Let’s consider a hypothetical scenario with a lady named Beth who is 55 years old and has a 10 year history of worsening low back pain. Within the past 5 years, Beth has gone from 130 lbs to 180 lbs. She is 5’5”. She can’t correlate the worsening of her back pain with the 50 lbs weight gain in the past 5 years. All she knows is that the pain started 10 years ago, and it’s been getting worse. Beth goes to her primary care about her low back pain. The first thing her primary care tells her is “you should consider losing weight.” Like she hasn’t thought of that before!
Is the primary care provider wrong in recommending this? How closely linked are weight and pain?
Weight gain affects pain, but the harder question is how much does it? The answer can be very person-specific. To get an idea of the stress additional weight puts on the body, let’s consider the knee joint. In relation to your knee joint, Harvard Health states that a 200 lb person will have 300 lbs of pressure on their knee joints.(1) This can lead to excessive strain, causing potentially earlier onset arthritis, changes in the shape of the knees, and more.
In relation to Beth’s scenario, this spine can be affected by weight gain. When we have excessive abdominal fat, or “belly fat,” this changes our center of mass. The weight is distributed forward more, creating a bigger curve in our low back which will stress it.
So, the primary care was not wrong in their recommendation, however, the delivery was wrong. Weight gain is not helping Beth’s pain, however, it may not be the primary cause of it. Her pain did start 10 years ago, before the weight gain. Beth could have something else causing her pain (maybe a muscle imbalance in her low back and abdominal muscles) that is stressed by weight gain. It’s important to be open to talking about weight, however, it is wrong to assume that it’s the primary cause or that weight loss is the ultimate “fix” to pain.
What if you are in pain and can’t lose weight because it hurts to move? This is an extremely common question that comes up in physical therapy. Weight loss occurs through altering your nutrition and your physical activity levels. Doing both are best. Most people assume that you need to significantly increase your activity levels to lose weight, but that’s untrue. Nutrition plays the biggest role in weight loss in a lot of cases.
You don’t have to lose weight to reduce your pain, but it could help. There are many methods of reducing pain. However, if you know you are overweight and if you are unhappy about your weight, you may be ready for it. The key is that you want to stay body positive. Body positivity is the concept of accepting your body regardless of its appearance. If you think you want to lose weight, make sure you have a body-positive mindset.
At Whole Body Health Physical Therapy, we know that everyone comes in different shapes and sizes and that pain is multi-factorial which means that there are many contributing factors, not just weight. Body positivity comes first and foremost. You can learn to love the body that you have and rehabilitate it in a healthy way. If you do want to lose weight or have been trying and can’t, we will support you with where you are and want to be. Key team healthcare players in Beth’s case could include her primary care, a physical therapist, a dietician, a personal trainer, and a mental health therapist.
Sources:
“Why Weight Matters When It Comes to Joint Pain.” Harvard Health, 11 Dec. 2019, https://www.health.harvard.edu/pain/why-weight-matters-when-it-comes-to-joint-pain.