Patients who are overweight or obese and suffer from back pain may not be aware that their excess weight is actually contributing to their back pain. While it has not been thoroughly studied exactly how excess weight can cause or contribute to back pain, it is known that people who are overweight often are at greater risk for back pain, joint pain and muscle strain than those who are not obese 1.
In addition to back pain, symptoms exhibited by persons who are obese or severely overweight may include fatigue, as well as difficulty breathing and shortness of breath during short periods of exercise 2. If the fatigue and shortness of breath causes one to avoid activity and exercise, then this can indirectly lead to back pain as lack of exercise contributes to many common forms of back pain.
This article examines the heightened risk and severity for certain back problems that obese or overweight patients may experience as a result of their weight. The article also provides practical tips and guidelines for how patients can use exercise, diet and weight loss to reduce their back pain.
Problems Caused by Obesity
According to the American Obesity Association, episodes of musculoskeletal pain, and specifically back pain, are prevalent among the nearly one-third of Americans who are classified as obese 2. The American Obesity Association also reports that more obese persons say they are disabled and less able to complete everyday activities than persons with other chronic conditions 1.
Some of the most common obesity-related problems include musculoskeletal and joint related pain 1. For people who are overweight, attention to overall weight loss is important as every pound adds strain to the muscles and ligaments in the back. In order to compensate for extra weight, the spine can become tilted and stressed unevenly. As a result, over time, the back may lose its proper support and an unnatural curvature of the spine may develop.
In particular, pain and problems in the low back may be aggravated by obesity. This occurs for people with extra weight in their stomachs because the excess weight pulls the pelvis forward and strains the lower back, creating lower back pain. According to the American Obesity Association, women who are obese or who have a large waist size are particularly at risk for lower back pain 1.
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Obese or overweight patients may experience sciatica and low back pain from a herniated disc. This occurs when discs and other spinal structures are damaged from having to compensate for the pressure of extra weight on the back. In addition, pinched nerves and piriformis syndrome may result when extra weight is pushed into spaces between bones in the low back area 3.
Arthritis of the spine that causes back pain may be aggravated when extra body weight strains joints. Those patients with a Body Mass Index (BMI) of greater than 25 are more likely to develop osteoarthritis than those with a lower BMI. The American Obesity Association recommends modest weight loss as a treatment for some types of osteoarthritis 2.
The effectiveness of back surgery may also be affected by a patient’s weight. Obese patients are at higher risk for complications and infections after surgery compared to patients who are not obese 2. For seriously overweight patients, paying attention to weight loss before undergoing back surgery may improve the healing process after surgery.
Identifying the Need for Weight Loss
Body Mass Index (BMI) is a measure commonly used by medical practitioners. BMI is a mathematical formula (BMI=kg/m2) that takes into account a person’s weight in kilograms and height in meters and calculates a number. The higher a person’s BMI falls on a pre-determined range of values, the higher the likelihood for obesity.
Although there is some debate over the specific meaning of BMI measurements, a BMI of 30 or higher is typically considered to be obese, while a measure of 25 to 29.9 is typically considered to be overweight 4.
It is also important to evaluate where excess fat is carried on the patient’s body. Patients who carry more weight around their midsection are at greater risk for obesity-related health problems, such as low back pain. Weight loss for health considerations is often advisable for women with a waist measurement of more than 35 inches or men with a waist measurement of more than 40 inches 4.
- American Obesity Association. “Health effects of obesity.” AOA Fact Sheets. 2002.
- American Obesity Association. “What is obesity?” AOA Fact Sheets. 2002.
- Fishman L., Ardman C. Back Pain: How to Relieve Low Back Pain and Sciatica. New York: W.W. Norton & Company, 1997:248.
- National Institutes of Health. National Institute of Diabetes & Digestive & Kidney Diseases. “Understanding adult obesity.” 2001. http://win.niddk.nih.gov/publications/understanding.htm.