-1s may indirectly improve fibro-related quality of life.
That said — and especially because evidence is limited — GLP-1s should be considered only in the context of a comprehensive plan, ideally under guidance of a physician experienced in both fibromyalgia and weight management.
GLP-1s are generally prescribed to individuals with obesity (or overweight with comorbidities), not everyone with fibromyalgia. So suitability depends on personal health profile. As with any medication: benefits must be weighed against side effects, cost, and long-term safety.
What You Can Do About Fibro and Weight Gain Now (Without Medication)
If you’re considering treatment for fibromyalgia or looking to reduce symptom activity, here are clinically supported strategies that often help fibromyalgia patients keep weight stable — or lose weight — even without medication.
Prioritize Sleep
Because poor sleep worsens appetite regulation, fatigue, and pain, restoring restful sleep is a first priority for fibromyalgia, including:
- Maintaining a consistent sleep–wake schedule
- Using relaxation techniques before bed (meditation, gentle stretching)
- Limiting stimulants and alcohol in the evening
- Considering behavioral therapies for insomnia (CBT‑I) if sleep problems persist
Better sleep helps regulate hunger, reduce fatigue, improve mood — all of which support weight stability and overall fibromyalgia symptom improvement.
Gentle, Consistent Movement (Pacing is Key)
You don’t need heavy exercise to get benefits for fibromyalgia symptoms. With fibromyalgia, pacing and gentle activity matter more than intensity. Try:
- Short walks (5–10 min)
- Water-based exercise (swimming, aquatic therapy)
- Gentle yoga or tai chi
- Light resistance or stretching
Pacing — breaking tasks into smaller chunks, resting before exhaustion sets in, and avoiding “boom-and-crash” cycles — can help maintain consistent energy. That consistency enables regular movement and reduces longer periods of inactivity
Even small increases in activity help counteract muscle deconditioning, improve metabolism, maintain mobility, and may reduce weight gain over time.
Review Medications — Especially Those Known to Affect Weight
If you’ve noticed weight gain after starting a fibromyalgia medication, consider discussing with your doctor:
- Could dosage be adjusted or timing changed?
- Might an alternative with less risk of weight gain work?
- Is the risk worth the benefit, given how you feel overall?
Keep in mind: Medication review should always occur under medical supervision.
Consider How Nutrition Affects Symptoms
If you have fibromyalgia, assessing overall nutrition and flare triggers can be one of the gentler but powerful ways to support weight loss as well as overall well-being. While there is no “magic diet,” research suggests that eating patterns such as a Mediterranean diet, a low-FODMAP diet, or a generally anti-inflammatory, whole-foods diet tend to offer the most promise.
These diets emphasize:
- whole grains instead of refined flour
- abundant fruits and vegetables
- lean proteins (like fish, poultry, beans or tofu)
- healthy fats (like olive oil, nuts, and seeds)
They minimize:
- red and processed meats
- refined sugars
- heavily processed foods
Focusing on nutrient-dense, fiber-rich foods also helps regulate metabolism, support gut health, and stabilize energy — factors that often become disrupted with fibromyalgia.
If you decide to try dietary changes, it can help to track what you eat and how you feel, then gradually shift toward whole, minimally processed foods — rather than jumping into restrictive or extreme diets.
Address Mood and Stress through Behavioral Approaches
Since hormonal and stress system dysregulation may drive appetite and fat storage, managing stress, mood, and emotional health is critical, both for weight and overall fibromyalgia symptoms.
Approaches that have been shown to improve mental health and overall symptoms in fibromyalgia include:
- Behavioral therapy (CBT, ACT)
- Mind-body practices (meditation, mindfulness, gentle yoga)
- Social support and community
- Self-care routines
Summary
Fibromyalgia and weight are often discussed together — but the common advice to “lose weight” to reduce symptoms is a very simplified picture of what’s really happening behind the scenes. Fibro can disrupt metabolism, hormones, sleep, energy, and activity — all of which make weight management harder.
The good news: a combination of sleep, pacing, movement, stress management, and possibly weight‑supporting medications can make a meaningful difference. And while no single approach works for everyone, working with your providers to find the personalized path that’s right for you can lead to improved symptoms and better overall quality of life.
Sources
[1] D’Onghia M, Ciaffi J, Lisi L, Mancarella L, Ricci S, Stefanelli N, Meliconi R, Ursini F. Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis. Semin Arthritis Rheum. 2021 Apr;51(2):409-424. doi: 10.1016/j.semarthrit.2021.02.007. Epub 2021 Mar 3. PMID: 33676126. https://pubmed.ncbi.nlm.nih.gov/33676126/
[2] Okifuji A, Donaldson GW, Barck L, Fine PG. Relationship between fibromyalgia and obesity in pain, function, mood, and sleep. J Pain. 2010 Dec;11(12):1329-37. doi: 10.1016/j.jpain.2010.03.006. Epub 2010 Jun 9. PMID: 20542742; PMCID: PMC2939916. https://pubmed.ncbi.nlm.nih.gov/20542742/
[3] Koca TT, Berk E, Seyithanoğlu M, Koçyiğit BF, Demirel A. Relationship of leptin, growth hormone, and insulin-like growth factor levels with body mass index and disease severity in patients with fibromyalgia syndrome. Acta Neurol Belg. 2020 Jun;120(3):595-599. doi: 10.1007/s13760-018-01063-6. Epub 2018 Dec 13. PMID: 30547374. https://pubmed.ncbi.nlm.nih.gov/30547374/
[4] Lee YH, Song GG. Association of circulating leptin, growth hormone, and ghrelin with fibromyalgia: A meta-analysis. Growth Horm IGF Res. 2024 Aug;77:101606. doi: 10.1016/j.ghir.2024.101606. Epub 2024 Jul 2. PMID: 38964272. https://pubmed.ncbi.nlm.nih.gov/38964272/
[5] Iqbal J, Wu HX, Hu N, Zhou YH, Li L, Xiao F, Wang T, Jiang HL, Xu SN, Huang BL, Zhou HD. Effect of glucagon-like peptide-1 receptor agonists on body weight in adults with obesity without diabetes mellitus-a systematic review and meta-analysis of randomized control trials. Obes Rev. 2022 Jun;23(6):e13435. doi: 10.1111/obr.13435. Epub 2022 Feb 22. PMID: 35194917. https://pubmed.ncbi.nlm.nih.gov/35194917/
[6] Bade S, Hurdle MFB, Bade S, Encalada S, Kanahan-Osman S, Gupta S. GLP-1 agonists: a game changer in pain treatment and addiction. Pain Manag. 2025 Oct;15(10):753-765. doi: 10.1080/17581869.2025.2536998. Epub 2025 Jul 28. PMID: 40726115. https://pubmed.ncbi.nlm.nih.gov/40726115/
