Association Between Obesity and Clinical Outcomes of Low Back Pain Among Adults Attending Riphah Rehabilitation Center: A Case-Control Study
DOI:
https://doi.org/10.61919/jhrr.v6i4.2000Keywords:
Low back pain, obesity, abdominal obesity, body mass index, rehabilitation, disability, pain severity, lumbar angle, case-control study.Abstract
Background: Low back pain is a major musculoskeletal disorder associated with substantial disability, reduced functional capacity, and impaired quality of life worldwide. Obesity and abdominal adiposity have been increasingly recognized as important contributors to chronic low back pain through biomechanical, inflammatory, and functional mechanisms. However, limited evidence is available regarding the association between obesity and clinical outcomes of low back pain among rehabilitation populations in Pakistan. Objective: To determine the association between obesity and clinical outcomes of low back pain among adults attending Riphah Rehabilitation Center. Methods: A case-control study was conducted among 178 participants, including 89 low back pain cases and 89 controls. Demographic, anthropometric, lifestyle, and clinical variables were assessed using standardized procedures. Body mass index, waist circumference, abdominal obesity, lumbar angle, pain severity, and disability scores were recorded. Logistic regression analysis was performed to identify predictors of poor clinical outcomes, while linear regression assessed the relationship between body mass index and pain score. Statistical significance was considered at p < 0.05. Results: The mean body mass index was significantly higher among low back pain cases compared with controls (31.1 ± 5.3 kg/m² vs 27.7 ± 4.4 kg/m², p = 0.001). Obesity (OR = 1.39, 95% CI: 1.12–1.73, p = 0.004), abdominal obesity (OR = 2.08, 95% CI: 1.15–3.78, p = 0.016), and increased lumbar angle (OR = 1.04, 95% CI: 1.01–1.07, p = 0.022) were significant predictors of poor clinical outcomes. Each 1 kg/m² increase in body mass index was associated with increased pain score (β = 0.11, p = 0.001). Conclusion: Obesity, particularly abdominal obesity, was significantly associated with greater pain severity, functional limitation, and poor clinical outcomes among adults with low back pain attending rehabilitation services. Integration of weight-management and biomechanical rehabilitation strategies may improve clinical recovery and reduce disability burden.
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References
Ambrosio L, Mazzuca G, Maguolo A, Russo F, Cannata F, Vadalà G, et al. The burden of low back pain in children and adolescents with overweight and obesity: from pathophysiology to prevention and treatment strategies. Ther Adv Musculoskelet Dis. 2023. doi:10.1177/1759720X231188831.
Arora P, Dey S. The impact of obesity on spinal biomechanics and pelvic kinematics: a pathway to chronic low back pain. Indian J Pain. 2024. doi:10.4103/ijpn.ijpn_89_24.
Basem JI, White RS, Chen S, Mauer E, Steinkamp ML, Inturrisi CE, Witkin LR. The effect of obesity on pain severity and pain interference. medRxiv. 2020. doi:10.1101/2020.03.02.20027425.
Chen LH, Weber K, Mehrabkhani S, Baskaran S, Abbass T, Macedo LG. The effectiveness of weight loss programs for low back pain: a systematic review. BMC Musculoskelet Disord. 2022;23(1). doi:10.1186/s12891-022-05391-w.
Dekker Nitert M, Mousa A, Barrett HL, Naderpoor N, de Courten B. Altered gut microbiota composition is associated with back pain in overweight and obese individuals. Front Endocrinol. 2020;11. doi:10.3389/fendo.2020.00605.
García-Moreno JM, Calvo-Muñoz I, Gómez-Conesa A, López-López JA. Obesity and overweight as risk factors for low back pain in children and adolescents: a meta-analysis. Int J Obes. 2024. doi:10.1038/s41366-024-01475-w.
Gun B, Banaag A, Khan M, Koehlmoos T. Prevalence and risk factors for musculoskeletal back injury among U.S. Army personnel. Mil Med. 2021. doi:10.1093/milmed/usab217.
Heuch I, Heuch I, Hagen K, Zwart JA. Overweight and obesity as risk factors for chronic low back pain: a new follow-up in the HUNT Study. BMC Public Health. 2024. doi:10.1186/s12889-024-20011-z.
Koremans FW, Chen X, Das A, Diwan A. Changes in back pain scores after bariatric surgery in obese patients: a systematic review and meta-analysis. J Clin Med. 2020;10(7):1443. doi:10.3390/jcm10071443.
Lucha-López MO, Hidalgo-García C, Monti-Ballano S, Márquez-Gonzalvo S, Ferrández-Laliena L, Müller-Thyssen-Uriarte J, et al. Body mass index and its influence on chronic low back pain in the Spanish population: a secondary analysis from the European Health Survey 2020. Biomedicines. 2023;11(8):2175. doi:10.3390/biomedicines11082175.
Nahorna A, Baur H. The relevance of identifying the biomechanical and functional effects of abdominal obesity on activities of daily living in individuals with low back pain. Curr Issues Sport Sci. 2023. doi:10.36950/2023.2ciss067.
Peiris W, Cicuttini F, Hussain S, Estee M, Romero L, Ranger T, et al. Is adiposity associated with back and lower limb pain? A systematic review. PLoS One. 2021;16(8):e0256720. doi:10.1371/journal.pone.0256720.
Rosa S, Martins D, Martins M, Guimarães B, Cabral L, Horta L. Body mass index and musculoskeletal pain: a cross-sectional study. Cureus. 2021. doi:10.7759/cureus.13400.
Ruiz-Fernández C, Schol J, Ambrosio L, Sakai D. The vicious cycle of obesity and low back pain: a comprehensive review. Appl Sci. 2025. doi:10.3390/app15126660.
Saludes R, Acevedo P, García I, Carrión ÁG, Sebastián CM, Fernández AN, et al. Abdominal adiposity increases lordosis and doubles the risk of low back pain. Appl Sci. 2022. doi:10.3390/app12157616.
Siddiqui A, Javed S, Abbasi S, Baig T, Afshan G. Association between low back pain and body mass index in Pakistani population: analysis of the software bank data. Cureus. 2022. doi:10.7759/cureus.23645.
Stokes A, Lundberg DJ, Sheridan B, Hempstead K, Morone NE, Lasser K, et al. Association of obesity with prescription opioids for painful conditions in patients seeking primary care in the US. JAMA Netw Open. 2020. doi:10.1001/jamanetworkopen.2020.2012.
Varallo G, Giusti E, Scarpina F, Cattivelli R, Capodaglio P, Castelnuovo G. The association of kinesiophobia and pain catastrophizing with pain-related disability and pain intensity in obesity and chronic lower-back pain. Brain Sci. 2020. doi:10.3390/brainsci11010011.
Varallo G, Scarpina F, Giusti E, Cattivelli R, Usubini AG, Capodaglio P, Castelnuovo G. Does kinesiophobia mediate the relationship between pain intensity and disability in individuals with chronic low-back pain and obesity? Brain Sci. 2021. doi:10.3390/brainsci11060684.
Zhou J, Mi J, Peng Y, Han H, Liu Z. Causal associations of obesity with the intervertebral degeneration, low back pain, and sciatica: a two-sample Mendelian randomization study. Front Endocrinol. 2021;12. doi:10.3389/fendo.2021.740200.
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