Weighing the Facts: BMI and Joint Pain
- Elizabeth Wells
- Nov 19, 2024
- 12 min read
On a daily basis I hear people say that if they could just lose some weight their joint pain would go away. Is this true? Is there a relationship between body weight and joint health? Or is this self-talk derived from body-shaming culture, constantly making us feel guilty about our weight? Let's find out if being overweight really affects musculoskeletal health or not.
Article Overview:
Is being overweight bad for your knees?
Does obesity make your bones weak and more likely to break?
Does being overweight cause back pain?
Your weight can't affect your posture, can it?
Is extra weight on the joints the only thing causing the joint pain?
Does obesity affect tendons and muscles, too?
Does obesity increase the risk of low back injury?
Can attaining a healthy BMI improve joint pain?
Building a positive body image while striving for better health
Is being overweight bad for your knees?
Yes.
Osteoarthritis is also called "wear and tear arthritis". Physical stress on the joints leads them to wear down over time. Studies show that being overweight does in fact contribute to this stress, especially when it comes to your knees. Individuals with obesity have a 1.5 to 2 times higher risk of developing knee osteoarthritis (Felson et al., 1988).
Obesity isn't great for the menisci of the knee either. The risk of tearing a meniscus increases by approximately 25% for every 5-point increase in BMI above normal range (Snoeker et al., 2013).
Does obesity make your bones weak and more likely to break?
No.
Higher body weight is associated with greater bone mineral density, potentially providing some protection against certain types of fractures. Obesity can be protective against osteoporosis and osteopenia (De Laet et al., 2005). This is more applicable for weight-bearing bones, like the back and legs, and less true for non weight- bearing bones like the hands and arms.
Does being overweight cause back pain?
Yes and no.
We can't say being overweight causes back pain. Lots of factors like genetics, lifestyle and physical activity play a role in whether or not someone has back pain. We can't assign the blame to one factor alone. What we can say is that you are far more likely to experience back pain if you are overweight or obese. Here is what we know:
Chronic low back pain: There is an association between obesity and increased risk of chronic low back pain (Shiri et al., 2010). Obesity increases the risk of chronic low back pain by 2.9 times, proportionally with an increased BMI (Shiri et al., 2019)
Disc degeneration: Individuals with obesity have a 2.4-fold increased risk of lumbar disc degeneration compared to those with normal weight. Obesity can increase pressure on the discs by up to 73% during standing and walking activities.
Facet joint arthritis: Facets are a type of joint located on spinal bones. Obesity increased risk of facet joint arthritis by 2.2 times (Suri et al., 2015)
Research also demonstrates that individuals with obesity and low back pain experience greater functional limitations, longer recovery times, and higher rates of work disability compared to normal-weight individuals. (Vincent et al., 2012)
Your weight can't affect your posture, can it?
Yes, it can.
Obesity affects joint loading patterns. It changes how your body executes movement and consequently affects the stress these movements have on your joints. This has been shown to alter posture and gait (walking patterns) through the entire kinetic chain (Hills et al., 2002).
You may recognize the word "kinetic" which is similar to "kinesiology". It comes from the root word "kinesis," meaning "movement". Think of your kinetic chain as the chain of movement that occur in your body whenever move. Your foot bone is connected to your neck/back/shoulder/arm/pinky bone, as the saying goes.
For example, if you sprain your ankle, you'll have to change how you walk. Your low back and subsequently your upper back and neck may begin to hurt from compensating for the change in your gait. Obesity has a similar effect. The added weight alters the initial movement, which then subsequently affects all other corresponding movements as it goes through the kinetic chain.
What does this have to do with posture? Over time our muscles learn a certain pattern of activation, firing and resting tone. As they become more reinforced over time, these patterns start to show up in our structural systems as well - in our skeleton and in our posture. Changes in spinal alignment and increased thoracic kyphosis (that upper back "hump") have been documented in individuals with obesity. Also documented is increased lumbar curvature, which increases the stress on the joints of the low back (Vismara et al., 2010).
And as a side note, obesity may indirectly increase the risk of ankle and upper arm fractures due to altered body mechanics and fall patterns (Compston et al., 2011).
Is extra weight on the joints the only thing causing the joint pain?
Nope, there's more.
Obesity-related metabolic syndrome affects cartilage metabolism in all joints (Thijssen et al., 2015). Cartilage has a tough job. It keeps your bones from rubbing against each other and keeps joints moving smoothly. As we move throughout the day, cartilage is worn down. It needs proper nutritional support in order to continually regenerate and stay healthy. Insulin resistance associated with obesity impairs joint tissue repair mechanisms, including cartilage repair. (Berenbaum et al., 2013).
Another factor that can contribute to joint pain is the systemic effects of excess weight through inflammatory chemicals. Cytokines are released from adipose (fat) cells and create inflammation throughout the entire body. Studies show that IL-6, an inflammatory marker, is increased in people with obesity.(Peltonen et al., 2003).
Does obesity affect tendons and muscles, too?
Yes.
