When we see a patient in our office who has joint or back pain and they have clear issues of excessive weight, we try to reassure the patient that we understand that it can be difficult to lose weight. We tell them that we are not going to lecture them and that we will try to present solutions that are realistic.
There has been a large amount of published research, recently released, that suggests that it is not only the mechanical stress that a big belly puts on your lower spine that can cause back pain, but the runaway inflammation that the belly fat is producing that may be attacking your spinal nerves.
Research: Overweight people have more neuropathic back pain, tingling sensations, severe back pain, and acute back pain compared to normal weight people with back pain.
A recent study published in the journal Pain research and management (1) made these suggestions:
- Obesity could be the cause of neuropathic (nerve) pain that is distinct from musculoskeletal pain. Neuropathic may not have an obvious source, such as the degenerative damage seen in disc disease. This pain may be originating from the inflammation the body fat of the obese people is producing.
- Study Finding: Results showed that the overweight patients with neuropathic pain complained of more severe pain than the normal-weight patients in spite of comparable analgesic dosages (i.e., on a proportional body-weight basis).
- In addition, the overweight patients seemed to experience more serious paroxysmal (sudden acute attacks of pain or spasm) pain, and their neuropathic negative symptoms (for example an increase in tingling or numbness) might tend to be aggravated. (It can be suggested that patients who suffer from spasms, acute pain, numbness and tingling sensations, have these symptoms caused not by a pinched nerve, but by the inflammation being generated by their abdominal fat.)
The researchers of this study then made this point:
Lumbar radiculopathy pain can be caused by obesity related inflammation
- In obese patients, an increased secretion of proinflammatory cytokines (an oxidant or inflammatory) and a decreased secretion of anti-inflammatory cytokines from adipose tissues are observed, and these can lead to increased levels of proinflammatory cytokines and systemic inflammation.
- This inflammation can lead to peripheral and central sensitization in the pain transmission system and result in hyperalgesia (heightening sense of pain) and allodynia (in some cases, acute pain for no reason, as we mentioned above, sudden acute spasms in the lower back for seemingly no reason).
- It can be suggested that lumbar radiculopathy pain can be associated with obesity related inflammation.
Inflammation may be a crucial player in Intervertebral Disc Degeneration
An April 2019 published study in the International journal of molecular sciences (2) further advanced the idea that obesity creates inflammation that creates back pain.
“Recent evidence indicates that besides abnormal and excessive mechanical loading, inflammation may be a crucial player in Intervertebral Disc Degeneration. Furthermore, obese adipose tissue is characterized by a persistent and low-grade production of systemic pro-inflammatory factors. In this context, chronic low-grade inflammation associated with obesity has been hypothesized as an important contributor to Intervertebral Disc Degeneration through different, but still unknown, mechanisms”
The researchers go on to suggest that thickened vertebral marrow adipose tissue was pointed as a source of inflammatory adipokines (fat cells) that trigger degenerative pathways in degenerative disc disease via metabolism disturbance and the establishment of an initial inflammatory environment.
Diet can help with your back pain but it is only one aspect
Continuing this research study: This research made these suggestions:
- Recent evidence indicates that besides abnormal and excessive mechanical loading (degenerative disc disease), inflammation may be a crucial player in Intervertebral Disc Degeneration. Furthermore, obese adipose (fat) tissue is characterized by a persistent and low-grade production of systemic pro-inflammatory factors. In this context, chronic low-grade inflammation associated with obesity has been hypothesized as an important contributor to degenerative disc disease.
- It is also important to recognize that degenerative disc disease is a complex and multi-factorial disease and thus, further basic and clinical research is needed to fully understand the extent role of inflammation is back pain.
The research suggests that there is a connection between the inflammation your abdominal fat is causing and your back pain. However, there are many factors in play to limit back pain to solely a problem of abdominal fat.
Obesity causes mechanical stress on the lower spine
In the studies above, the inflammatory factors related to obesity were linked to back pain. This included the production of chronic, damaging inflammation, and the environment to produce this inflammation. Obesity now delivers its second blow to the spine. The weight load of mechanical stress.
In the April 2019 issue of the European Journal of Pain, (3) researchers made this observation:
- Patients who lost more than 5% of their body weight (a modest 10 pound loss on a 200 pound frame for example) had significant reductions in their low back pain.
