Overweight and Obesity As Risk Factors for Chronic Low Back Pain: a New Follow-up in the HUNT Study

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2024 Sep 28

PMID 39334024

Authors

Ingrid Heuch

Ivar Heuch

Knut Hagen

John-Anker Zwart

Affiliations

Soon will be listed here.

Abstract

Background: Numerous studies have examined associations between overweight and obesity and risk of low back pain (LBP), but the exact magnitude of these associations is not yet clear. The purpose of this work was to assess such sex-specific associations in a community-based setting in Norway, taking into account potential relationships with other risk factors.

Methods: A cohort study was conducted combining data from two waves of the Trøndelag Health Study, HUNT3 (2006-2008) and HUNT4 (2017-2019). Separate analyses were performed of risk of chronic LBP in HUNT4 among 14,775 individuals without chronic LBP in HUNT3, and of recurrence or persistence in HUNT4 among 5034 individuals with chronic LBP in HUNT3. Relative risks were estimated in generalised linear models for overweight and obesity compared to normal weight. Body size classification was based on values of BMI computed from measurements of height and weight. Chronic LBP was defined as LBP persisting at least 3 months during last year.

Results: After adjustment for age, smoking, physical activity in leisure time and work activity, analysis of risk among women produced relative risks 1.11 (95% CI 1.00-1.23) for overweight, 1.36 (95% CI 1.20-1.54) for obesity class I and 1.68 (95% CI 1.42-2.00) for obesity classes II-III. Relative risks among men were 1.10 (95% CI 0.94-1.28) for overweight, 1.36 (95% CI 1.13-1.63) for obesity class I and 1.02 (95% CI 0.70-1.50) for obesity classes II-III, the last estimate being based on relatively few individuals. Analyses of recurrence or persistence indicated similar relationships but with smaller magnitude of relative risks and no drop in risk among obesity classes II-III in men. The change in BMI from HUNT3 to HUNT4 hardly differed between individuals with and without chronic LBP in HUNT3.

Conclusions: Risk of chronic LBP increases with higher values of BMI in both sexes, although it is uncertain whether this applies to very obese men. Very obese women carry a particularly large risk. Probabilities of recurrence or persistence of chronic LBP among those already afflicted also increase with higher values of BMI. Adjustment for other factors does not influence relationships with overweight and obesity to any major extent.

Citing Articles

Low back pain trends attributable to high body mass index over the period 1990-2021 and projections up to 2036.

Zhang J, Wang B, Zou C, Wang T, Yang L, Zhou Y Front Nutr. 2025; 11:1521567.

PMID: 39906897 PMC: 11790459. DOI: 10.3389/fnut.2024.1521567.

References

Krokstad S, Langhammer A, Hveem K, Holmen T, Midthjell K, Stene T . Cohort Profile: the HUNT Study, Norway. Int J Epidemiol. 2012; 42(4):968-77. DOI: 10.1093/ije/dys095. View

Maher C, Underwood M, Buchbinder R . Non-specific low back pain. Lancet. 2016; 389(10070):736-747. DOI: 10.1016/S0140-6736(16)30970-9. View

Klesges R, Robinson L, Zbikowski S . Is smoking associated with lower body mass in adolescents? A large-scale biracial investigation. Addict Behav. 1998; 23(1):109-13. DOI: 10.1016/s0306-4603(97)00022-1. View

Hershkovich O, Friedlander A, Gordon B, Arzi H, Derazne E, Tzur D . Associations of body mass index and body height with low back pain in 829,791 adolescents. Am J Epidemiol. 2013; 178(4):603-9. DOI: 10.1093/aje/kwt019. View

Singer R, Stoutenberg M, Gellman M, Archer E, Davis S, Gotman N . Occupational Physical Activity and Body Mass Index: Results from the Hispanic Community Health Study/Study of Latinos. PLoS One. 2016; 11(3):e0152339. PMC: 4816339. DOI: 10.1371/journal.pone.0152339. View

Bae Y, Shin S, Kang H . Body mass index at baseline directly predicts new-onset diabetes and to a lesser extent incident cardio-cerebrovascular events, but has a J-shaped relationship to all-cause mortality. BMC Endocr Disord. 2022; 22(1):123. PMC: 9097180. DOI: 10.1186/s12902-022-01041-3. View

Leboeuf-Yde C . Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine (Phila Pa 1976). 2000; 25(2):226-37. DOI: 10.1097/00007632-200001150-00015. View

Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E . The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2009; 171(2):135-54. DOI: 10.1093/aje/kwp356. View

Foti K, Hardy S, Chang A, Selvin E, Coresh J, Muntner P . BMI and blood pressure control among United States adults with hypertension. J Hypertens. 2022; 40(4):741-748. PMC: 8897212. DOI: 10.1097/HJH.0000000000003072. View

10.

Janke E, Collins A, Kozak A . Overview of the relationship between pain and obesity: What do we know? Where do we go next?. J Rehabil Res Dev. 2007; 44(2):245-62. DOI: 10.1682/jrrd.2006.06.0060. View

11.

. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403):157-63. DOI: 10.1016/S0140-6736(03)15268-3. View

12.

Hjorthen S, Sund E, Skalicka V, Eikemo T, Getz L, Krokstad S . Trends in absolute and relative educational inequalities in health during times of labour market restructuring in coastal areas: The HUNT Study, Norway. Soc Sci Med. 2021; 292:114541. DOI: 10.1016/j.socscimed.2021.114541. View

13.

Funck-Brentano T, Nethander M, Moverare-Skrtic S, Richette P, Ohlsson C . Causal Factors for Knee, Hip, and Hand Osteoarthritis: A Mendelian Randomization Study in the UK Biobank. Arthritis Rheumatol. 2019; 71(10):1634-1641. PMC: 6790695. DOI: 10.1002/art.40928. View

14.

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 (Lausanne). 2021; 12:740200. PMC: 8692291. DOI: 10.3389/fendo.2021.740200. View

15.

Heuch I, Hagen K, Heuch I, Nygaard O, Zwart J . The impact of body mass index on the prevalence of low back pain: the HUNT study. Spine (Phila Pa 1976). 2010; 35(7):764-8. DOI: 10.1097/BRS.0b013e3181ba1531. View

16.

Myers S, Govindarajulu U, Joseph M, Landsbergis P . Work Characteristics, Body Mass Index, and Risk of Obesity: The National Quality of Work Life Survey. Ann Work Expo Health. 2020; 65(3):291-306. PMC: 8244120. DOI: 10.1093/annweh/wxaa098. View

17.

da Silva T, Mills K, Brown B, Herbert R, Maher C, Hancock M . Risk of Recurrence of Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther. 2017; 47(5):305-313. DOI: 10.2519/jospt.2017.7415. View

18.

Lake J, Power C, Cole T . Back pain and obesity in the 1958 British birth cohort. cause or effect?. J Clin Epidemiol. 2000; 53(3):245-50. DOI: 10.1016/s0895-4356(99)00155-9. View

19.

Lucha-Lopez M, Hidalgo-Garcia C, Monti-Ballano S, Marquez-Gonzalvo S, Ferrandez-Laliena L, Muller-Thyssen-Uriarte J . 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). PMC: 10452522. DOI: 10.3390/biomedicines11082175. View

20.

Oppert J, Bellicha A, Ciangura C . Physical activity in management of persons with obesity. Eur J Intern Med. 2021; 93:8-12. DOI: 10.1016/j.ejim.2021.04.028. View