Obesity and overweight as risk factors for low back pain in children and adolescents: a meta-analysis

Background Childhood obesity and overweight are associated with musculoskeletal pain, but the association between low back pain (LBP) and overweight/obesity in this population needs clarification. The objective of this meta-analysis is to ascertain the relationship between LBP and obesity/overweight in children and adolescents. Methods Various databases and specialized journals were queried from inception to October 2022. Encompassed were all studies examining the association between overweight or obesity and LBP among participants aged 6 to 18 years. The ROBINS-E tool was employed to assess bias. Random-effects models were used to pool results across studies, with location-scale models used to search for moderator variables where evidence of heterogeneity was found. Results In total, 34 studies were incorporated. Four studies had a low risk of bias, while the remaining studies had some concerns. Nine studies evinced an association between overweight and LBP, in contrast to normal weight, yielding an OR of 1.13 (95% CI 1.10–1.16) and no heterogeneity. Eight studies demonstrated a similar association between obesity and LBP compared to normal weight, with an OR of 1.27 (95% CI 1.20–1.34) and no heterogeneity. Ten studies established an association between overweight/obesity and LBP compared to normal weight, yielding an OR of 1.18 (95% CI 1.14–1.23) and no heterogeneity. Finally, nineteen studies showcased an association between body mass index (BMI) and LBP, with an OR of 1.19 (95% CI 1.03–1.39) with evidence of heterogeneity. For this last analysis, we compared the mean BMI in groups and transformed results to log OR, and then retransformed to OR. Conclusion Overweight and obesity may be risk factors for LBP in children and adolescents. The association between LBP and obesity appears to be stronger than with overweight. However, the analysis revealed considerable heterogeneity and risk of bias across studies.