Native Hawaiian and Pacific Islander Patients with Fibromyalgia: Insights into BMI, Pain, and Comorbidities in a Multiethnic Cohort

Background: Native Hawaiian and Pacific Islanders (NHPI) are significantly underrepresented in fibromyalgia literature. This study aims to characterize the clinical presentation of fibromyalgia across ethnoracial groups to identify potential disparities in symptoms and comorbidities. Methods: A retrospective chart review was conducted at a single-center clinic involving 200 patients diagnosed with fibromyalgia. Patients were stratified by race: Native Hawaiian, Pacific Islander, Asian, and White. Clinical variables including Body Mass Index (BMI), pain severity, exercise frequency, and comorbidities were analyzed using ANOVA and Chi-Square tests with Bonferroni corrections. Results: The primary ethnoracial difference identified was BMI (p=0.0336). Mean BMI was highest in Pacific Islander and Native Hawaiian groups compared to White and Asian. While pain and depression did not differ significantly by race, higher BMI was significantly associated with increased pain severity (p=0.009), higher prevalence of diabetes (p=0.004) and hypertension (p=0.006), and lower exercise frequency (p=0.045). Patients with high pain scores also showed higher depression rates compared to those with low scores (p=0.024). Conclusions: BMI may be a key pathway for elucidating ethnoracial clinical differences in fibromyalgia presentation, with higher BMI being linked to increased pain severity, higher depression rates, and a greater burden of cardiometabolic comorbidities. While analyses by race alone did not display these relationships, NHPI patients presented with disproportionately higher BMIs. This suggests that BMI may act as a key mediator for ethnoracial health disparities, highlighting the importance of culturally informed and multidisciplinary management that integrates pain care, mental health, and metabolic risk reduction.