Connection Between Obesity and Low Back Pain

Types of Spine Conditions Made Worse by Those Extra Pounds

Is obesity making your back pain worse?
Is obesity making your back pain worse?. Piccell/Photographer's Choice RF/Getty Images

For those who are obese, it’s entirely possible that extra poundage places undue pressure on spinal and other joints. For this reason, many people are quick to attribute their back pain to their weight.

Whatever may be at play under the hood, so to speak, the jury is still out as to whether extra body weight is an actual cause of back pain. Just the same, most experts do agree that very often, an overweight, and especially an obese, condition certainly contributes to back pain.

A number of studies confirm this general opinion. For example, a 2017 retrospective study looked at the records of 1152 Japanese men and found that a higher percentage of body fat as well as a higher BMI each were correlated with the presence of back problems. Generally, studies such as these focus only on the BMI measurement, which classifies an individual as under, normal or overweight, or as obese, based on the relationship between height and weight. But the researchers felt that adding % body fat as a second measure would increase the accuracy of their findings. This is because it is possible to have a high BMI but still be fit. 

Another 2017 study sought to analyze the findings from the 2014 Medical Expenditure Panel Study – perhaps to try to determine where future treatment dollars may best be spent. This one got more specific, looking at the relationships between body weight and four different spine problems in a little over 23,000 people.

The problems were low back pain, spondylosis, internal disc disruption (IDD) and neck problems not related to spondylosis or disc disruption.

The large study population nicely represented a cross-section of the American people, according to the authors.

The 2017 number crunchers found that at least for low back pain and internal disc disruption, an obese condition serves as a predictor.

The authors ended their report by recommending more studies be done that emphasize helping people lose weight and keep it off as a way of reducing IDD and low back pain.

Does Harboring Extra Weight Up Your Risk for Chronic Low Back Pain?

And a 2010 study ordered the degree of excess weight in terms of the likelihood of developing chronic low back pain. Their results were as you might expect: Normal weighted people were at the least risk for back pain, overweight was next and finally, obese people had the highest risk. The study also found that both overweight and obese people were strongly associated with seeking medical care for their low back pain. 

How does Obesity Contribute to Your Spinal Woes, Exactly?

Since extra weight is not considered a cause of back pain, how exactly does it makes matters worse? A 2015 study published in the journal Medical Archives Obesity, confirms that as far as we know now, obesity does not exert a direct influence on back pain (and neither does age, which was another factor considered in this particular study.)

Instead, the authors say, both weight and age might complicate things for people who have back pain — by prolonging the time it takes to heal and get past the problem.

Obesity may affect your body’s biomechanics, resulting in excessive and/or uneven wear and tear at the joints. This, in turn, might hasten or worsen any number of spinal problems from a herniated disc, degenerative changes in discs, ligament hardening, spinal arthritis and others, the 2017 study mentioned above says.

Obesity and Herniated Disc

Herniated disc is one of the more common spine injuries for which people seek medical care. If you’re overweight or obese, your body mechanics may play a role in both the onset and healing of this often painful condition.

A 2014 meta-analysis published in The American Journal of Epidemology found that both overweight and obese conditions may lead to sciatica and/or lumbar radicular pain.

Lumbar radicular pain is pain that may be associated with lumbar radiculopathy, but not always.

While the names sound familiar and while they may be related conditions, the two are not the same. Lumbar radicular pain is just that – pain, often the shooting variety. Lumbar radiculopathy is the set of sensory and/or motor symptoms due to irritation and/or compression of a spinal nerve root.

Many lay people and some doctors refer to lumbar radiculopathy as sciatica, but sciatica is a phrase used to describe the symptoms of more than one possible condition.

Patients often describe lumbar radiculopathy symptoms as pins and needles, weakness, numbness or electrical sensations that go down one leg.

Obese participants in the 2014 The American Journal of Epidemology study were also more likely to need a lumbar disc surgery.

Obesity and Osteoarthritis of the Spine

Obesity is widely acknowledged as a risk factor for osteoarthritis, and one that can negatively affect treatment outcomes, according to Bliddal, et. al, in their 2014 Obesity Review study.

And where you hold your weight may factor into your degree of arthritis risk. A 2015 study published in Spine reports that fat in the trunk of the body is strongly linked to degenerative changes in the spine, including spinal osteoarthritis.

And while body mechanics that lead to joint misalignment, increased pressure and weakened cartilage certainly can and does play a key role in keeping spinal and other joints free of arthritis, researchers are starting to look at more internal risk processes, as well.

In particular, molecular biology is helping to redefine osteoarthritis (OA.) Musumeci, et. al, in their 2015 study published in the International Journal of Molecular Studies say that OA is now seen as a complex, degenerative disease with many factors, including metabolic ones such as “low-grade inflammation in cartilage and synovium."

