WEST PALM BEACH, Fla. — Obesity in multiple sclerosis (MS) was tied to faster worsening of disability and an increased risk of physical, psychological, and cognitive decline, a prospective cohort study showed.

Compared with normal weight, obesity was associated with a faster increase in scores on the Expanded Disability Status Scale (EDSS), which ranges from 0-10 with higher numbers reflecting greater disability, reported Lars Alfredsson, PhD, of the Karolinska Institute in Stockholm, Sweden, in a presentation at the ACTRIMS Forum 2024, the annual meeting of the Americas Committee for Treatment and Research in Multiple Sclerosis.

The risk of reaching EDSS 3 was 41% higher in MS patients with obesity (hazard ratio [HR] 1.41, 95% CI 1.51-1.72). The risk of reaching EDSS 4 was 31% higher (HR 1.31, 95% 1.03-1.68).

Obesity also was associated with an increased risk of self-reported physical quality of life (HR 1.40, 95% CI 1.18-1.67) and psychological quality of life (HR 1.24, 95% CI 1.04-1.46), and with cognitive disability worsening (HR 1.47, 95% CI 1.08-2.01).

Several studies have shown obesity may be a risk factor for developing MS, but few have drawn definitive conclusions about the role of obesity in MS progression, Alfredsson noted. One recent study, however, found that obesity in newly diagnosed MS patients was linked with a significantly higher risk of reaching EDSS 3 over 6 years, compared with normal weight.

“Patients commonly ask about ways they can impact the course of MS using lifestyle interventions,” said Robert Bermel, MD, of the Cleveland Clinic in Ohio, who wasn’t involved with the study.

“Based on this and other studies, weight loss can be recommended as a lifestyle intervention for obese patients with MS, in addition to treatment with disease-modifying therapy,” Bermel told MedPage Today in an email.

He and Alfredsson also brought up the potential study of GLP-1 agonists like semaglutide (Ozempic, Wegovy) for therapeutic weight loss in patients with MS.

Differences in disease progression were not as stark for patients categorized as overweight, Alfredsson reported. In patients who did not change BMI category during the study period, the differences were greater than among the overall group, with higher risks of reaching EDSS 3, physical and psychological worsening, and cognitive disability worsening.

The study also found that patients in the overweight and obesity groups had a slightly increased risk of new lesions on MRI post-diagnosis.

Data came from 3,249 patients in the Swedish MS Registry from 2005-2019, and from questionnaires patients answered at study inclusion and later in 2021. Patients were categorized by body mass index (BMI) at diagnosis and followed for up to 15 years post-diagnosis. Patients with a BMI of 18.5-24.99 were categorized as normal, 25-30 were considered overweight, and those with a BMI over 30 were classified as having obesity.

Most patients (74%) were female and mean baseline age was 37.8 years. In addition to EDSS, the study assessed scores from the Multiple Sclerosis Impact Scale 29 and the Symbol Digit Modalities Test.

Limitations included self-reported data on BMI and potential residual confounding from factors not accounted for by the study. BMI alone may be an imperfect clinical measure because it does not directly assess body fat.

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