Overweight, Obesity and Back Pain: What's the Connection?

obesity and back pain

Obesity is often referred to as the “evil of the century”. Ironically, we use the same qualifier to describe back pain.

What if the two were linked? Could your overweight (more or less pronounced) explain your back pain? If so, what exactly can be done?

This article written by a physiotherapist will discuss the link between overweight, obesity and back pain. As a bonus, we offer you a solution that could help you lose weight while relieving your lower back pain.

What exactly do we mean by overweight?

Before any relationship between back pain and obesity can be established, it is necessary to familiarize yourself with the concepts of overweight and obesity.

Normally, the "normal" fat mass in men represents between 10 and 15% of body weight, while it is 20 to 25% of body weight in women. In the presence of overweight or obesity, there is an abnormal or excessive accumulation of body fat. This excessive accumulation poses a health risk.

How do you know if you are overweight (or obese)?

Overweight and obesity are defined from the body mass index (or BMI). BMI is calculated by dividing a person's weight by height squared.

Your BMI = Your weight / (Your height in cm)²

If the BMI is:

  • < 18,5 kg/m², this is underweight;
  • = or > 18,5 and < 25 kg/m², corpulence is normal;
  • = or > 25 and < 30 kg/m², there is a overweight ;
  • = or > 30 kg/m², this isobesity.

Anatomical and physiological changes related to overweight

Being obese has consequences on several systems of the human body. Let's look together at how being significantly overweight can affect your health, your vitality, and your quality of life:

The nervous system

Being overweight or obese increases the risk of having a stroke. Obese people often have low self-esteem, which can lead to depression.

Respiratory system

If there is excess fat around the neck area, this can affect the circulatory pathways and cause sleep apnea problems in particular. Some people stop breathing altogether for a period of time during the night in the presence of sleep apnea.

Digestive system

Obesity increases the chances of having gastroesophageal reflux disease (GERD), which is the backing up of some of the stomach contents into the esophagus.

Being overweight also increases the chances of developing gallstones, a condition that sometimes requires surgery.

Finally, the accumulation of fat can occur in the liver, which can sometimes lead to liver failure.

Cardiovascular system

Since the heart has to work harder to pump blood in the presence of obesity, it is not uncommon to observe an increase in blood pressure. As hypertension is the main cause of cerebrovascular accident (CVA), this places this clientele particularly at risk.

Obesity creates an increase in the body's resistance to insulin. As a reminder, the role of insulin is to transport sugar from the blood to the cells to be used as energy. Insulin resistance can therefore lead to conditions like type 2 diabetes where blood sugar levels are too high.

Finally, the accumulation of fat in the vessels (associated with hypertension, high cholesterol and high blood sugar) increases the risk of heart attack.

Reproductive system

In obese women, it is more difficult to get pregnant. Similarly, the risk of complications during pregnancy is increased in the presence of excess weight.

Integumentary system (skin)

Skin rashes are often observed at the folds caused by excess fat. A condition named "Acanthosis Nigricanscan occur, where areas of skin become darker, thicker, rougher and drier.

What is the link between obesity and back pain?

And the back pain in all this? We know that obesity affects several systems of the human body, but what is the link between back pain and being overweight?

A priori, one can imagine that the relationship between obesity and back pain is directly proportional. Indeed, there is an indisputable and statistically proven relationship between excess weight and low back pain.

On the other hand, it is difficult to attribute back pain to the presence of obesity alone. Indeed, anatomical changes (such as a Scoliosis, a degeneration ou herniated disc, osteoarthritis, etc.) are not enough to explain lower back pain. Rather, it is a combination of physical factors – and even psychological – which can explain the back pain.

Now, how can excess weight manifest itself in the form of lower back pain? Here are 5 potential reasons (some will probably surprise you!):

Joint overload

This is the most intuitive cause. Being overweight alters certain bodily factors such as the center of gravity, posture and curvature of the back.

Thus, when you are overweight, this can increase the stress on the joints. An increase in joint stress can therefore manifest itself in the form of pain (such as middle back, lower back, knees, etc.).

However, be careful not to generalize. Not all obese people have back pain. Thus, if the weight gain has been over a long period, it is possible that the body has adapted to this progressive overload. In this case, the pain is either less significant or altogether absent.

Lower tolerance to physical activity

Although eating habits have a lot to do with it, overweight people are generally not as active as those at a healthy weight. Likewise, cardiovascular and physical activities are generally less well tolerated in this population.

When we know that the inactivity is one of the main causes of back pain, it is easy to understand that we are more at risk when we are overweight. Here's why obesity and back pain are (indirectly) connected in this case.

Poorer quality of sleep 

Sleep apnea is present between 40 and 70% in the obese population. This causes in particular an alteration of the respiratory pattern, as well as a disturbance of the sleep cycle (sometimes even insomnia!).

