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Obesity and Lower Back Pain

Lower back pain is a very common ailment affecting a large portion of the population at any given time.  It’s also generally accepted that we are suffering from an obesity epidemic in South Africa and in many other countries across the world.

"A Matched Set" by Tony Alter under licence CC BY 2.0
“A Matched Set” by Tony Alter under licence CC BY 2.0

I have had many patients who have come for treatment report that their doctor has blamed their lower back pain on their weight.  Being overweight is often a touchy subject for people carrying the extra pounds, so I’ve never been very comfortable making those types of associations or discussing weight issues with these patients.  Moreover, I’ve also had so many skinny patients with severe cases of lower back pain that I preferred to focus on the structural causes of the presenting lower back pain in these individuals rather than any weight issues.

Read my post on lower back pain and driving posture

However, is this the correct approach?  Does one’s weight impact on one’s experience of lower back pain and should it really be swept aside like I tend to do out of deference to people’s feelings?  I thought it might be useful to look at the research to see what studies have found, but first of all, we need to define the parameters of our discussion.

What does it mean to be overweight, and what does it mean to be obese?  According to the Obesity Organisation, a body mass index (BMI) of 24.5-29.9 will place you in the overweight category, a BMI of 30-39 will mean that you are obese, and a BMI of 40+ will mean that you are morbidly obese.

How do you go about calculating your BMI?  

To calculate your BMI, divide your body weight (in kilograms) by your height squared (in centimeters).

Bear in mind, however, that if you’re very muscular, pregnant or breast feeding, your BMI will not be a proper indication of your health.

Use this BMI Calculator to easily workout your BMI.

Right, now that you know your BMI and in which bracket you fall, let us return to my original question: Does being overweight or obese have an influence on your lower back pain?

Some researchers did a literature review of all studies performed in relation to body weight and lower back pain up to 2009 (click here to access the article) and found that there was an association between carrying extra weight and a higher incidence of lower back pain.  They also found that obese people (BMI of 30+) had more lower back pain than overweight people (BMI of 25-29).  This shows an increasing correlation between your weight and your experience of lower back pain.  In other words, the more weight that you carry, the greater your risk of experiencing lower back pain.  

A more recent study published in 2015 (click here to access this article) also probed the associations between body weight and the experience of lower back pain.  Unfortunately this study only focused on men, however, they did look at the associations of weight gain and lower back pain over time (decades).  They found that an increasing BMI of overweight and obesity was linked an increased risk of experiencing radiating lower back pain (in other words lower back pain that has pain going into one or more legs).  What was interesting though, was that they found that generalised lower back pain (known in the medical community as non-specific lower back pain) was not linked to weight gain at all.

This implies that not all lower back pain is affected by your weight, which from experience as a clinician, I know to be true.

So, after all of that, what is the ‘take home’?  Basically, if you are carrying extra weight and are either overweight or obese, you are more likely to experience lower back pain.  However, (and logically), not all lower back pain is influenced by weight gain.

What types of lower back pain are influenced by being overweight?  I will explore this in a future post.

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