Obesity and Back Pain

Obesity is a disease in which a person has more body weight than is recommended. It is indicated generally by a BMI of 30 or higher. Unchecked obesity contributes to coronary heart disease, diabetes, high blood pressure, and colon cancer.

However, the co-relation between obesity and back pain is not well recognized. In recent years, I have seen an increasing number of patients with chronic back pain due to osteoarthritis of the small joints of the lumbar spine. Osteoarthritis of the knee and hip joint are known and, every day, there are hundreds of patients who get an artificial knee or hip-joint replacement.

One major risk factor for developing osteoarthritis of the spine, apart from acute or chronic trauma, is obesity. Once severe osteoarthritis of the spine sets in, chronic back pain results. The obvious recommendation of spine surgeons is to lose weight.

Apart from something drastic like bariatric surgery, patients find it difficult to lose weight. They cannot exercise because of back pain and a sedentary lifestyle leads to further weight gain and so a vicious cycle develops. eThe cycle has to be broken and initially this is possible with painkillers and physiotherapy. The patient is encouraged to stay active. Bed rest is discouraged beyond a day or two. Prolonged bed rest leads to muscle hypotonia and wasting, further weakening the back and aggravating the back pain.

Should physiotherapy, exercises and pain killers fail to relieve pain, then the spine surgeon has to decide if the lumbar facet joint and sacro-iliac joint is the source of pain. One way of making sure of the pain source is to block the pain nerves to the joints and assess the degree of pain relief. If the facet and/or Sacro-iliac joint is the source of pain, pain relief can be prolonged using Radio-frequency current in a procedure called RF rhizotomy.

What Causes Obesity?

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:

  1. an increased intake of energy-dense foods that are high in fat; and

  2. an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.

Medical imbalances can also result in increase in body fat and overall weight.

How Being Overweight or Obese Can Affect the Spine The spine is designed to carry the body's weight and distribute the loads encountered during rest and activity. When excess weight is carried, the spine is forced to assimilate the burden, which may lead to structural compromise and damage (E.g., injury, sciatica). One region of the spine that is most vulnerable to the effects of obesity is the low back—the lumbar spine and the small joints called facet joints in particular.

Why Exercise is Important Lack of exercise can lead to poor flexibility and weak muscles in the back, pelvis, and thighs. This can increase the curve of the lower back, causing the pelvis to tilt too far forward. Further, this is detrimental to proper posture and as posture weakens, other regions of the spine (neck) may become painful.

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