Bariatric Surgery Instead of Spinal Surgery?

I saw a patient recently in clinic who came in for back and leg pain.  He was a very kind gentleman, who in the few years since his retirement, had put on a significant amount of weight.  While he was once quite healthy, by body mass index (BMI) calculations he is now classified as morbidly obese: BMI over 40.

There’s an old saying that spine surgeons use with their patients: “the problem with your back is your front.”  In other words, the patient’s obesity is the root cause of their back pain. This isn’t just anectodotal, several studies in the literature have confirmed the link between low back pain and obesity.

The rate of obesity in the United States has doubled since 1980 and now over 35% of US adults are obese (for this and other depressing stats see:  As the rate of obesity increases, bariatric surgery (i.e. gastric bypass, banding, etc.) has become a useful tool for patients who cannot lose weight with diet and exercise alone.  The dramatic weight loss seen in patients after bariatric surgery reverses many of the medical conditions associated with obesity: high cholesterol, diabetes, high blood pressure, etc.  In addition, recent studies have shown dramatic decreases in back pain and leg pain in patients who had bariatric surgery (see figure).    

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Figure: graph demonstrating the decrease in back and leg pain after bariatric surgery.  In this study patients lost an average of 40kg and decreased their BMI from 42.8 to 29.7 after bariatric surgery.  Source: Lidar et al, Spine 37(23):1947-1952, 2012.

As a minimally-invasive spine surgeon I embrace the term “minimally-invasive” as an overall philosophy, that is I think that the least invasive surgery is no surgery at all.  I’d be willing to bet that many of the patients in these studies, after they lost 50, 60 even 100 pounds after bariatric surgery, never required spine surgery!

I commend my patient on being able to see the big picture and how it is affecting his overall health.  I’ve had the same discussion with other patients who don’t want to face the facts and in some cases even get offended because they think I’m calling them fat.  This patient enthusiastically accepted my advise, is on his way to see a bariatric surgeon and surely is going to do very well. Who knows, if he is successful at his weight loss plan I may never see him in my office again.  And that would be a great thing for him.  

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