Back Pain and Obesity

	Christopher P. Silveri, MD Associate Clinical Professor Georgetown University and George Washington University Medical Center Fairfax, VA, USA
	Susan Spinasanta Medical Editor SpineUniverse Desert Hot Springs, CA, USA

According to the American Obesity Association (AOA) 64.5% of adult Americans (about 127 million) are categorized as being overweight or obese (1). The unfortunate truth is that obesity is becoming a global epidemic affecting adults and children.

Connection to Back Pain
Most people know that obesity contributes to the development of coronary heart disease, diabetes, high blood pressure, and colon cancer. However, did you know that obesity is a contributing factor to back pain? It is true. Being overweight or obese can significantly contribute to symptoms associated with osteoporosis, osteoarthritis (OA), rheumatoid arthritis (RA), degenerative disc disease (DDD), spinal stenosis, and spondylolisthesis.

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. Lack of exercise and bodily conditioning leads 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.

You may try to dismiss the cause of some of these spinal disorders to the process of normal aging. It is true that with age body tissues can cause changes to spinal anatomy (2). However, if you are overweight or obese, chances are you have, or will have, back pain. You may have or develop one of the following conditions:

• Osteoporosis
  A sedentary lifestyle coupled with an unbalanced diet can affect the density, or strength of the bones (spinal vertebrae). When the structural architecture of a vertebral body is compromised, it is at risk for fracture. Vertebral fractures can be painful and disabling. If you have been diagnosed with osteoporosis, you have probably lost between 25-30% of desirable bone density.

  If the diagnosis is osteopeonia, bone loss has been in the range of 10-15% (3).

• Osteoarthritis (OA) and Rheumatoid Arthritis (RA)
  The joints in the spine are called facet joints. Excessive body weight places unnatural pressure and stress on the joints during movement and at rest.
• Low Back Pain
  Obesity may aggravate an existing low back problem and contributes to recurrence of the condition.
• General
  Unhealthy posture accounts for neck and back pain. A level of physical fitness is necessary to properly support the spine.

Development of Obesity
Industrialization and modernization has had a tremendous impact on our food. For example, food can be purchased just about anywhere. No longer is it necessary to expend physical effort to hunt and forage for food. There are vast numbers of processed food products available and labor-saving devices (e.g., microwave ovens) to cook food. The market for many convenience foods and kitchen devices came about when women entered the work force.

Childhood obesity is on the rise due to many factors that include sedentary behavior (e.g., computer games), eating when not hungry, television advertising high-calorie 'tasty' foods, and even genetics.

According to the Surgeon General's "Call to Action to Prevent and Decrease Overweight and Obesity," 40% of adults in the United States do not participate in any leisure-time physical activity and less than 1/3 engage in at least 30 minutes of physical activity most days (4).

Another consideration is where meals are eaten. In 1992, 38% of the food dollar was spent on foods eaten away from home (5). It can be difficult to control what you eat and how the food is prepared (e.g., fried versus broiled) at a restaurant; especially 'fast food' establishments.

If you are overweight, obese, or working at maintaining a healthy weight, there are many tools available to empower your efforts.

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