It shouldn’t come as a surprise to anyone reading an article on back pain that there is an epidemic of obesity in america. There is no doubt in my mind that as weight increases, there is a proportional increase in back pain. I believe that one of the reasons for this correlation is that our skeletons are simply built to carry less load. In this series of images that come from the very enlightening movie Food, Inc., we see a parody of the classic illustration of the ascent of man to the point where the anatomic structures of the spine are simply overwhelmed by mass they have to carry and move.
While it has been very difficult to prove that obesity is directly correlated with an increased amount of back pain, there is no doubt that obesity contributes to a sedentary lifestyle and the combination of the two is bound to give you a back ache. This is a very sensitive subject to broach with patients. Several studies have weighed in (pun intended) on either side of the issue of whether or not it is advisable to discuss weight issues with patients and the results have often been contradictory. Some authors believe that obesity should be directly discussed with patients and there are patients who are apparently unaware of the ill effects of obesity. There are also others who believe that identifying obesity as the cause of symptom can often undermine the therapeutic relationship because the patient feels criticized or judged. In my experience, this has been very difficult terrain to navigate. I have had a number of patients who have come to see me with back pain, with an abnormal MRI scan, after a failed course of physical therapy, and who are substantially overweight. I have found that it is very difficult to please this patient since meaningful weight loss is a very difficult goal to achieve, and exercise is hard when you already have back pain.
I am very sympathetic to plight of people who have gained a significant amount of weight and I acknowledge the extreme difficulty associated with trying to lose weight in the setting of obesity AND back pain or arthritis. However, I do believe that obesity and a sedentary lifestyle do contribute to back pain and I feel that it is my responsibility as a surgeon to discuss this with patients. I am close personal friends with Dr. Mark Vierra who is a world renowned general and laparoscopic surgeon with a very busy weight loss/bariatric practice and we have discussed this issue on many occasions. I frequently refer patient’s to Dr. Vierra’s monthly lectures at Community Hospital on the subject of weight loss, and if you are interested in attending one of these lectures: please click here. I am often asked for an opinion on dietary advice. I rely heavily on the author Michael Pollan who wrote the book Food Rules and was a key figure in the documentary Food Inc. There are three things that I ask everyone who wants to discuss dieting to read or watch. The first is Food Rules (here’s the summary: eat less, not too much, mostly plants!), the second is the following article on caloric restriction from the New York Times (http://www.nytimes.com/2009/10/11/magazine/11Calories-t.html), and the third is the documentary Food Inc.
Take home message #4: if you have a BMI of 30 or greater, chances are that I will tell you that your weight is a contributing factor to your back pain. Here is a link to a body mass index calculator: http://www.nhlbisupport.com/bmi/ Ultimately, I am very happy to discuss these issues with patients, but that conversation typically is more enjoyable for both parties when my biases and opinions are known in advance.