This research team concluded: “Weight loss can reduce musculoskeletal pain, particularly for those who lose more weight. Imbedding pain management strategies within these services may provide a more holistic approach to obesity management.”
Back pain in middle-aged women caused by weight load stress
A February 2022 study (4) investigated the effects of being overweight and its effects on back pain on 826 middle-aged women. Two problems that the researchers looked at were if the back problems were only mechanical in nature or was there an indirect cause of pain being caused by inflammation coming from fat.
- The researchers found that increased weight was directly associated with increased odds of having back pain episode. The cause of this back pain? The study show “that in middle-aged women, weight, body mass index and total fat mass are directly related to back pain, indicating prominence of mechanical loading effect.” The weight is causing strain.
Belly fat worse for back pain
A 2019 study (5) examined the relationship between fat mass and fat distribution on back pain intensity and disability. In this study participants (aged 25-60 years) were assessed at baseline through a three year follow up for body fat and back pain.
- Results: Higher baseline body mass index (BMI) and fat mass (total, trunk, upper limb, lower limb, android (belly fat), and gynoid (fat around the breasts, thighs, and hips) were all associated with high intensity back pain at either baseline and/or follow-up. There were similar findings for all fat mass measures and high levels of back disability. A higher android to gynoid ratio (big belly) was associated with high intensity back pain.
Standing instead of sitting can help you lose weight –
Just standing reduces belly fat
Recently, doctors at the The University of Queensland (6) suggested that standing an extra two hours per day rather than sitting, was associated with approximately a 2% lower average fasting blood sugar level and an 11% lower average level of triglycerides. They also suggest that the two extra hours a day standing equated to people having better HDL cholesterol levels and a reduction in HDL to LDL ratio. Replacing two hours a day of sitting time with standing or stepping / walking was associated with an approximately 11% lower average BMI and nearly 3 inches smaller average waist circumference.
Men adding weight training increased weight loss benefits moreso
A study from Harvard (7) found that men who could do twenty minutes of daily weight training had less age-related abdominal fat compared with men who spent the same amount of time doing aerobic activities.
1. Hozumi J, Sumitani M, Matsubayashi Y, Abe H, Oshima Y, Chikuda H, Takeshita K, Yamada Y. Relationship between Neuropathic Pain and Obesity. Pain Research and Management. 2016 Mar 29;2016.
2 Ruiz-Fernández C, Francisco V, Pino J, Mera A, González-Gay MA, Gómez R, Lago F, Gualillo O. Molecular Relationships among Obesity, Inflammation and Intervertebral Disc Degeneration: Are Adipokines the Common Link?. International journal of molecular sciences. 2019 Jan;20(8):2030.
3 Dunlevy C, MacLellan GA, O’Malley E, Blake C, Breen C, Gaynor K, Wallace N, Yoder R, Casey D, Mehegan J, Fullen BM. Does changing weight change pain? Retrospective data analysis from a national multidisciplinary weight management service. European Journal of Pain. 2019 Apr 9.
4 Perera RS, Chen L, Hart DJ, Spector TD, Arden NK, Ferreira ML, Radojčić MR. Effects of body weight and fat mass on back pain–direct mechanical or indirect through inflammatory and metabolic parameters?. InSeminars in Arthritis and Rheumatism 2022 Feb 1 (Vol. 52, p. 151935). WB Saunders.
5 Brady SR, Urquhart DM, Hussain SM, Teichtahl A, Wang Y, Wluka AE, Cicuttini F. High baseline fat mass, but not lean tissue mass, is associated with high intensity low back pain and disability in community-based adults. Arthritis research & therapy. 2019 Dec;21(1):1-8.
6 Healy GN, Winkler EA, Owen N, Anuradha S, Dunstan DW. Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers. European heart journal. 2015 Oct 14;36(39):2643-9.
7 Mekary RA, Grøntved A, Despres JP, De Moura LP, Asgarzadeh M, Willett WC, Rimm EB, Giovannucci E, Hu FB. Weight training, aerobic physical activities, and long-term waist circumference change in men. Obesity. 2015 Feb;23(2):461-7.