Uncover the benefits of chiropractic care in addressing obesity and enhancing your wellness approach in your health.
Table of Contents
Introduction and Abstract
Obesity in older adults is much more than an issue involving body weight. As people age, they naturally experience changes in muscle mass, metabolism, bone density, balance, mobility, and body composition. When excess body fat is added to these age-related changes, the result can affect nearly every part of daily life.
One of the most overlooked consequences is obesity’s effect on the musculoskeletal system. Extra body weight places greater mechanical stress on the knees, hips, feet, pelvis, and spine. At the same time, excess adipose tissue can contribute to low-grade systemic inflammation that may influence joint symptoms and pain. Together, these factors can make walking, climbing stairs, exercising, sleeping comfortably, and completing ordinary activities more difficult (Binvignat et al., 2024).
Pain can then create another problem: less movement. When people move less because their back, knees, or hips hurt, they can lose muscle strength and physical conditioning. Reduced muscle strength can move harder and contribute to additional weight gain, balance problems, and loss of independence.
This creates an important clinical cycle:
Excess body fat ? increased joint stress and inflammation ? pain ? reduced movement ? muscle loss ? decreased function ? greater difficulty controlling weight.
Breaking this cycle usually requires more than one treatment. Nutrition, resistance exercise, aerobic activity, medical management, rehabilitation, sleep improvement, and appropriate nonsurgical musculoskeletal care can work together.
Chiropractic care may have a role for selected patients who also have mechanical back pain, joint stiffness, movement restrictions, or other musculoskeletal complaints. Chiropractic treatment does not treat obesity itself. Instead, it can be incorporated into a broader, coordinated treatment plan designed to reduce musculoskeletal symptoms, improve function, and help patients become more physically active when appropriate.
Obesity and Aging: Why Body Composition Matters
Aging changes the body even when the number on the scale does not change dramatically.
Muscle mass usually decreases with age. Bone density may decline. Metabolic rate can slow. Fat distribution also tends to shift toward the abdomen and internal organs. For this reason, an older adult can maintain roughly the same weight while gradually losing muscle and gaining fat.
This is one reason Body Mass Index, or BMI, does not tell the entire story.
An older adult may have an acceptable BMI but still carry excess abdominal fat and have inadequate muscle mass. Waist circumference, physical performance, strength testing, and body-composition measurements can provide additional information when evaluating health risks.
Obesity also remains common in later life. National Health and Nutrition Examination Survey data from August 2021 through August 2023 found that approximately 38.9% of U.S. adults age 60 and older had obesity (Emmerich et al., 2024).
The goal, therefore, should not simply be to lower the scale. In many older adults, a better goal is to improve the ratio between fat mass and functional lean tissue while maintaining strength, mobility, balance, and independence.
Sarcopenic Obesity: When Excess Fat and Muscle Loss Occur Together
One particularly important condition is sarcopenic obesity.
Sarcopenia involves reduced muscle strength, muscle quantity or quality, and physical performance. Sarcopenic obesity occurs when decreased muscle function exists alongside excessive body fat.
The European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity have emphasized the importance of identifying this combination because it can significantly affect physical function and patient-centered outcomes (Donini et al., 2022).
Sarcopenic obesity can be particularly challenging because excess body mass increases the amount of work required for movement while the muscles responsible for performing that work are becoming weaker.
A patient may notice difficulty getting out of a chair, walking across a parking lot, climbing stairs, carrying groceries, maintaining balance, or getting up from the floor.
Pain can make it even harder. A person with knee pain may stop walking. Someone with low-back pain may avoid exercise. Reduced activity then contributes to further muscle loss and deconditioning.
This is why treatment should focus on function as much as weight.
How Obesity Can Contribute to Musculoskeletal Pain
Obesity and musculoskeletal pain are connected through several pathways.
Increased Mechanical Loading
Everyday activities require joints to manage forces often several times greater than body weight.
Additional body mass can increase loading across the knees, hips, ankles, feet, and spine. Over time, this added mechanical stress can change joint mechanics and may aggravate symptoms in people with osteoarthritis.
Obesity is strongly associated with osteoarthritis, particularly knee osteoarthritis, but researchers increasingly understand that the relationship is more complicated than mechanical loading alone (Binvignat et al., 2024).
Inflammation and Joint Symptoms
Adipose tissue is biologically active.
