When you have obesity, excess body weight may put pressure on your spine or alter your posture, making back pain more likely.

Obesity is a common condition that affects about 2 in 5 adults in the United States. Obesity can contribute to several types of back pain, including lower back pain, sciatica, and disk degeneration.

Carrying excess weight puts strain on your spine that can affect the disks in between your vertebra. Excess weight in the abdomen and breasts can also affect your posture. Poor posture often contributes to back pain.

In this article, we’ll provide information about the connection between obesity and back pain. We’ll also discuss treatments and strategies you can use to alleviate discomfort.

Not every person with obesity will experience back pain, but these conditions often coincide. Obesity can be a primary cause of back pain, but it can also make an existing condition worse.

A large study published in 2017 found that obesity and excess weight are linked to lower back pain and degenerative disk conditions. The researchers found that obesity can be used as a predictor of future problems in the lower back, but the researchers weren’t able to prove that obesity directly causes back pain.

There are a number of theories about why people who have obesity are more likely to experience back pain. These theories include:

  • Altered posture: If you have too much weight around your middle, your posture may become altered. Your pelvis and lower back may tilt forward, changing the natural curve of your spine. This change may place excess pressure on the spinal disks and nerves of the back, causing conditions such as:
    • spinal compression
    • disk degeneration
    • pinched nerves
  • Disk compression: Excess weight may increase the pressure on the joints in your spine (vertebra). Over time, pressure on these joints may cause the cushiony disks between your spinal bones to thin or bulge, leading to chronic pain and pinched nerves.
  • Inflammation: Obesity is linked to chronic, low-grade inflammation. Whole-body inflammation may increase your risk of chronic pain disorders.

Your back is made up of four regions, from top to bottom:

  • cervical spine (neck region)
  • thoracic spine (upper and middle back)
  • lumbar spine (lower back)
  • sacrum and coccyx (posterior pelvic wall and tailbone)

Anyone can get back pain in any of the four regions. If you have obesity, you may be more likely to experience back pain in your lower back.

Lower back pain

Many conditions and injuries can lead to lower back pain. Even a bad night’s sleep can cause temporary lower back pain. Chronic and severe lower back pain typically have more serious underlying causes, such as spinal compression, sciatica, and joint inflammation.

If you have obesity, lower back pain may result in areas such as the:

  • joints
  • nerves
  • intervertebral disks
  • ligaments
  • tendons
  • muscles
  • vertebrae

If you carry excess weight in your stomach, your spine may eventually become arched and curved. This change can cause further pressure on your sacrum and the sacroiliac joints at the bottom of your spine.

Disk-related issues

The intervertebral disks of the back are situated between the vertebrae. When you walk or run, your intervertebral disks cushion your vertebrae and act as shock absorbers. These disks also help your spine with flexibility, so you can bend and twist.

If you have obesity, the excess weight may put more pressure on the disks than they can handle. Increased pressure on the disks can lead to disk degeneration, in which the disks grow thinner over time, or disk injuries such as a herniated disk.

A herniated disk occurs when the jelly-like substance within a disk pushes through its outer lining, putting pressure on the nerve roots that branch out of your spinal cord. Sciatica is a condition that happens when one of the disks in your lower back pushes (or pinches) a nerve running down into your leg.

Obesity can contribute to the long-term progressive weakening of one or more disks (degenerative disk disease).

Degenerative changes

Degenerative changes to the spine are caused by long-term gradual changes in the structure and functionality of your spine. Aging is the primary cause of degenerative changes to the spine.

Another cause of spinal degenerative changes is osteoarthritis. Excess weight places pressure on joints, which can worsen arthritis in the back and other areas of the body, such as knees. Fat cells also secrete inflammation-causing chemicals, which may make arthritis pain worse.

Losing weight can ease inflammation and take pressure off your spine, which may reduce pain.

If exercise is part of your weight loss plan, you may also strengthen your stomach and back muscles. Strengthening these areas provides better support for the spine and is beneficial for pain relief.

Obesity is difficult to treat with diet and exercise alone. Even if you lose a significant amount of weight on your own, the effects are often temporary.

Talk with a healthcare professional about your weight loss goals. Obesity is a treatable medical condition.

Treatments may include:

  • weight loss surgery
  • weight loss medications
  • therapy or coaching programs
  • medically supervised diet and exercise programs

Weight loss medications

There are several weight-management drugs on the market, and more are on the way. Many people have had success with glucagon-like peptide-1 (GLP-1) agonists. Semaglutide (Wegovy) is a Food and Drug Administration (FDA) approved treatment for obesity.

The same medication, marketed as Ozempic, is FDA-approved for the treatment of type 2 diabetes, but it has the same weight loss effects.

According to one study, once-weekly semaglutide injections help people lose an average of 15% of their body weight in less than a year and a half.

Weight loss medications work by reducing your appetite and making you feel full faster. They also help with insulin resistance.

Talk with a healthcare professional about your options.

Physical therapy can be immensely helpful in reducing back pain.

Physical therapists use strategies such as manual therapy, massage, and electrical stimulation to alleviate inflammation, loosen muscles, and reduce back pain.

A physical therapist will also guide you through exercises that strengthen the back and abdomen and support flexibility. These activities may include strength training exercises with props such as body bands and low impact aerobic activities such as riding a stationary bike.

Good posture while sitting and standing helps promote proper spinal alignment and can reduce back pain. The way you hold your body when you’re lifting, bending, and performing other movements also has an effect.

Being aware of your posture takes work. If you catch yourself slumping, try to sit or stand up straighter. Holding your shoulder blades in and engaging your core (stomach muscles) can help.

Using ergonomic aids, such as posture-correcting seat cushions, may also help. These devices work by keeping your body in proper alignment without your need to focus on it.

Obesity can contribute to back pain and aggravate existing conditions. If you carry excess weight, it may be placing undue pressure on your spine. Excess weight can also increase inflammation.

Losing weight and exercising can be beneficial for reducing back pain. If you have obesity, you may want to talk with a healthcare professional about your options.