Obesity's Impact on MS Progression: Risks and Solutions

The Impact of Obesity on MS Progression

The Impact of Obesity on MS Progression
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Published on January 7, 2026
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Multiple sclerosis (MS) is a progressive disease of the central nervous system that can cause symptoms throughout the body, including both physical and cognitive symptoms.

Obesity in childhood and early adulthood raise the risk of developing multiple sclerosis,

 but does obesity have an impact on people already diagnosed with MS?

Here’s what you need to know about how obesity affects MS, from symptoms to progression.

Practical Downsides of Obesity in MS

According to Le Hua, MD, director of the multiple sclerosis program at Cleveland Clinic's Lou Ruvo Center for Brain Health in Las Vegas, obesity can worsen a number of health-related problems for people with MS. It can put additional stress on the body, leading to more severe MS symptoms and increased disability.

Lower Quality of Life, More Disability

Obesity is associated with a lower health-related quality of life, higher levels of fatigue and pain, and lower overall health for people with MS.

People who are obese are more likely to have a higher score on the Expanded Disability Status Scale (EDSS), a clinical benchmark used by neurologists to measure the level of disability, including walking ability, in MS.

Increased Risk of Comorbidities

Obesity also raises the risk of comorbidities, or coexisting conditions, including diabetes and cardiovascular disease.

“Obesity is a risk factor for worsening vascular disease,” says Dr. Hua. “When you have increased vascular risk factors and vascular comorbidities, that has been clearly associated with worsening MS progression and disability.

 We know that by reducing vascular risk factors, including obesity, patients have better outcomes. We need to optimize and treat those other comorbid conditions, so that the overall progression in MS is decreased.”

Pain in the Muscles and Joints

People with MS and obesity are more likely to experience pain, as both pain in the muscles and joints (arthritis) and nerve pain can be worsened by the added stress of carrying extra weight.

“Obesity certainly impacts joints and arthritis, so patients who have more arthritis will have mobility impairments in addition to their MS,” says Hua. “Lack of mobility is also associated with more pain because you’re kind of sitting around more, you’re not getting improved blood flow, and the pressure on joints can then increase.”

Increased Inflammation

Obesity is characterized by chronic, low-grade inflammation in the body.

 According to Hua, this is due to the fact that adipose tissue (fat) “secretes numerous inflammatory factors.”
That increased inflammation may contribute to neurodegeneration (destruction of neurons) and worsened cognitive function in MS.

Additional Bladder Issues

People with MS may already experience bladder issues, either problems storing urine or problems emptying the bladder. This occurs when MS damages areas in the brain or spinal cord that control bladder function.

 Excess weight puts pressure on the pelvic floor, which can lead to stress incontinence, or unexpected leaks.

Worsened Mental Health

Obesity can have adverse effects on mental health.

 It can contribute to low self-esteem, and the additional stress of reduced mobility, increased pain, and more pronounced MS symptoms can create a vicious cycle that impacts your ability to cope. It’s important to seek help to break the cycle for both your physical and mental health.

Delayed MS Diagnosis

Hua notes that obesity may lead to later diagnosis for some people with MS. “A lot of the time due to obesity, early signs and symptoms of MS are missed, and then patients are told they just need to lose weight, and that could actually lead to delays in diagnosis of their underlying MS,” she says.

Effect of Obesity on MS Progression

In addition to being linked to worse health outcomes in general, obesity is associated with more disease progression, measured by a faster time to reach a higher EDSS, more new lesions seen on MRIs, and more rapid cognitive decline.

One of the reasons for this may be the increased risk of cardiovascular problems that come with obesity:

  • High blood pressure
  • High cholesterol
  • Atherosclerosis, or hardening of the arteries
  • Type 2 diabetes and insulin resistance
  • Metabolic syndrome
These conditions are associated with faster MS progression, brain shrinkage, and worse brain energy metabolism.

While treatments exist for the various cardiovascular diseases that can worsen MS progression, the potential for overlapping symptoms of obesity, MS, and other comorbidities can make treatment more complicated.

As an example, Hua notes that both diabetes, which is often linked to obesity, and MS can cause numbness, tingling, and vision changes. It’s “important to sort out what is actually going on with that patient, rather than either only blaming MS or only blaming it on their obesity, when it may be one or the other, and further investigations need to be taken into account,” she says.

Finally, obesity may have an impact on treatment effectiveness. Most MS treatments “use a standard adult dose, even though body size varies significantly from person to person,” Hua says. “We typically don’t adjust these doses based on weight, which raises important considerations: Could differences in body mass influence drug metabolism, side effects, or overall risk? These are factors that researchers continue to explore.”

Talking to Your Doctor About Obesity

Weight management is an important part of MS treatment, and your doctor can help support you in reaching your weight and health goals.

That said, managing obesity isn’t about a number, says Hua. “When I talk to my patients, I don’t ever want to focus on a number,” she says. “I think we run into problems when we think about what the ideal weight is.” Instead, she says to focus on how you feel. If you can move better, you’ll feel healthier.

Hua suggests working with your doctor to come up with a comprehensive care plan on how to address your needs from multiple angles.