Fat cells and surrounding immune cells can produce signaling molecules called adipokines and inflammatory mediators. Research suggests these processes may influence cartilage, synovial tissues, pain pathways, and other structures involved in osteoarthritis (Binvignat et al., 2024; Shumnalieva et al., 2024).
This helps explain why obesity is associated with symptoms involving more than simply weight-bearing joints.
Low-Back Pain
The lumbar spine must support the upper body while allowing bending, rotation, walking, lifting, and balance.
Excess abdominal weight can shift the body’s center of gravity and change the mechanical demands on the pelvis and lumbar spine. Weak abdominal, gluteal, and spinal-support muscles may make those demands even more difficult to manage.
Research has consistently linked excess body weight to low-back pain (Shiri et al., 2010).
This does not mean their weight causes every episode of back pain in a person with obesity. Back pain is multifactorial. Disc degeneration, arthritis, previous injuries, occupational demands, sleep, stress, muscle weakness, physical inactivity, and many other factors can contribute.
Knee and Hip Pain
Knee and hip osteoarthritis can make standing and walking painful.
Pain may then cause patients to shorten their walking distance or avoid stairs and exercise. Over time, quadriceps, hip, and core muscles can weaken.
Unfortunately, weaker muscles provide less support during movement.
The patient can become trapped in a pain-inactivity cycle in which painful movement leads to inactivity, inactivity promotes weakness, weakness makes movement harder, and reduced activity makes weight management more difficult.
Foot and Ankle Stress
The feet and ankles support the entire body during standing and walking.
Higher loads may contribute to discomfort and may alter walking mechanics. Those changes can potentially influence the knees, hips, pelvis, and lower back through the kinetic chain.
For this reason, evaluation of an older adult with obesity and musculoskeletal pain should not focus exclusively on the painful area. Gait, balance, strength, footwear, lower-extremity mechanics, range of motion, and functional movement can also be important.
Pain, Mobility, and the Loss of Independence
Musculoskeletal pain matters because it can affect more than comfort.
Obesity in older adults has been associated with reduced walking ability, stair-climbing ability, chair-rise performance, physical activity, and mobility (Vincent et al., 2010).
Consider what happens when standing from a chair becomes difficult.
A person may begin using their arms more heavily to push themselves upward. Eventually, they may avoid low chairs or restaurants with difficult seating. They may stop shopping independently because walking through a large store becomes exhausting. They may decline social invitations because they are concerned about stairs or long distances.
A musculoskeletal problem can gradually become a social and functional problem.
That is why improving mobility can be one of the most meaningful goals of obesity treatment in older adults.
Nonsurgical Treatment Should Address Both Symptoms and Function
For many musculoskeletal complaints, conservative care is an appropriate starting point after evaluating for conditions that require other medical treatment.
An integrated nonsurgical program may include:
- individualized exercise and progressive resistance training;
- walking or another tolerated form of aerobic activity;
- mobility and flexibility exercises;
- balance and fall-prevention training;
- nutritional counseling with adequate protein intake;
- chiropractic or other appropriately selected manual therapy for mechanical musculoskeletal symptoms;
- physical or occupational therapy when indicated;
- sleep and stress management;
- weight-management treatment under appropriate medical supervision;
- evaluation and management of diabetes, cardiovascular disease, metabolic disorders, and other medical conditions; and
- coordination among the patient’s chiropractor, primary-care provider, nurse practitioner, physical therapist, dietitian, and other specialists.
The objective is not simply temporary symptom relief. The larger goal is to help a patient move more comfortably and confidently so that movement itself can become part of the long-term solution.
Where Chiropractic Care May Fit
View chiropractic treatment as one component of an integrated musculoskeletal care plan rather than a stand-alone treatment for obesity.
A chiropractor can evaluate posture, spinal and extremity movement, joint restrictions, muscle tightness, gait, movement patterns, and mechanical contributors to pain.
Depending on the individual and the diagnosis, conservative chiropractic management may involve spinal manipulation, mobilization, soft-tissue techniques, stretching, therapeutic exercises, movement education, ergonomic recommendations, and home-care strategies.
For chronic primary low-back pain, the World Health Organization includes exercise and spinal manipulative therapy among the nonsurgical interventions that may be offered as components of care. WHO emphasizes that chronic back-pain management should be person-centered, integrated, coordinated, and based on the patient’s individual physical, psychological, and social circumstances (World Health Organization, 2023).
Evidence should still be interpreted carefully. A 2026 Cochrane review involving 76 randomized trials found that spinal manipulative therapy may produce improvements in pain or function compared with sham or no treatment. Still, the certainty of much of the evidence was low or very low. Compared with other conservative treatments, differences in pain were small, with a small improvement in functional status (de Zoete et al., 2026).
