Weight loss can reduce back pain

Ross A. Hauser, MD, Danielle R. Steilen-Matias, MMS, PA-C

Abdominal fat causes back and spinal nerve pain

We know that people do not like to hear that the joint and back pain problems they face are made worse by abdominal obesity. We do see patients who tell us that they have been lectured for years to get rid of that big belly. Clearly lecturing is not motivation. In this article, we will give you the science of how obesity works to give you back pain. We hope that you will see how your back pain is made worse in a different light beyond any gimmicky type article which suggests “8 easy to lose weight and reduce back pain.” If they were that easy you would have lost the weight by now.

The evidence is mounting that when you wake up in the morning with that back pain, with that numbness extending into your feet, that your belly is A if not THE culprit of your problems.

But the evidence is mounting that when you wake up in the morning with that back pain, with that numbness extending into your feet, that your belly is A if not THE culprit in your problems. The goal of this article is to help provide you with reliable information that will make you look down and look at your belly and realize that a big belly is not your friend and for some, will cause you to lose your independence.

Research: There is a link between a big belly and back pain.
Common sense: There is a link between a big belly and back pain

Researchers at the Medical University of Graz in Austria conducted a study that lasted over 35 years. (1) They followed patients throughout their lives to determine what impact abdominal obesity had on their back pain and general health. Here is what 35 years of research revealed:

You lose your independence faster if you have a big belly and you will become dependent.

Note: When someone comes into one of our clinics, one of the greatest fears they have is the loss of independence, loss of mobility, and the need to depend on others to help them get around. The evidence is clear, people rid themselves of these fears when they embark on a program to get rid of their big belly.

The evidence presented by the Austrian team:

For many people, it would seem obvious, a large belly is putting mechanical stress on the spine and that is the cause of back problems.

When there is back pain and there are problems of being sedentary, you have to move or the problems will accelerate.

Big belly causes stress and mechanical load in a bad back – weight loss is very good in many cases

The further your belly sticks out the more back pain

L5-S1 problems? A lot of it may be due to weight stress

The loss of correct spinal curvature – pain, herniated discs, numb and burning sensation into your feet

What are we seeing in the next image?

It is all about the curvature of the spine. 

A. Normal spine:

B. Hyperlordosis:

C. Kyphosis: The hunchback

spine curves

The hunchback in women not only caused by osteoporosis but by obesity

Above we discussed a research study that suggested that the problem of big belly and back pain was more frequent in women. We are going to look at another study that helps explain why. Breast size and a big belly are not a good combination for women fearful of hunchback.

Here is a study, reported in March 2020 in the Journal of Sport and Health Science. (4) Look at all the things that happen to obese women and the factors that can lead to the hunchback formation. Yes, it is all about obesity. Here are the learning points of this study:

“This study investigated the effects of obesity on breast size, thoracic spine structure and function, upper torso musculoskeletal pain and physical activity participation in women living independently in the community.”

Learning points:

Breast size:

Significant structural problems

You can’t be active and this will increase the risk of the hunchback

Obesity, back pain, and the workplace

Big Belly? Don’t lift anything heavy

It should be obvious that if you carry a big belly and you have low back pain you are at higher risk for disability. But what if you are the owner of a landscaping company, a building contractor, anything that requires you to be on the worksite? Many of the people that fit this description that we see at our center are stuck in a repetitive cycle of self-managed treatments.

In the work-place injury-related journal Work, doctors suggest that severely obese individuals are likely at an increased risk of lifting-related low back pain compared with normal-weight individuals. (5)

Most people do not think their big belly is the problem.

People do recognize weight is a problem and want help in losing the big belly in agricultural/rural communities 

And so and so on, numerous studies on mechanical load as the cause of back pain in obese people.

Neuropathic pain not from musculoskeletal damage was higher in overweight and obese patients. In other words, the weight is causing the pain whether you hurt your back or not

There have been many studies that suggest that it is not the physical load of carrying the extra weight that is causing back pain in obese and overweight patients, but inflammation caused by excess fat changing the body environment to that of chronic inflammation.  Please see our article: Excessive weight and joint pain – the inflammation connection.

Now researchers are suggesting a relationship between neuropathic pain and obesity with an inflammation connection. In a paper from the University of Tokyo, doctors made these observations:

Pain in your back was clearly made worse by carrying a belly load. Now add to that pain made worse by high blood sugar

A well-cited study in the Journal of the Peripheral Nervous System found that nerve sensory thresholds were metabolically altered which could lead to future clinical neuropathy. (8) What was suspected of metabolically altering the spinal nerves? Hyperinsulinemia and insulin sensitivity. 

Doctors at the University of Calgary writing in the journal Osteoarthritis and Cartilage examined obese laboratory animals and found that obesity causes inflammatory osteoarthritis. The inflammation attacking the joints of the animals was caused by a high fat/high sugar diet. (9)

This type of research is helping doctors understand metabolic inflammation, obesity, and back pain

This was confirmed by French researchers in Current Opinion in Rheumatology, who suggested that the rising prevalence of hand osteoarthritis is from obesity and since the hand does not bear weight, this suggests that the role of systemic inflammatory mediators in fat cells cause inflammation signaling to be sent out and attack joints. (10)

Please see our article Excessive weight and joint pain – the inflammation connection for more on this subject.

