Obesity and Back Pain; Super-Sized Pain

Are you one of the 1.9 billion adults battling obesity?  Do you also have back pain?  
This is no coincidence.  I am sure many of you are like me and celebrate by eating; eat when I’m sad and love to socialize around food.  Jim Gaffigan, my favorite comedian, said it best; “I haven’t been hungry in 12 years.”   In our society poor food choices are everywhere we look and often disguised as a “healthy choice”.   I often argue we would be better off as #2 on the food chain.  A little extra motivation to skip Dairy Queen on the way home from the office if a bear is hiding around the corner.  Remember you only need to run faster than the other guy!

In my practice, I have the “Obesity Discussion” with my patients every day.  Often the response I get is, “Well, I would lose weight if my back didn’t hurt”.   The honest question I want my patients to ask themselves is “Was I obese before my back pain started?”   This is a very difficult, but necessary dialogue to have with yourself.  If you do not recognize the role your weight plays in your daily back pain then you will not modify your behavior after treatment.  Sadly, many studies show us that not only patients fail to lose weight following spine surgery; many GAIN even more weight after surgery. (1,2)  This is very disheartening as many patients go through the turmoil of spine surgery and rehabilitation only to return a few years later with similar symptoms.  Unfortunately, they are just as heavy, still have arthritis, and wonder why this keeps happening to them.   But, all is not lost!  I strongly believe this is a failure on several fronts and one we can fix together.  As a provider, I need to spend more time educating my patients that diet and exercise are necessary components to spine surgery.  As a patient, you need to accept that lifestyle changes are required in order to have a complete recovery and to avoid future surgery.  These lifestyle changes need to start before surgery and continue after surgery. 

It is very important for patients to understand how their weight is measured and considered in surgery.  In medicine, we use BMI (Body Mass Index) as a tool to determine if a patient is healthy weight.  The BMI is a measure of body fat based on weight and height.  The formula is your weight in kilograms over your height squared in centimeters.  Simple right? Not really, but you can do what we all do and “google it”.  There are plenty of apps or websites that will do the calculation for you.  Is this BMI a perfect indicator?  Absolutely not, but it is a simple and standardized tool that serves as a point of reference.  Don’t get caught up in the labels you get thrown into.  For example, you exercise and watch what you eat but never been below “overweight” which is BMI of 25 to 29.9.  I know this can be very frustrating, however forget the labels and just focus on dropping that number.

How Much Weight Should I Lose?
Anything!  I’m not kidding! We will take anything!  This is because of the way even a small amount of abdominal weight translates exponentially into strain on your back.  Imagine taking a 10 lb dumbbell and strapping it to your belt.  Then go about your day.  Would that be comfortable?  How good would it feel to take that dumbbell off and drop it on the floor?  Ahhhh! What if it was a 20 or 30 lb weight?  Even better right?  The benefits of weight loss happen immediately.  Abdominal weight specifically is a large force pulling your lower back (lumbar spine) over your pelvis and towards the ground.  This leads to increased strain in your lumbar discs and small joints at each level in your lower back called your facet joints.  This is an unnatural strain that your body cannot accommodate and it leads to lumbar disc herniations and accelerates arthritis.  

How Should I Lose Weight?
First and foremost, you have to commit to a lifestyle change.  In the modern age we have done some pretty crazy things to make losing weight easier.  Heck!  We even used to ingest tape worms to do the work for us.  Other than severe anemia, abdominal cramping and pooping worms, it worked great!  You may have tried less extreme measures like Atkin’s, South Beach Diet, No Carb, even just eating Watermelon for several days!  Sadly, the only proven long term weight loss plan is lifestyle change, diet, and exercise.  We need to accept the fact that a 1400 calorie Bloom’in Onion at Outback Steakhouse is not acceptable for human consumption even though they will gladly serve it to you. 

So where to start?  Everyone is different.  How overweight are you?  Can you walk 2 miles? Do you also have knee pain?  Do you have heart or lung disease?  My point is that we all have different starting points so talk with your primary provider or us and we will come up with a plan that works for you.  In the meantime, look at your activity level.  Are you putting more calories in than you are putting out?  If you cannot exercise because of your pain then you need to adjust your caloric intake and stop the downward spiral.  

Recent studies show that diet is the most important factor in successful weight loss.  I’m not talking about eating carrots for the rest of your life.  I am talking about looking seriously at how much fat, sugar and calories are in your diet every day.  You will be surprised!  A general rule to follow is to shop the perimeter of a grocery store.  If you imagine most stores; the meats, dairy, cheese, grain, fruit and vegetables are all around the outside.  All the processed, high calorie food is in the middle.  How much food should you consume? It is based on your age, gender, and current weight.  The American Heart Association has an excellent calculator to help you with this. 

Want help reading labels? Check out this helpful website:

Yup, you have to do it!  With regards to your back, muscle fitness is essential.   Your spine is just scaffolding wanting to blow over.  Your deep stabilizing muscles help maintain space for nerves and keep you up and moving.  As your pain increases, it is human nature to move less.  The structural benefits these muscles provide are lost when the muscle atrophy and as a result the pain gets worse.  This increased pressure through the spine raises your risk of lumbar disc herniations and/or accelerated arthritis. 

So what should you do? Again, since we all have different starting points you should discuss this with your provider.  Generally, we love it when our patients walk.  It is a low impact, healthy exercise but let’s be honest, may be boring as hell.  One helpful tip is to watch your favorite show or listen to a good book while exercising.  The rule is however, you can only watch or listen when you are exercising.  This is a little extra motivation to start the exercise and then it will be over before you know it!  You might even want to go a few extra minutes to get to that next chapter!  Another option is to try something new.  Ever paddled a canoe?How long since your last hike?  Sign up for a 5k walk.

I hope you find something helpful in this blog.  I want you to remember that we are here for you.  We understand this is not easy.  We are people who love ice cream too!  If it were easy we would not be writing blogs about it!  Please keep checking back for more information regarding obesity and spine conditions, I’m sure this will not be our last post on this topic.

Sean Brown PA-C

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