On the one hand, the breathing is often disturbed in people with back pain. A poor respiratory pattern affects optimal oxygenation and circulation, and could increase back pain.

On the other hand, the non-restorative sleep prevents optimal healing of the body, which directly impacts back pain.

We therefore better understand why being overweight, due to its high prevalence of sleep apnea, can have a role to play in back pain.

Affects social activities

It's unfortunate, but obesity often affects quality of life. Many people are ashamed of eating in public or taking part in social activities. Worse still, some are the object of ridicule and discrimination.

With this in mind, it is easy (and sad!) to see that obese people are more at risk to have depression.

Unfortunately, back pain is also linked to depression. Whether it is social isolation or reduced activities, some people fall into a vicious cycle that distances them from their loved ones, and thereby increases their pain.

In short, both obesity and back pain are influenced by physical – but also psychological – factors. Emotional issues can not only cause “binge eating” but also increase back pain.

Affects post-surgery recovery

Although we try toavoid the operation at all costs after back pain, it sometimes happens that it is absolutely necessary.

In the presence of obesity, it sometimes happens that the operation is delayed – or even completely impossible – because of the cardiovascular risks it presents, particularly due to anesthesia.

Likewise, post-surgical recovery is often more difficult if you are overweight. The risk of complications is higher, mobility is often more restricted, getting up for the first time is more difficult, etc.

What do scientific studies say?

Here is a series of results from scientific studies showing a relationship between overweight and back pain:

  • People at a “healthy” weight are least at risk of developing lower back pain. Overweight people are at moderate risk, and obese people are at the highest risk.¹
  • A high BMI, combined with a high fat percentage, would be directly related to the prevalence and risk of low back pain.²
  • Obesity increases the risk of low back pain and disc disease (problems with intervertebral discs), but would not be directly related to the degeneracy of the spine, or neck pain (neck pain).³

Overweight and back pain: What to do?

If you have back pain, several solutions are available to you to relieve your symptoms. You may have already consulted your doctor, visited a physio or osteo, done activities or tried to improve your postural habits.

On the other hand, a solution that is often underestimated is weight loss. If you're storing excess weight, losing weight could lead to a reduction in symptoms.

Here are some practical tips for those who are overweight and want to treat their back pain:

Choose low-impact cardiovascular activities

    • Swimming and aquagym : Water supports the weight of the body, reducing pressure on the spine and joints. These activities are ideal for improving cardiovascular fitness without exacerbating back pain.
    • Stationary bike : A stationary bike, especially recumbent models, allows you to exercise without putting undue strain on your lower back. Place a rolled towel on your lower back to support your lumbar region.
    • Marche : Walking, especially on soft surfaces like a treadmill or dirt path, is a great low-impact activity that can help lose weight and strengthen your back.

    Do appropriate therapeutic exercises

    • Core strengthening exercises : Exercises like glute bridge, modified planks, and hamstring stretches can strengthen core muscles and stabilize the spine.
    • Comfortable positions : Work with a therapist to find positions and exercises that do not cause pain. Using exercise balls or lumbar supports can be helpful.

    Use a CPAP for Sleep Apnea :

    Using a CPAP (Continuous Positive Airway Pressure) machine can treat sleep apnea, improving sleep quality and regeneration of body tissues, which can help reduce back pain.

    Adopt an anti-inflammatory diet :

    It is relevant to include foods rich in omega-3 (such as oily fish), fruits and vegetables, nuts, seeds, and anti-inflammatory spices such as turmeric and ginger in your diet.

    Additionally, you should reduce processed foods, sugar and saturated fats as much as possible.

    To find out everything about anti-inflammatory diet, see the following article.

    Surround yourself to avoid social isolation and depression

    Join support groups, participate in community activities, or simply maintain active social relationships to combat isolation and depression, which can worsen your perception of pain.

    Rethink your relationship with food

    • mindful eating : Practice mindful eating to better understand hunger and satiety signals. Work with a nutritionist or dietitian to establish healthy eating habits.
    • Avoid emotional snacking : Identify and manage emotional triggers that lead to overeating.

    Have regular medical check-ups

    Regular visits to your doctor help monitor complications related to being overweight and prevent disease. Follow-up may also include examinations to detect and treat back pathologies.

    Consider bariatric surgery as a last resort

    For severely overweight people who have failed to lose weight with other methods, bariatric surgery may be an option.

    Sleeve gastrectomy and gastric bypass are common procedures that reduce the size of the stomach to help with weight loss.

    Conclusion (the take-home message)

    It's no longer a secret that obesity affects almost every system in the human body. Among other things, there is a clear correlation between obesity and back pain. On the other hand, it is difficult to determine whether being overweight is the cause of the pain, or rather a contributing factor.

    Anyway, the relationship is indeed present, and losing extra pounds is often an effective solution to reduce back pain.

    Good recovery!  

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