Back surgery and the problems of obesity

A 2016 study published in the Chiropractic & Manual Therapies (11) made these observations:

In a recently published article in the American Journal of Bone and Joint Surgery, researchers examined the effect that obesity has on patients managed for symptomatic lumbar disc herniation. They studied a group of patients who underwent back surgery and a group of patients who had more conservative non-surgical treatments. Both groups showed significantly less improvement as it related to problems of obesity. (12)

The same was found in newer research from St. Olavs University Hospital, in Norway for patients having surgery for lumbar spinal stenosis. The researchers noted: “Obese patients were less likely to achieve a minimal clinically important difference.”(13)

In February 2017, researchers at Cornell, Clemson, the University of Georgia, and Xi’an Jiaotong University in China, completed a study which found that :

A component of failed spinal surgery is obesity

A study in The Spine Journal said that a component of failed spinal surgery was obesity. This recent research was the first to examine obesity’s role in recurrent disc herniation after spinal surgery.

“Obesity was a strong and independent predictor of recurrent (disc herniation) after lumbar microdiscectomy. Surgeons should incorporate weight-loss counseling into their preoperative discussions with patients.”(15)

There is even a suggestion from University researchers in Rome, who wrote in the European Spine Journal that elevated cholesterol levels and triglycerides have a role: “patients with symptomatic herniated lumbar disc showed statistically significant higher triglyceride concentration and total cholesterol concentration. Serum lipid levels may be a risk factor for [symptomatic disc herniation]. An enhanced understanding of these factors holds the promise of new approaches to the prevention and management.”(16)

How beneficial is spinal surgery for obese patients?

Any procedure that offers a patient relief of their symptoms is a good procedure. But how much risk should a patient take and for how much relief?

Let’s look at two studies FAVORABLE to spinal surgery for obese patients

The question of how obese patients respond to surgery as compared to non-obese patients was tackled by doctors at the Department of Neurosurgery, the University of Alabama at Birmingham. In this September 2017 study, the doctors looked at obese and non-obese patients treated with lumbar laminectomy for symptomatic lumbar spinal stenosis.

What to make of this?

The researchers concluded: “obese patients with symptomatic lumbar spinal stenosis may require longer to recover after decompression but can expect to reach equivalent outcomes of similarly treated (non-obese) patients”(17)

In the second favorable study, Spanish doctors writing in the medical journal Neurocirugia (Neurosurgery) write off the growing evidence that connects the metabolic processes within the adipose tissue, preferentially abdominal fat, with a low-intensity chronic inflammatory state that causes back pain.

They suggest: Some meta-analyses have confirmed an increase of complications following lumbar spine surgery (mainly infections and venous thrombosis) in obese subjects.

However, functional outcomes after lumbar spine surgery are favorable although inferior to the non-obese population, acknowledging that obese patients present with worse baseline function levels and the prognosis of conservatively treated obese cohorts is much worse. (18)

A 2015 study from doctors at University hospital researchers in the United Kingdom also supported surgery for obese patients.

For obese and non-obese patients pain and functional outcome are similar to non-obese patients. So if the surgery failed, it was not the fault of the obesity.

Again, this all comes down to lifestyle choices to accelerate healing or make healing more difficult.

The Spinal ligament repair injection treatment option Prolotherapy

Need help beyond weight loss? Prolotherapy is an in-office injection treatment that research and medical studies have shown to be an effective, trustworthy, reliable alternative to surgical and non-effective conservative care treatments. In our opinion, based on research and clinical results, H3 Prolotherapy (H3 is a type of Prolotherapy named after three of its leading physician innovators Hackett-Hemwall-Hauser) is superior to many other treatments in relieving the problems of chronic joint and spine pain and, most importantly, in getting people back to a happy and active lifestyle.

A Prolotherapy treatment into the lumbar spine.

Learning Points

Questions about our treatments?

If you have questions about back pain and how we may be able to help you, please contact us and get help and information from our Caring Medical staff.


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1 Großschädl F, Freidl W, Rásky É, Burkert N, Muckenhuber J, Stronegger WJ. A 35-year trend analysis for back pain in Austria: the role of obesity. PloS one. 2014 Sep 10;9(9):e107436.[Google Scholar]
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17 Elsayed G, Davis MC, Dupépé EC, McClugage SG, Szerlip P, Walters BC, Hadley MN. Obese (Body Mass Index> 30) Patients Have Greater Functional Improvement and Reach Equivalent Outcomes at 12 Months Following Decompression Surgery for Symptomatic Lumbar Stenosis. World Neurosurgery. 2017 Sep 1;105:884-94.[Google Scholar.]
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This article was updated January 27, 2021

A July 2022 study published in the journal Orthopedic reviews (20) examined what happened to obese patients after they had a spinal surgery. What they found was: “Evidence suggest that obese patients could benefit from spine surgery and (the) outcomes be satisfactory. A higher rate of peri-operative complications is reported among obese patients, especially in posterior (rear incisions) approaches. The use of minimally invasive techniques plays a key role in order to reduce surgical risks.”

But do, as suggested minimally invasive surgeries reduce spinal surgical risks? It may depend on belly fat.

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