Weight loss is perhaps the single most important contributor to long-term back pain relief.
We rarely if ever see a patient with chronic low back pain of non-traumatic origin that is not significantly overweight, and we have literally never had a patient who lost a significant amount of weight report that their weight loss did not positively impact their back pain.
Unfortunately, most people have a hard time losing weight and keeping it off for a significant amount of time. The explanations offered up by patients for there stubborn obesity are many, but there are two common explanations we hear more than all others combined. They tend to be versions of the following:
- “I barely eat anything! My body is in starvation mode because I never eat; therefore I cannot lose any weight.”
- “I cannot exercise because my back hurts so bad, therefore I cannot lose any weight!”
Both of these excuses, frankly, are bologna.
The Starvation Mode Myth
Study after study has demonstrated that humans never enter a so-called “starvation mode” wherein their body stubbornly hangs on to body fat upon encountering periods of calorie restriction. In fact, all the research points to a slow down in basal metabolic rate (BMR) but never does that declining BMR result in a situation wherein one is unable to lose weight, especially over the short term (<3 weeks). If an individual is exposed to a very low-calorie diet (VLCD) of less than 800 calories per day for months on end, then they will, in fact, see their BMR be lower than an individual who is at the same weight but eating normally. However, upon restoring calorie intake to levels above 800 calories per day, those individuals rapidly mimic their peers’ BMR.
Bottom Line: If you stay at or above 1200 calories per day, you will NEVER enter a so-called starvation mode.
The Exercise-Weight Loss Myth
Yes, exercise does burn calories and therefore two identical people will lose weight at different rates if one exercises and the other does not.
However, the one that does not exercise will still lose weight!
We all must burn 3500 calories more than we eat to lose one pound. So in order to lose two pounds per week, we must have a weekly calorie deficit of 7000 calories or a daily deficit of 1000 calories. For example, if my daily BMR is 2400 calories and I eat 1400 calories daily, I will, in fact, lose 2 pounds weekly regardless of how much or how little we exercise!
The benefit of exercise is that we can eat more calories and still lose the same weight or we can maintain our calorie intake and lose more weight over the same period of time. For example, suppose I go out and take a brisk walk every evening and using a heart rate monitor (this is the only real way to guesstimate calories expended during exercise and even this method has a wide margin of error) I find that my exercise accounts for 400 calories burned. Therefore, assuming I do this each and every day I will have burned an additional 2800 calories weekly. This deficit results in an additional 0.8 pounds of weight loss. Think about this: 45 minutes of vigorous cardiovascular exercise each and every day results in less than half the weight loss that a simple calorie reduction provides.
Bottom Line: You do NOT need to exercise AT ALL to lose a significant amount of weight! Exercise is great and should be done for fitness, but do not let your inability to perform exercise be an excuse to explain an inability to lose weight.
Solution: If you are struggling to lose weight, we guarantee your success if you simply count your calories. Diligently. Everything that enters your mouth, weight it and document it. Get OCD about it. And do not LIE or cover up your food intake — if you really are honest with yourself in your food diary what you will find is that you are likely eating MUCH more than you realize. The reality is that long-term obesity is rarely just a physics problem but instead more of a spiritual problem.
Your back will thank you!