Original articlesBack pain and obesity in the 1958 British birth cohort: cause or effect?
Introduction
Back pain is particularly common in early adulthood, with 34% of 25–34 year olds in Britain reporting low back pain, 9% with onset in the last 12 months [1]. Between 1991 and 1992, 8% of British 25–44 year olds consulted their GP about back pain [2]. In Canada, 6% of 25–34 year olds were identified as having a long-term back problem [3]. Several risk factors have been documented, including occupational factors, postural and heavy manual work 3, 4, 5, tall stature [6], smoking 3, 4, 7, and psychological factors such as depression [8]. Elevated risk of back pain has also been observed in relation to obesity, especially among women 3, 4, 7, 9, 10. Some studies suggest a positive linear trend of back pain risk and adiposity 4, 7, while others show that the risk is confined to those at the extreme of the BMI distribution (upper fifth of obesity) [10]. One study found the overweight to have a higher mean low back pain symptoms score than those of normal weight, but they did not have a significantly higher risk of lumbosacral disorder [11].
A major shortcoming of work to date is that few studies have been able to establish the direction underlying any association between back pain and adiposity. Garrow [12] recognized that the association could reflect different processes, given that back pain may lead to a reduction in physical activity, and thence to increased adiposity, that is, obesity could be a consequence of back pain. Alternatively, obesity could increase the mechanical load on the spine, thereby increasing the risk of back pain (i.e., obesity could play a causal role). Because most studies are cross-sectional, there is scant evidence on the relative importance of these different processes. There are, to our knowledge, few longitudinal studies investigating whether back pain is associated with increased adiposity. Aro and Leino [11] examined the temporal relationship between change in low back pain symptoms score and weight change over a 10-year period, but found no association. They also found no relationship between incident lumbosacral disorder over the 10-year period and relative weight [11]. Given the paucity of longitudinal evidence, we sought to clarify the causal direction of the association between obesity and back pain, using longitudinal data from the 1958 British birth cohort study. We examine (a) whether back pain is associated with greater weight gain in early adulthood, and (b) whether adiposity in childhood and early adulthood influences the risk of subsequent back pain. We expect that if adiposity is a consequence of back pain, weight gain over a 10-year period in early adulthood will be greatest among those with preexisting back problems. Conversely, if adiposity influences the likelihood of back pain, we expect that obesity will increase the risk of subsequent pain onset.
Section snippets
Sample
The 1958 birth cohort study includes all children born in Scotland, Wales, and England, between the 3 and 9 March 1958 [13]. From a target population of 17,733 births, information was obtained on 98%. Major follow-ups of surviving children were conducted at ages 7, 11, 16, 23, and 33 [14]. Immigrants to Britain born during the same week in 1958 were included into the survey at ages 7, 11, and 16. At age 33 11,407 subjects (73% of the target population) provided information. Sample attrition has
Results
Eleven percent of men and 14% of women were identified as having chronic back pain, 27% and 21%, respectively, had incident pain in the 10 years between ages 23 and 33, about a quarter of whom had pain with onset in the 12 months preceding the survey (Table 2). The five back pain groups were compared with respect to their mean weight increase over the 10 years between ages 23 and 33 (Table 3). No significant relationship was found for men, but among women weight gain differed significantly
Discussion
Our study suggests, first, that back pain is associated with weight gain in early adulthood, with particularly marked increases among those with chronic pain. This was significant for women, among whom the greater weight increase of those with chronic pain was due, in part, to their heavier weight initially at age 23. Second, the study suggests that obesity in early adulthood increases the risk of back pain onset among women, with an estimated 47% to 78% excess risk (for 10- and 1-year
Acknowledgements
Data acknowledgement: Centre for Longitudinal Studies, Institute of Education, National Child Development Study Composite File including selected Perinatal Data and sweeps one to five (computer file). National Birthday Trust Fund, National Children's Bureau, City University Social Statistics Research Unit (original data producers). Colchester Essex: The Data Archive (distributor). Sources of support: UK Department of Health/ Medical Research Council Nutrition Initiative and Institute for Work
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