Effect of Obesity on the Development, Management, and Outcomes of Spinal Disorders

Deeptee Jain, MD; Sigurd Berven, MD


J Am Acad Orthop Surg. 2019;27(11):e499-e506. 

In This Article

Abstract and Introduction


Obesity is a major public health issue in the United States, and rates of obesity continue to increase across the population. The association of obesity with degenerative spinal pathology underlies the observation that a substantial number of patients undergoing spine surgery are either overweight or obese. Obesity is a notable independent risk factor for both surgical and medical complications in the perioperative period and an important consideration in preoperative planning, intraoperative strategies, and postoperative management. Despite these increased risks, surgery in obese patients for a variety of degenerative conditions results in improvement in outcomes. Although obese patients may undergo gains that are absolutely lower than their nonobese counterparts, they still experience a positive treatment effect with surgery appropriate for their condition. An evidence-based approach to both preoperative and perioperative management of patients with obesity is not well established. The purpose of this article is to review the effect of obesity on the development, management, and outcomes of patients with spinal disorders and to provide data that may guide an evidence-based approach to care in this expanding patient population.


Obesity is defined by the World Health Organization[1] as body mass index greater than 30 kg/m2 and is subdivided into classes I, II, and III as body mass index (BMI) between 30 to 34.99, 35 to 39.99, and >40 kg/m2, respectively. Obesity has become a prevalent comorbidity in many parts of the world, and rates of obesity have substantially increased over the past few decades, affecting an estimated 35% of the US population, approximately 78 million people[2] (Figure 1). Not only does this problem have tremendous health consequences but also presents a substantial financial burden to our healthcare economy. The annual estimated medical spending attributable to obesity and obesity-related complications is 147 billion dollars.[3] Hospital stays related to a primary diagnosis of obesity have been increasing, accounting for more than 9% of all stays in 2009[4] (Figure 2). The cost consequences of general neck and back complications independent of obesity are also impressive, with 90 billion dollars spent in medical costs annually, not including an estimated 10 to 20 billion dollars lost in productivity.[5] In combination, obesity and spinal disorders present a major burden on our healthcare economy and present an important priority to our healthcare system.

Figure 1.

Graph showing trends in adult overweight, obesity, and extreme obesity among men and women aged 20 to 74 years: United States, 1960 to 1962 through 2013 to 2014. Overweight is body mass index (BMI) greater than or equal to 25 kg/m2 but less than 30 kg/m2; obesity is BMI greater than or equal to 30 kg/m2 but less than 40 kg/m2; and extreme obesity is BMI greater than or equal to 40 kg/m2. Pregnant women were excluded from the analysis. Sources: NCHS, National Health Examination Survey, and National Health and Nutrition Examination Surveys.

Figure 2.

Trend line chart showing hospital stays with obesity as a principal or secondary diagnosis, 1996 to 2009. Discharges with obesity as a principal diagnosis trended upward slightly from 1996 through 2009, leveling out in 2008 and 2009 at just more than 100,000 discharges. Discharges with obesity as a secondary diagnosis trended upward at a much faster rate, beginning in 1996 at approximately 750,000 and continuing upward at 2,750,000 in 2009. Sources: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, and Nationwide Inpatient Sample, 1996 to 2009.