Tendons
A tendon is a type of soft tissue that securely attaches bones and muscles together. Tendiopathy is a condition where a tendon has become weakened and dysfunctional. Obese individuals are 2.6 times higher risk of tendinopathy, particularly in load-bearing tendons (Gaida et al., 2009) The Achilles tendon, in the back of the heel, is the most vulnerable to this.
Studies show that obesity is correlated with an increased thickness and disorganized collagen patterns. (Abate et al., 2014) This alters the integrity of the tendon, leads to reduced tendon strength, and impaired collagen synthesis (Fearon et al., 2017).
And as we talked about with the kinetic chain, modified tendon strain patterns increase injury risk (Scott et al., 2015)
Muscles
Studies show that an increase in adipose tissue creates increased intramuscular fat infiltration. This infiltration reduces muscle function (Rahemi et al., 2015) Obese individuals have been found to have decreased muscle fiber density and quality (Tomlinson et al., 2016). While this may just be a symptom of an inactive lifestyles, other studies have shown that obesity causes impaired muscle protein synthesis and recovery (Akhmedov & Berdeaux, 2013). This means even with healthy stress and activation of the muscles (think, exercise), an increased BMI will hamper the muscles ability to recover and ultimately slow down progress towards muscle strengthening.
Fascia
Fascia has mainly been shown to be affected by obesity through altered fascial sliding mechanics affecting movement patterns (Langevin et al., 2018). Again, we can refer back to the kinetic chain. Changes in movement patterns in fascia will affects muscles, joints, and overall health of the musculoskeletal system.
Does Obesity Increase the Risk of Low Back Injury?
No, but...
In a study of over 7000 participants, no significant increase in acute low back pain episodes were found in individuals with obesity. However, when acute injuries occurred, recovery time was 71% longer (Knox et al., 2014)
Muscle strains were found to have no significant increase in incidence when BMI was considered, but 2.1 times higher risk of recurrence and delayed healing times in obese individuals. (Korpinen et al., 2013)
The incidence of ligament sprains were similar to that of muscle strains. There was no significant increase of incidence of sprains in individuals with obesity. However, individuals with obesity experienced a higher risk of having a more severe sprain and a 2.3 times greater risk of developing chronic symptoms after an acute sprain. (Brooks et al., 2016)
Disc herniations are the exception. They are 12% more likely to occur in obese individuals due to the increased pressure on the discs. It is also 35% more likely these individuals will require surgery because the increase disc pressure will make it more difficult for the disc to heal on its own. (Shiri et al., 2014)
Can attaining a healthy BMI improve joint pain?
Yes.
Multiple studies have shown that a 10% weight loss in obese individuals can:
Reduce low back pain intensity by 83%
Reduce knee pain among adults with knee osteoarthritis by 50% (Christensen et al., 2007).
Improve functional capacity by 61%
Reduce need for pain medication (Vincent et al., 2012)
Create improvements in tendon pain and function (Wearing et al., 2013).
Building A Positive Body Image While Striving for Better Health
While this article discusses the impacts of weight on joint health, it's crucial to approach weight management in a healthy, balanced way that considers both physical and mental well-being.
Understanding Healthy Weight Ranges
Research shows that being underweight can have detrimental impacts on all the systems and organs in the body. Be sure to calculate what a healthy BMI is for you, and do not attempt to lower your body weight farther than it's healthy range.
Understanding Healthy Weight Loss
Be very wary of fads and trends promising you that you can lose weight quickly and with minimal effort. You should be extremely skeptical of any diets or exercise regimens that appear extreme or unusual. Losing weight safely means exercising in moderation and eating in a caloric deficit, but not lower than you BMR, basal metabolic rate. We are not starving ourselves here. If you start losing hair, getting cavities, getting sick more easily, often feel tired or lightheaded, or overall start feeling poorly, that is a serious red flag that you are not following a healthy, sustainable plan.
Warning Signs to Seek Help
If you experience any of the following, please pause any weight loss efforts and seek professional help:
Obsessive thoughts about weight, food, or body image
Anxiety or distress around eating or weight management
Compulsive exercise behaviors
Restrictive eating patterns
Feelings of loss of control around food
Body image distortions
Using weight loss methods that feel unsafe or extreme
Professional Support
Supervision by a Healthcare Provider
Work with healthcare providers to develop appropriate, individualized goals
Regular monitoring of physical and mental health
Safe, sustainable approaches to weight management
Mental Health Support
Eating disorder specialists and mental health professionals can help
Address underlying psychological factors
Develop healthy coping mechanisms
Create balanced approaches to health and wellness
Treatment of co-existing conditions like anxiety or depression (Bulik et al., 2012)
Conclusion
As we can see, obesity has quite an effect on joint health, joint pain, recovery from injury, and metabolic health. My aim was to provide you with the facts to replace this mystical belief that if we were just skinnier, stronger, more toned, etc then all our problems would be solved. If you are considered obese in BMI, then losing weight may help you feel better and move better, but please give yourself some compassion and treat your body with the respect it deserves. If you do decide to embark on a lifestyle change do it slowly and within your current capabilities. Use professional guidance if you need to. Don't push yourself to do it faster than is healthy and stay away from gimmicky sales pitches. Your body is very adaptable and can do amazing things, but you have to take care of it if you want to get the most from it over the course of your life.
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