Obesity and low back pain: relationships and treatment

SUMMARY Low back pain (LBP) and obesity (defined as BMI ≥30 kg/m(2)) are common problems in the general population. The treatment of LBP is not clearly defined and has variable success in different populations and time-frames. When a person presents with LBP who also meets the criteria for obesity, many questions are raised as to the value of weight-loss treatments and the success and/or safety of usual treatments of LBP, especially exercise. Based on the current medical literature for the treatment of LBP in patients who are obese: there should be attempts at weight loss (nonsurgical or surgical), especially if the person is in the morbidly obese (BMI >40 kg/m(2)) range; all usual forms of exercise and physical therapy treatments are possible and can be beneficial without increased concerns for injury; and, if necessary, invasive treatments such as spinal injections or surgery are potentially beneficial and have similar complication rates to the nonobese population. These options should be offered when medically necessary and appropriate.