Obesity and Diffuse Idiopathic Hyperostosis

Diffuse idiopathic hyperostosis (acronym DISH) is a disease process in which, essentially, spinal ligaments harden. New bone forms in areas where ligaments, tendons and other types of connective tissue insert, including the outer fibers of intervertebral discs. DISH patients may also experience a general increase in bone, as well as bone-making, in the spine and other areas.

While DISH may affect your body mechanics by creating back stiffness, limiting your movement and/or resulting in pain upon spinal movement, researchers have identified a number of metabolic factors with which it is associated. Two that are strongly associated are diabetes and a high BMI.

Obesity and Back Pain Due to Lordosis

A large belly may pull your pelvis forward, which in turn may increase the curve in your low back (lordosis). The increased lordosis will probably tighten up your back muscles and cause strain or pain. But strong lower abdominal muscles may help bring your pelvic position into neutral, and reducing your weight, and particularly belly weight, may prevent or minimize the tendency towards a pelvic forward tilt.

Obesity, Spondylolysis and Spondylolisthesis

Spondylolysis and spondylolisthesis are related conditions, with sponylolysis often preceding the development of spondylolisthesis. It’s possible, but not proven, that obesity may affect them both by increasing strain in the key L4-L5 joint. Also, as described above, obesity may make things worse by pulling your pelvis forward and accentuating the low back curve, both of which might decrease the much needed stability in that area of your spine.

Obesity and Back Surgery

If you are very obese, and to a lesser extent if you are overweight, you may have a higher risk of post back surgery complications.

A review of medical studies published in the journal Anesthesia and Analgesics found that super obese people (i.e., those whose BMIs are higher than 50) are at increased risk for complications related to surgery of any type. People whose BMIs are lower don't seem to have increased risks unless they are also dealing with other health conditions, according to the review.

Speaking about spine surgery specifically, a high BMI and obesity are risk factors for complications, as well as for adjacent segment diseases that sometimes follow lumbar fusion, according to the 2015 Spine journal study mentioned above.

The good news is that minimally invasive spine surgery (MIS) may be an option.

A 2015 study published in World Neurosurgery found MIS to be a safe and viable option for morbidly obese patients. The researchers compared MIS and traditional open transforaminal lumbar interbody fusion to assess resulting reduction in pain levels and increases in physical functioning for each surgical approach. It turns out that improvement in both factors (pain reduction and physical improvement) were similar regardless of surgery type. The same was true for post-operative complications.

A Word from Verywell

In general, experts say that even if you can only lose 10% of your body weight you will be doing your health a favor. As far as reducing back pain goes, you may find moving, and therefore exercising to be less painful once you’ve started losing the weight. And if surgery is in your future, losing weight as part of your preparation may help you avoid complications such as adjacent segment disease.

Sources:

Adogwa, O. et.al. A prospective, multi-institutional comparative effectiveness study of lumbar spine surgery in morbidly obese patients: does minimally invasive transforaminal lumbar interbody fusion result in superior outcomes? Adogwa, O. et.al. World Neurosurg. May 2015. http://www.ncbi.nlm.nih.gov/pubmed/25535070

Bliddal H. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons - a scoping review. Obes Rev. July 2014. http://www.ncbi.nlm.nih.gov/pubmed/24751192

Ibrahimi-Kacuri, D. et. al. Low Back Pain and Obesity. Med Arch. April 2015.

Hashimoto, Y., et. al.Obesity and low back pain: a retrospective cohort study of Japanese males. J Phys Ther Sci. June. 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468219

Knutsson B., et. al., Body Mass Index and Risk for Clinical Lumbar Spinal Stenosis: A Cohort Study. Spine. Sept. 2015. https://www.ncbi.nlm.nih.gov/pubmed/26165225/

Musumeci, G. et. al. Osteoarthritis in the XXIst Century: Risk Factors and Behaviours that Influence Disease Onset and Progression. Int J Mol Sci. March 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394521/

Pillai, S., et. al. Metabolic Factors in Diffuse Idiopathic Skeletal Hyperostosis - A Review of Clinical Data. Open Rheumatol J. Dec 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293739/

Shiri, R., et. al., Obesity as a Risk Factor for Sciatica: A Meta-Analysis. American Journal of Epidemiology. April 2014. https://academic.oup.com/aje/article/179/8/929/108237/Obesity-as-a-Risk-Factor-for-Sciatica-A-Meta

Shiri, R., et. al. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. Jan 2015. https://www.ncbi.nlm.nih.gov/pubmed/20007994

Sato S., et. al. Reoperation rate and risk factors of elective spinal surgery for degenerative spondylolisthesis: minimum 5-year follow-up. Spine J. July 2015. http://www.ncbi.nlm.nih.gov/pubmed/25681581

Sheng, B., et. al., Associations between Obesity and Spinal Diseases: A medical Expenditure Panel Study Analysis. Int J Environ Res Public Health. Feb. 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334737/

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