Does Being Overweight Hurt Your Spine?

For years I’ve heard patient come into my office and say things to the effect that if they lost weight, they’re backs wouldn’t give so much trouble. After 30 years of practice and of observing patients of all sizes, I’ve long since come to the conclusion that of all the factors that determine spinal health, excess weight is one of the least consistent. Many people who are very much over-weight, by definition, obese, have little or no low back pain. Lecturing patients about their weight is one of the standard cop-outs of family physicians who have little else to offer the person in pain.

I sometimes feel sorry for these doctors. They have all that knowledge at their disposal, all those lab tests, x-rays, CT scans, MRI procedures and oodles of specialists, yet; somehow, the low back completely baffles them. Rather than admit their limitations, they try to sound authoritative and offer advise that is all too often ridiculously out-of-date or sometimes, simply ridiculous.

I’ve occasionally seen a patient take this advise to heart and subsequently lost a bunch of weight only to find that the low back problem that motivated the dieting is worse!

It is well known that the average North American is gaining weight at an unprecedented rate. All the diseases that have been related to obesity are on the rise: diabetes, heart disease, strokes, and now even many types of cancer are apparently more common in the obese. Of course, the incidence of lower back pain is also rising; however, this has been proven to be unconnected to body weight.

Although there is probably some causal relationship, epidemiological studies have failed to prove a connection between body weight and spinal problems. By causal relationship I mean, the inactivity and poor diet that goes along with obesity, not the weight itself. It seems to be logical that the extra weight would put lots more strain on the discs, joints and bones of the low back. And perhaps it does, but not enough to show up in over 60 studies. There seems to be no significant difference between people who have back problems and what they weigh. No one has yet studied the extremely obese, so perhaps they could have more than their share of trouble, but I don’t think so. I really don’t have an office full of fat people, in fact I would venture that the average person that I see for lower back pain, is just that: average.

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