Chronic pain and obesity, and their associated impairments, are major health concerns. We estimated the association of overweight and obesity with five distinct pain conditions and three pain symptoms, and examined whether familial influences explained these relationships. We used data collected from 3,471 twins in the community-based University of Washington Twin Registry. Twins reported sociodemographic data, current height and weight, chronic pain diagnoses and symptoms, and lifetime depression. Overweight and obese were defined as body mass index of 25.0 -29.9 kg/m 2 and ≥ 30.0 kg/m 2 , respectively. Generalized estimating equation regression models, adjusted for age, gender, depression, and familial/genetic factors were used to examine the relationship between chronic pain, and overweight and obesity. Overall, overweight and obese twins were more likely to report low back pain, tension-type or migraine headache, fibromyalgia, abdominal pain, and chronic widespread pain than normal weight twins after adjustment for age, gender, and depression. After further adjusting for familial influences, these associations were diminished. The mechanisms underlying these relationships are likely diverse and multifactorial, yet this study demonstrates that the associations can be partially explained by familial and sociodemographic factors, and depression. Future longitudinal research can help to determine causality and underlying mechanisms. KeywordsChronic Pain; Genetics; Heritability; Obesity; Twins Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. PERSPECTIVE This article reports on the familial contribution and the role of psychological factors in the relationship between chronic pain, and overweight and obesity. These findings can increase our understanding of the mechanisms underlying these two commonly comorbid sets of conditions. NIH Public Access

In rural Native American communities, access to healthy foods is limited and diet-related disparities are significant. Tribally owned and operated convenience stores, small food stores that sell ready-to-eat foods and snacks primarily high in fat and sugar, serve as the primary and, in some areas, the only food stores. The Tribal Health and Resilience in Vulnerable Environments or “THRIVE” study, implemented between 2013 and 2018, is the first healthy retail intervention study implemented in tribally owned and operated convenience stores. THRIVE aims to increase vegetable and fruit intake among Native Americans living within the Chickasaw and Choctaw Nation of Oklahoma. The study comprises three phases: 1) formative research assessing tribal community food environments and associated health outcomes; 2) intervention development to assess convenience stores and tailor healthy retail product, pricing, promotion, and placement strategies; and 3) intervention implementation and evaluation. In this paper we share the participatory research process employed by our tribal-university partnership to develop this healthy retail intervention within the unique contexts of tribal convenience stores. We summarize our methods to engage tribal leaders across diverse health, government, and commerce sectors and adapt and localize intervention strategies that test the ability of tribal nations to increase fruit and vegetable purchasing and consumption among tribal members. Study processes will assist in developing a literature base for policy and environmental strategies that intervene broadly to improve Native community food environments and eliminate diet-related disparities among Native Americans.

Objective.-To determine if shared genetic or environmental vulnerabilities could underlie depression and migraine. Background.-Depression and migraine headaches frequently coexist and their comorbidity may be due to shared etiologies.Methods.-Female twins in the University of Washington Twin Registry responded to a mailed survey regarding their health history. Depression and migraine were determined by self-report of a physician's diagnosis. We used bivariate structural equation modeling to test for shared genetic, common environmental, and unique environmental components, and to estimate the magnitude of any shared component.Results.-Among 758 monozygotic and 306 dizygotic female pairs, 23% reported depression and 20% reported migraine headaches. Heritability was estimated to be 58% (95% confidence interval: 48-67%) for depression and 44% (95% confidence interval: 32-56%) for migraine. Bivariate structural equation modeling estimated that 20% of the variability in depression and migraine headaches was due to shared genes and 4% was due to shared unique environmental factors.Conclusions.-The comorbidity of depression and migraine headache may be due in part to shared genetic risk factors. Research should focus attention on shared pathways, thereby making progress on 2 disease fronts simultaneously and perhaps providing clinicians with unified treatment strategies.

Research suggests chronically reduced sleep times are associated with obesity. [6][7][8][9][10][11] Experimental studies in humans show that sleep curtailment influences the neuroendocrine control of appetite in healthy individuals. 12 Population-based studies demonstrate a significant U-shaped non-linear relationship between nightly sleep duration and body mass index (BMI). 13,14 Compared to those sleeping 7-8 h/night, individuals sleeping ≤ 6 h are at greater risk of being obese. 14 Prospective family and cohort studies have found short sleep duration is associated with the development of obesity over time. [15][16][17] Although the relationship between sleep duration and BMI may be caused by environmental influences such as voluntary sleep restriction, many measures of sleep are heritable, raising the possibility that genetic factors are central to this association. [18][19][20][21][22][23] To date, no studies have accounted for shared genetic and environmental factors when considering the relationship between sleep duration and BMI.Twins are identical in age and, if reared together, are typically well-matched for shared family background and numer-

Objective. To determine the type and frequency of neurologic signs and symptoms in individuals with fibromyalgia (FM).Methods. Persons with FM (n ‫؍‬ 166) and painfree controls (n ‫؍‬ 66) underwent systematic neurologic examination by a neurologist blinded to disease status. Neurologic symptoms lasting at least 3 months were assessed with a standard questionnaire. We used logistic regression to evaluate the association of neurologic symptoms and examination findings with FM status. Within the FM group we examined the correlation between self-reported symptoms and physical examination findings.Results. Age-and sex-adjusted estimates revealed that compared with the control group, the FM group had significantly more neurologic abnormalities in multiple categories, including greater dysfunction in cranial nerves IX and X (42% versus 8%) and more sensory (65% versus 25%), motor (33% versus 3%), and gait (28% versus 7%) abnormalities. Similarly, the FM group had significantly more neurologic symptoms than the control group in 27 of 29 categories, with the greatest differences observed for photophobia (70% versus 6%), poor balance (63% versus 4%), and weakness (58% versus 2%) and tingling (54% versus 4%) in the arms or legs. Poor balance or coordination, tingling or weakness in the arms or legs, and numbness in any part of the body correlated with appropriate neurologic examination findings in the FM group.Conclusion. This blinded, controlled study demonstrated neurologic physical examination findings in persons with FM. The FM group had more neurologic symptoms than did the controls, with moderate correlation between symptoms and signs. These findings have implications for the medical evaluation of patients with FM.

Objectives. To assess a healthy retail intervention in Tribal convenience stores in Oklahoma. Methods. We adapted healthy retail strategies to the context of 8 Tribally owned stores. We assessed individual- and store-level outcomes in a cluster-controlled intervention trial (April 2016–June 2017). We measured fruit and vegetable intake, store environment perceptions, and purchases before and after the intervention among a cohort of 1637 Native American shoppers. We used mixed-effects linear regression to estimate pre- to postintervention changes in and between groups. Results. We followed 74% of participants (n = 1204) 9 to 12 months. Intervention and control participants perceived healthier stores after intervention. Higher shopping frequency was related to purchases of fruits, vegetables, and healthy items. Conclusions. Intervention exposure was associated with healthy purchasing but not fruit and vegetable intake. Research is needed to further assess impacts of environmental interventions on intake. Public Health Implications. As the first healthy retail intervention in Tribally owned stores, our results contribute evidence for environmental and policy interventions to address obesity in Tribal Nations. Multicomponent interventions, led by Tribal leaders from diverse sectors, are needed to create healthy environments and sustainable improvements in Native American health.

Background-Studies have found a modest association between depression and obesity, especially in women. Given the substantial genetic contribution to both depression and obesity, we sought to determine whether shared genetic influences are responsible for the association between these 2 conditions.

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