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Pain Management
Weight Management
A surgeon's perspective on weight and the spine — an honest, non-judgemental account of how body weight affects back pain and surgical risk, and where support comes from.
This is a topic that has to be handled with honesty and without judgement, and that is how I try to approach it. Body weight has a genuine effect both on spinal pain and on the safety and success of spinal surgery, so it is a legitimate and important part of the conversation. At the same time, I am a spinal surgeon, not a weight-management or dietetic specialist, and the support to lose weight is provided by GPs, dietitians and specialist services — not by me. My role is to explain the relevance clearly and kindly, and to help people access the right support. This page explains, from a surgeon's viewpoint, why weight matters and where help comes from.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
How weight affects the spine and back pain
Carrying excess weight increases the mechanical load on the spine and is associated, in the evidence, with a higher likelihood of low back pain — both having it and it becoming persistent. This is not the whole story of anyone's back pain, and it is never a reason for blame, but it is a factor that can be modified, which makes it worth discussing. For some people, weight loss is one of several things that genuinely helps their symptoms and their overall health, alongside activity and physiotherapy.
Why weight matters for surgery
Where surgery is being considered, weight becomes relevant for a different reason: it affects the risks and the technical demands of an operation. Higher body weight is associated, in the surgical literature, with longer operating times, greater blood loss, higher rates of wound and other complications, and, in some studies, higher reoperation rates. This does not mean surgery cannot be done — it very often can, and minimally invasive approaches can reduce some of these risks — but it does mean that, where there is time before a planned operation, working on weight can improve safety. This is part of honest preoperative counselling.
How support is provided
Because weight management is complex and personal, effective support comes from the right services rather than from a surgeon's advice alone. GPs, dietitians, specialist weight-management services and, increasingly, medical and surgical weight-loss options provide structured help. My part is to explain, without judgement, why weight is relevant to the person's back or their surgery, and to help them access that support where they wish to. I regard this as offering a factual, modifiable opportunity — not as a barrier or a criticism.
What the evidence shows
The evidence links weight to both back pain and surgical outcomes. Meta-analyses find that obesity is associated with a higher prevalence and incidence of low back pain and of chronic low back pain. In the surgical literature, meta-analyses and systematic reviews report that obesity is associated with longer operative times, greater blood loss, higher surgical-site infection and complication rates, and worse outcomes after spine surgery, while noting that minimally invasive techniques can mitigate some of this risk. This evidence is why weight is a legitimate part of the conversation, framed as a modifiable opportunity.
What to expect
Where relevant, I will raise weight honestly and supportively and help direct people to the appropriate services; the weight-management support itself is provided by GPs, dietitians and specialist teams over time. For anyone facing planned surgery, the period beforehand can be a useful window to work on this alongside the wider preparation, though decisions about surgery are always individualised and are never withheld solely on this basis without careful discussion.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Mr Madi is a spinal surgeon; weight management is supported by GPs, dietitians and specialist weight-management services. Every patient is different, and treatment options, risks and outcomes depend upon an individual's diagnosis, general health and personal circumstances. Decisions regarding weight management and surgery should always be made following consultation with your treating spinal surgeon, GP, dietitian or healthcare professional.
Evidence & further reading
- —Shiri R, et al. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol 2010. (PMID 20007994)
- —Obesity as a risk factor for low back pain: a meta-analysis. (PMID 27875413)
- —Jiang J, et al. Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop Relat Res 2014. (PMID 23851765)
- —Abdallah DY, et al. Body mass index and risk of surgical site infection following spine surgery: a meta-analysis. Eur Spine J 2013. (PMID 23828507)
- —Impact of obesity on outcomes following lumbar spine surgery: systematic review and meta-analysis. J Clin Neurosci 2019. (PMID 30583093)
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Personalised, consultant-led advice
Every patient is different. The information on this page is a starting point — Mr Madi will tailor any plan to your specific imaging, symptoms and goals.