Weight Loss -- Does It Really Ease the Severity of Low Back Pain?Patients with low back pain who are overweight or obese are often advised to lose weight. But is there any evidence that weight loss is linked with reduction of back pain? In other words, is it worth all the calorie restriction, exercise, meal replacement, and group therapy needed to accomplish the goal?
That's what this pilot study was designed to find out. They used a medically supervised nonsurgical weight loss program and studied change in back pain. A group of 46 obese adults with mild-to-severe back pain and moderate-to-severe loss of function participated in the study.
Everyone followed a diet and exercise plan for a full year. The first 12 weeks involved a liquid meal program followed by another 13 weeks of reduced food intake. Throughout the first six months, everyone attended group therapy and educational meetings. Physical activity and exercise were a daily requirement (60 to 90 minutes).
Various aspects of the program were supervised by a variety of different health care professionals. This multidisciplinary team was made up of nurses, dieticians, physicians, and exercise specialists.
Before and after results were measured in three main ways: weight loss, pain intensity, and function. Weight loss is easy to measure with a scale. Pain is more of a subjective phenomenon so it can't be measured directly. A pain scale called the numeric pain scale (NPS) was used in which patients rate their pain from zero (no pain) to 10 (worst pain).
A valid and reliable tool called the Oswestry Disability Index (ODI) was used to measure change in function. The ODI measures pain and level of physical activity at work and during leisure time. It is a self-report questionnaire, which relies on the patient to complete it either directly or over the phone with someone else asking the questions and taking down the answers.
After 14 weeks, 98 per cent of the group had lost a significant amount of body weight. Half the group reported major pain relief. Function improved for almost three-fourths of the group (73 per cent). But only one-third of the group who lost weight was able to maintain that throughout the rest of the study.
Those who did lose weight and kept it off had the greatest amount of back pain relief. But this study did not evaluate whether the decrease in back pain could have been the result of the natural course of back pain (i.e., it gets better over time for many people without doing anything).
In summary, one-fourth of all adults in Canada and the United States are considered obese by medical standards. Studies have shown that obesity and low back pain go hand-in-hand together. But whether or not weight loss would reduce low back pain has not been clearly established.
This pilot (small) study did show a change in back pain but the program used did not involve just weight loss. There was also exercise, group support, individual attention, and behavioral changes as part of the whole package. Using a comprehensive program like this did yield some promising results.
More study is needed to find out if all parts combined are really required for change in back pain or if some individual components have a greater impact than others. The authors suggest a larger study with longer follow-up comparing different programs as the next step in this process of discovery around weight loss and low back pain.
Darren M. Roffey, PhD, et al. Pilot Evaluation of a Multidisciplinary, Medically Supervised, Nonsurgical Weight Loss Program on the Severity of Low Back Pain in Obese Adults. In The Spine Journal. March 2011. Vol. 11. No. 3. Pp. 197-201.
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