Your doctor may recommend these experts:

  • A dietitian for nutrition support and help with meal planning
  • A physical therapist, trainer, or exercise specialist for exercise help
  • An occupational therapist to help you adapt your movements and daily activities based on your ability
  • GLP-1 medications for appetite control

While obesity isn’t easily treated, it’s worth having a discussion with your doctor about what help is available. They can support you in setting realistic goals, sticking to a plan, and adjusting it as needed.

Hua suggests encouraging your healthcare provider to look deeper than just diet and exercise. Someone “might eat an exceedingly healthy diet and exercise and still be larger, in which case we might need to then address other options to help them lose weight,” she says.

It can help to come to your appointment with clear priorities as well as an understanding of the barriers you face in meeting your goals. For instance, you may want to focus on exercises to improve your balance and fatigue but face barriers like heat sensitivity, pain, and time constraints. Your doctor can help you work through these limitations to come up with realistic solutions.

The Takeaway

  • Obesity in MS lowers quality of life by increasing fatigue and pain, and by contributing to difficulties with walking, balance, and coordination.
  • Obesity itself is associated with increased disease progression and worse neurological outcomes by contributing to inflammation, and it additionally raises the risk of comorbidities such as cardiovascular disease and diabetes, which can further accelerate MS progression.
  • If you have obesity, ask your doctor for help developing a personalized plan for addressing it, focusing on realistic goals that might include dietary strategies and physical therapy.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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  2. Waubant E et al. Environmental and genetic risk factors for MS: an integrated review. Annals of Clinical and Translational Neurology. August 7, 2019.
  3. Wu J et al. Obesity Affects Disease Activity and Progression, Cognitive Functioning, and Quality of Life in People With Multiple Sclerosis. Neurology: Neuroimmunology & Neuroinflammation. November 13, 2024.
  4. Obesity. MS Trust. April 4, 2022.
  5. Wicks TR et al. Comorbid onset of cardiovascular diagnosis and long-term confirmed disability progression in multiple sclerosis: A 15-year follow-up study. Journal of the Neurological Sciences. September 15, 2024.
  6. Obesity and Multiple Sclerosis—A Multifaceted Association. Journal of Clinical Medicine. June 18, 2021.
  7. Bladder problems. MS Trust. January 5, 2024.
  8. Steptoe A et al. Obesity and psychological distress. Philosophical Transactions of the Royal Society of London. September 4, 2023.
  9. Marrie RA et al. Comorbidity delays diagnosis and increases disability at diagnosis in MS. Neurology. January 13, 2009.
  10. Lutfullin I et al. Association of obesity with disease outcome in multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry. January 2023.
  11. Perlman J et al. Effects of vascular disease risk factors on brain metabolism in multiple sclerosis. Multiple Sclerosis and Related Disorders. December 2025.
  12. Conway DS et al. Body mass index trends over four years in persons with multiple sclerosis. Multiple Sclerosis and Related Disorders. January 2025.
  13. Patz A. Can Weight Loss Drugs Benefit People With MS? National Multiple Sclerosis Society. March 25, 2025.
  14. Bruce JM et al. Modifying diet and exercise in multiple sclerosis (MoDEMS): A randomized controlled trial for behavioral weight loss in adults with multiple sclerosis and obesity. Multiple Sclerosis. December 2023.
Meet Our Experts
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Barbara S. Giesser

Barbara S. Giesser, MD, FAAN, FANA, Dipl. ABLM

Medical Reviewer

Barbara S. Giesser, MD, FAAN, FANA, Dipl. ABLM, is a neurologist who has specialized in the care of persons with multiple sclerosis since 1982. She has been faculty in the departments of neurology at the Albert Einstein College of Medicine, the University of Arizona Health Science Center, and the David Geffen UCLA School of Medicine, where she is professor emeritus of clinical neurology.

She currently directs the MS Comprehensive Care Clinic at the Pacific Neuroscience Institute in Santa Monica, California. Her clinical strategy combines state of the art diagnostics and therapeutics with integration of lifestyle practices to develop a comprehensive, personalized treatment plan for each patient.

Dr. Giesser’s professional activities throughout her career have been primarily as a clinician, educator, and advocate. She has created curricula in MS for trainees at all levels, as well as peers and lay audiences. She has also created wellness curricula for the American Academy of Neurology (AAN) and the National MS Society.

She serves and has served on task forces convened by the National MS Society to generate expert consensus recommendations on wellness research and practical recommendations for clinicians, specifically in the areas of diet and exercise. She has been recognized for educational and clinical achievement at local, regional, and national levels, including the 2018 American Academy of Neurology Frank Rubino Award for Excellence in Clinical Neurology Training, and the 2022 AAN/American Brain Foundation Ted Burns Humanism in Neurology Award.

Giesser has been an investigator on several clinical trials of novel therapeutic agents for MS, and has also conducted peer reviewed exercise-related research. Her CV includes over 100 peer-reviewed publications, books, and chapters.

Giesser has been active in advocacy efforts for over two decades. She has lobbied at state and federal levels to promote legislation on behalf of patients, neuroscience research, and the practice of neurology.

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Crystal Hoshaw

Crystal Hoshaw

Author

Crystal is a mother, writer, longtime yoga practitioner, and an editorial professional with over 14 years of experience creating best-in-class SEO-optimized health and wellness content.

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