Background/Purpose: Low back pain and obesity are both major public health problems.  Known risk factors for back pain include age, female gender, lower educational attainment, strenuous physical activity and mood disorders. Obesity has also been linked with low back pain with recent studies reporting an association between increased fat but not lean tissue mass and back pain.  However, these studies predominantly examined women.  The relationship between body composition and low back pain in men is unknown. Therefore, the aim of this study was to examine the relationship between body composition and low back pain and disability in a population-based sample of men. 

Methods: 978 male participants from the Geelong Osteoporosis Study, which is a population-based Australian study designed to investigate the epidemiology of osteoporosis among adults, were invited to participate in a follow up study in 2006. Participants completed questionnaires on sociodemographics and health status. Low back pain was determined using the validated Chronic Back Pain Grade Questionnaire and the presence of mood disorders was assessed using the Hospital Anxiety Depression Scale. Body composition was measured using dual energy x-ray absorptiometry. Binary logistic regression and estimated marginal means were used to examine the relationships between obesity measures and body composition in participants with high intensity pain and disability compared to those with no or low pain and disability. Multivariate analyses included adjustments for age, mood disorder, education, mobility and body mass index (BMI). To examine the multivariate associations between body composition and back pain, adjustment was also made for the alternate body composition measure. Interactions between risk factors for low back pain and measures of obesity, including measures of body composition were also examined.

Results: Of the 820 respondents (84% response rate), 124 (15%) had high intensity low back pain and/or disability.  Participants with high intensity pain and/or disability were older, more likely to have a mood disorder, less likely to have completed secondary school and more likely to have poor mobility than those with no or low back pain and disability (p<0.002 for all). Low back pain was associated with higher BMI (28.7±0.4 vs 27.3±0.2 kg/m², p=0.02) and waist-hip ratio (0.97±0.006 vs 0.96±0.006, p=0.04), with increased tendency towards having a higher fat mass index (8.0 vs 7.6 kg/m², p=0.08), but not fat-free mass index (p=0.68). The relationships between back pain and measures of obesity were stronger in those with a mood disorder, particularly for waist-hip ratio (p=0.05 for interaction) and fat mass index (p=0.06 for interaction).

Conclusion: In a population-based sample of men, high intensity low back pain and/or disability were associated with increased levels of obesity, particularly in those with mood disorders. This provides evidence to support a biopsychosocial interaction between mood disorders and obesity with low back pain.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-relationship-between-obesity-and-low-back-pain-and-disability-is-affected-by-mood-disorders-a-population-based-cross-sectional-study-of-men/