It is a well known fact that overweight is a major risk factor for a number of noncommunicable diseases such as cardiovascular diseases, diabetes, musculoskeletal disorders and some cancers. The risk for these noncommunicable diseases increases, with the increase in BMI (Body Mass Index). But not many people know that overweight can also cause people pain in the back.
Recently, researchers at The University of Hong Kong found that being overweight and obese significantly contributes to the development of disc degeneration. Degeneration of the joints of the spine, known as the intervertebral discs, is one of the major causes of low back pain. Traditionally, it is believed that it occurs with only aging.
Two studies for adults, one cross-section, one time series, were conducted on this issue.
The cross-sectional one was the study of adults with age 21 or above. A total of 2,599 individuals (1,040 men and 1,559 women with mean age of 42) were assessed with magnetic resonance imaging (MRI). Participants were from diverse social and economic backgrounds and were recruited regardless of whether they had lower back pain or not.
After the assessment, it was found that 73 per cent of them had disc degeneration with men (76%) having a significantly higher prevalence of degeneration than women (71%). Increasing age was also found to increase its prevalence.
Of those who had disc degeneration, 7 per cent were underweight, 48 per cent in the normal weight range, 36 per cent overweight and 9 per cent were obese.
Overweight and obese individuals were found to have a greater extent and severity of disc degeneration in comparison to those individuals of normal weight or underweight.
"Our research confirms that with elevated BMI, there is a significant increase in the extent and global severity of disc degeneration. In fact, its end-stage with narrowing of the disc space was more pronounced in obese individuals," said Dr. Samartzis, one of the team leaders of this study.
In another study, 129 working middle-aged men, representing three occupations (machine drivers, construction carpenters and office workers), were recruited. The selection was based on the age (40-45) and place of residence. MRI images of the lumbar spines were obtained two times, one at baseline and another at 4 years later (follow up stage).
In this study, besides measuring their current weight, the participants' weight at age 25, their height, history of car driving, smoking, and back injuries were also obtained.
The findings of the study showed that persistent overweight (with BMI ≥25 kg/m2 at the age of 25 and at the current age) associated strongly with risk of increased number of lumbar disc degeneration.
Overweight at young age was a stronger predictor of an increase in the number of degenerated discs during follow-up than overweight in middle age.
Thus it can be concluded that overweight with BMI above 25 kg/m2 increases the risk of lumbar disc degeneration.
This is the case for adults. As more children are now becoming overweight, how detrimental would this also affect their lumbar spine?
Another cross-sectional study was on adolescents who were 13-20 years of age. The sample size was 83.
It was found that 35 per cent of them had disc degeneration. The majority (93%) of these adolescents with disc degeneration experienced low back pain and decreased physical function.
More importantly, being overweight in adolescence triples the likelihood of having disc degeneration and developing more severe forms of the condition than those with normal weight. Individuals with juvenile disc degeneration had an increased prevalence and greater intensity of low back pain and/or sciatica and hence greater physical disability.
Also, the development of disc degeneration in young age may potentially contribute to its greater severity early on in life and possibly a life-time of low back pain episodes.
Disc degeneration is irreversible and may cause a lot of long-term suffering and psychological distress for patients. Serious low back pain may prohibit the patients to maintain normal work and social life. And so it could lead to a serious need for back surgery.
Because of more weight, physical loading on the disc and/or a chronic low-grade inflammation from the fat cells may play a role in its degeneration, Dr. Samartzis explained.
Thus there is a need for the overweight people to employ successful weight loss strategies to prevent suffering from these diseases.
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