Edited by Dr. Enrico Paoletti
The prevalence of overweight is worryingly increasing: around the world there are about 300 million obese, including adults and children. According to data from the World Health Organization, in many European countries more than half of the adult population is above the "overweight" threshold and about 20-30% fall into the obese category.
Obesity is not a real pathology, but as such it must be addressed to avoid, or at least mitigate, the numerous complications it can cause; in fact, superfluous fat is one of the major risk factors for the development of many diseases. These include heart and respiratory diseases, non-insulin dependent diabetes mellitus or type 2 diabetes, hypertension, osteoarthritis in the load-bearing joints, neck pain, back pain and lumbosciatica, some forms of cancer and the risk of early death; furthermore, the negative influence on the quality of life and the onset of psychological disturbances linked to the sense of discomfort should not be forgotten.
The reasons that lead obese people to lose weight are therefore numerous, but according to scientific realities, lower back pain is not at the top of the list.
The importance of weight loss in the obese subject is certainly to be considered undoubted and physical activity is one of the best means to obtain lasting results over time and to favor a physiological change in the subject, with a strong positive impact on the health of the person himself.
Often, doctors and therapists inform their patients that obesity causes back pain and that this disorder can increase in proportion to the weight load. Some recommend that patients lose weight and argue that maintaining a normal weight can prevent future problems. to the column.
However, the etiology of many painful conditions of the lower spine remains still unknown; "Currently, identifying with some certainty the exact tissues involved in most cases of lower back pain is virtually impossible." What is certain is that the pathogenesis of lower back pain in the obese is largely linked to muscle tendon strains rather than to disc pain; tendon muscle it is observed above all in middle-aged people, overweight, who lead a sedentary lifestyle and who are continually subjected to stress resulting from work activities, the constant maintenance of incorrect postures, but also the accentuation of internal conflicts: in 30% of cases the painful condition depends on organic reasons, while in the remaining 70% the somatic aspect is secondary to the effects that emotional stress have on the central nervous system.
Lower back pain can include so-called nociceptive pain that comes from degenerating intervertebral joints, neuropathic pain due to compression of the spinal roots by osteophytes or disc herniation, dysregulatory pain due to a reflex hypertonicity of the back muscles and pain psychosomatic relating to the subject's inadequate adaptability; moreover, pain can arise suddenly, sharply, in relation to exertion or gradually.
In general, patients with ligamentous muscle pain in which there is an "evident mechanical component, report that the symptoms disappear with bed rest and are accentuated by standing or by increasing the load, while other patients with intervertebral disc disease may report a acute radiating pain in the legs especially when coughing and sneezing.
Obviously, a sedentary lifestyle and above all the increase in body weight are very important in the lumbago sufferer: it is now well known that obesity and / or overweight constitute an aggravating factor of these pathological conditions.
The existing epidemiological certainties denote a clear causal relationship between obesity and back pain, or rather between weight loss and the absence of this. There are controlled studies where it is certified that weight loss relieves back pain and reduces the number of relapses; however, there is very little belief that maintaining a normal weight prevents back pain.
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