Advising a patient to lose weight can be an emotional time bomb - is it justified? Unfortunately this advice does not get clear support in scientific studies. Epidemiological studies on the relationship between low back pain and weight gain are inconclusive. The relationship does however have strong theoretical support. Perhaps the relationship is yet to be found but does exist, confounded by many variables. This is despite increasing weight gain and obesity in many industrialised countries.
Honesty is always the best policy. We should inform patients that there is no conclusive evidence that losing the beer belly will have any impact on low back pain and that their spine will not collapse under the load of the belly. But a return to healthy exercise is clearly beneficial for patients with low back pain. And they may reduce weight as well.
Reference
Leboeuf-Yde C, Body Weight and low back pain. Spine 2000: 25(2)
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