Obesity and Low Back Pain

How Being Obese makes Low Back Pain Worse

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

Obesity and Low Back Pain - Conditions

Back pain is a very common problem in heavy people.  In fact, many wonder if obesity or an overweight condition is what causes their back pain. To cut to the chase, no, according to research.  

A 2015 study published in the journal Medical Archives found Obesity found that neither obesity nor age exert direct influences on back pain.  But, the authors say, both may complicate things by prolonging your healing time.


That said, according to some practitioners who see overweight spine patients regularly, being heavy is associated with certain back conditions.

Pressure on the Spine

Extra weight puts added pressure on the spine, which can cause pain, says Kevin Cichocki, DC, clinical chiropractor and founder of Palladian Health in Buffalo, NY. "It has long been known that a rise in body weight results in a geometric increase in the pressure on the spine."

For those who are morbidly obese, Cichocki says that potential injury to the spine is even greater. This is due to it degenerative changes in the vertebral column it can cause, he says. "The pressure may increase your risk of herniated disc, degenerative disc disease and back strain."

Obesity and Herniated Disc

"The extra pressure that weight puts on your spine can -- over time -- cause a wearing away of the outer fibers of the disc, increasing your risk of an injury." Being obese may also prevent you from managing pain that is due to herniated disc-related sciatica, he adds.

Obesity and Osteoarthritis of the Spine

According to Bliddal, et. al, in their 2014 study published in the journal Obesity Review, obesity is widely acknowledged as a risk factor for osteoarthritis, and can negatively affect treatment outcomes.  The authors says that if you lose at least 10% of your body weight, and you exercise, you may be able to get back in action with less pain.

In the past, experts believed that osteoarthritis was caused by increased pressure, joint misalignment and weakened cartilage.  More recently, molecular biology is helping to redefine this disease process. Musumeci, et. al, in their 2015 study published in the International Journal of Molecular Studies say that OA (osteoarthritis) is now seen as a complex disease with many factors, including metabolic ones.  They describe OA as a "degenerative disease characterized by 'low-grade inflammation' in cartilage and synovium."

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.

According to Cichoki, keeping a healthy weight and strong abs (which may help pull your pelvis into neutral alignment) can help you counter the effects of an exaggerated low back curve.

Obesity, Spondylolysis and Spondylolisthesis

Spondylolysis and spondylolisthesis are related conditions.

Obesity may affect them both by increasing strain in the key L4-L5 joint. Also, as described above in the section on lordosis, obesity may make things worse by pulling your pelvis forward, accentuating the low back curve (which can increase muscle tension in the area.)

In a 2015 study published in Spine Journal, increased BMI (a measure of body fat relative to your height and weight) was found to be a risk factor for re-operation in patients with degenerative spondylolisthesis.

Obesity and Diffuse Idiopathic Hyperostosis

Diffuse idiopathic hyperostosis (acronym DISH) is the hardening of one or more spinal ligaments. It is more common in elderly men than other types of people. This back condition has been linked to a high BMI and diabetes.

Obesity and Back Surgery

If you are very obese, you may have a higher risk of post-surgical complications.  For overweight people, the likelihood is less.

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.

Minimally invasive spine surgery (MIS) may provide a safe option for overweight people who need back surgery.

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 see how similar or different the resulting pain levels and physical functioning from the two surgical approaches might be.  They reported similar improvement in both outcomes, as well as similar post-operative complication rates.

Will Losing Weight Reduce My Back Pain?

It's only common sense to think that along with controlling your risk for heart attack, diabetes, stroke and other degenerative diseases, losing weight can help you get rid of back pain.

Dr. Andre Panagos, physiatrist and director of Spine & Sports Medicine of New York says, "in my office, every single person who loses a significant amount of weight finds that their back pain is also significantly improved". Panagos believes the reason for this is related to a decrease in the amount of work muscles need to do in order to accomplish everyday tasks once weight loss has been achieved. Let this tip from a doctor fuel your motivation as you as continue your efforts to reach and maintain a healthy weight!


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. Accessed June 2016. 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. Accessed: June 2016. http://www.ncbi.nlm.nih.gov/pubmed/24751192

Cichocki, K., D.C. Interview. Nov 2008.

Ibrahimi-Kacuri, D. et. al. Low Back Pain and Obesity. Med Arch. April 2015. Accessed June 2016.

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. Accessed June 2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394521/

Panagos, A., M.D. Interview. Nov 2008.

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. Accessed: June 2016. http://www.ncbi.nlm.nih.gov/pubmed/25681581

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