Weight, smoking and your spine

This page looks at two things linked with back pain that people can sometimes change: body weight and smoking. Both can be hard to talk about. Weight and smoking are shaped by many things, including genes, health conditions, medicines, stress and nicotine addiction. Neither is a personal failing.

Support can come from your clinician, a registered dietitian, a physical therapist, a weight program or a quit-smoking counselor.

Most of this research is about low back pain. Much less is known about neck pain.

Body weight

People with higher body weight report more low back pain than others. They are also more likely to seek care for it and to have pain that lasts.

Researchers are not sure why. Ideas include more load on the spine and low-level inflammation linked with body fat, but none of these is proven.

The link may also run both ways. Back pain can make it harder to be active, which can affect weight.

Smoking

People who smoke, and people who used to smoke, report more low back pain than people who never smoked. The link is modest, and it is stronger for current smokers.

Researchers think smoking may reduce the flow of oxygen and nutrients into the spinal discs. In one study of identical twins, the twin who smoked tended to have more disc wear on MRI scans. Disc wear also shows up on scans of many people who have no back pain, so this is only part of the story.

Smoking also slows bone healing. In studies, people who smoked were more likely than nonsmokers to have a broken bone or a spinal fusion heal slowly or not at all. This is one reason surgeons often ask people to stop smoking before spine surgery.

Body weight

Slow, steady changes in eating and activity tend to be easier to keep up than big, sudden ones.

US preventive care experts advise clinicians to offer adults with a body mass index (BMI) of 30 or more an intensive program that combines healthy eating, activity and coaching.

A registered dietitian can help build an eating plan that fits your health, your tastes and your budget.

For some people, a clinician may discuss prescription medicines for weight, used along with changes in eating and activity.

Exercise can ease long-lasting low back pain on its own, whether or not your weight changes. A physical therapist can help find ways to move that feel comfortable.

Smoking

Quitting often takes more than one try. That is common and does not mean failure.

Help makes quitting more likely to succeed. Counseling and approved quit-smoking medicines each help, and they can be used together.

Quit-smoking medicines include nicotine replacement, such as patches, gum and lozenges, and prescription medicines. Your clinician can talk through which might fit you.

In the US, you can call 1-800-784-8669 (1-800-Quit-Now) for free coaching through your state’s quitline, or visit smokefree.gov (opens in a new tab).

Body weight

It is not yet clear whether losing weight eases back pain.

In one trial of 160 adults with long-lasting low back pain and higher body weight, six months of phone coaching on healthy eating and activity did not reduce back pain compared with usual care. The coaching also did not change the habits it targeted.

Some studies that followed people after large weight loss, mostly after weight-loss surgery, found their back pain improved. These studies had no comparison group, so they cannot show how much the weight loss itself helped.

Weight loss can bring other health benefits, such as a lower chance of type 2 diabetes for people at risk.

Smoking

In one large study of more than 5,000 people getting care for spine pain, those who quit smoking during their care reported more improvement in pain than those who kept smoking. This kind of study cannot prove that quitting caused the improvement, because people who quit may differ in other ways.

Quitting also brings big benefits for the rest of the body. Smoking is the leading preventable cause of disease, disability and death in the US.

Vaping and other nicotine products have been studied much less. Early research raises concerns about bone and wound healing, but it is too soon to say how they affect the spine.

US preventive care experts found too little evidence to say whether e-cigarettes help adults quit smoking. They point people to quit methods with proven benefit.

Body weight

• Progress is often slow, and lost weight can come back. Setbacks are common and are not a failure.
• Very low calorie “crash” diets can cause problems. In one large study, people on a very low calorie diet had a higher chance of gallstones needing hospital care, though the overall chance was still low.
• Weight-loss medicines can have side effects and costs, and they are often meant to be taken long term.
• Weight stigma, meaning unfair judgment about body size, is common, including in health care. It can harm health and make people less likely to get good care. You deserve respectful care. If a visit feels judgmental, it is fair to say so or to ask to see someone else.

Smoking

• Nicotine withdrawal can bring cravings, irritability, anxiety, restlessness, and trouble concentrating or sleeping. These feelings usually peak in the first week and fade over 2 to 4 weeks.
• Some weight gain is common after quitting, often in the first few months. The amount varies widely, and some people lose weight. Your care team can help you plan for appetite changes and concerns about weight while you work toward quitting. ^[15]
• Quit-smoking medicines can have side effects. Your clinician or pharmacist can explain what to watch for.
• Tell your care team if low mood or anxiety after quitting feels severe or does not ease. If you have thoughts of harming yourself, call or text 988, the Suicide and Crisis Lifeline in the US, or call 911 right away.