Therefore, the strongest clinical approach is usually not “chiropractic instead of everything else.”
It is chiropractic integrated with appropriate exercise, rehabilitation, nutrition, medical management, and patient education.
How Pain Relief Can Support Weight-Management Goals
This connection is important.
A patient may understand that walking and strength training are beneficial but still be unable to participate because every step hurts.
In these cases, treating a mechanical source of pain may help the patient tolerate progressively greater activity.
For example, a person experiencing mechanical low-back pain may initially tolerate only short walks. A conservative treatment program might combine appropriate manual care with gradual strengthening, mobility work, walking progression, and home exercises.
As symptoms become more manageable, the patient may be able to increase physical activity.
Greater physical activity can then help improve cardiovascular fitness, muscle strength, balance, glucose regulation, mood, sleep quality, and overall function.
The goal is not to replace exercise with passive treatment. Instead, symptom management can sometimes bridge the gap and help a patient participate in active rehabilitation.
Exercise Is Essential for Protecting Muscle During Weight Loss
Weight loss in an older adult must be approached differently than weight loss in a younger person.
Losing weight without protecting muscle can create a serious problem.
Villareal and colleagues studied adults with obesity and found that combining weight management with both aerobic and resistance exercise produced particularly favorable improvements in physical function. Resistance-based programs also helped limit lean-mass loss compared with aerobic training alone (Villareal et al., 2017).
Resistance exercise is especially important because it challenges skeletal muscle to remain active and strong.
Examples can include chair squats, resistance-band exercises, light weights, machines, appropriately modified body-weight exercises, or other programs matched to the person’s abilities.
Aerobic exercise remains important as well. Walking, stationary cycling, swimming, water exercise, and other low-impact activities can help improve endurance and cardiometabolic health.
For many older adults, the ideal program combines strength, aerobic conditioning, balance, and mobility work.
Nutrition Must Protect Muscle and Bone
Calorie reduction by itself is not enough.
Older adults need adequate nutrition while losing weight, particularly sufficient protein and micronutrients needed for muscle and bone health.
A severe calorie deficit can accelerate lean tissue loss, especially in someone who is already sedentary or frail.
Protein intake should therefore be individualized according to age, body composition, kidney function, medical history, activity level, and treatment goals.
Protein is most useful when paired with resistance exercise because exercise provides the physical stimulus that tells the body muscle tissue is still needed.
Vitamin D, calcium, magnesium, vitamin B12, and other nutrients may also warrant attention depending on the patient’s diet, lab results, medications, and medical conditions.
Older adults with kidney disease, heart failure, diabetes, swallowing disorders, or other complex conditions require individualized nutritional recommendations rather than generic high-protein or low-calorie diets.
Why Rapid Weight Loss Requires Extra Caution
An older adult can lose substantial body weight while simultaneously becoming weaker.
That is not necessarily a successful outcome.
The clinician should watch for decreasing grip strength, slower walking speed, difficulty rising from a chair, unusual fatigue, worsening balance, recurrent falls, and declining performance during normal activities.
These may indicate that too much functional tissue is being lost.
This becomes particularly important when appetite is significantly reduced through illness, medications, or aggressive dietary restriction.
The objective should be to preferentially reduce excess fat while preserving as much muscle, strength, and bone health as possible.
Weight Loss Can Also Influence Musculoskeletal Symptoms
Weight management and pain management can reinforce each other.
A systematic review evaluating weight-loss interventions in people with knee or hip osteoarthritis or spinal pain found evidence suggesting improvements in pain and disability among people with osteoarthritis. However, evidence quality and certainty varied substantially across studies (Robson et al., 2020).
This is another reason to avoid viewing musculoskeletal care and obesity care as separate topics.
Reducing excess mechanical load may make movement easier. Improving mobility may make exercise easier. Exercise helps protect muscle. Better muscle function can make movement more efficient.
Each improvement can support the next.
Metabolic Comorbidities Still Matter
Obesity can coexist with type 2 diabetes, hypertension, abnormal lipids, sleep-disordered breathing, fatty liver disease, cardiovascular disease, depression, and other chronic conditions.
These disorders can directly affect a patient’s ability to exercise.
For example, poorly controlled diabetes may contribute to fatigue or neuropathy. Sleep apnea may cause daytime exhaustion. Cardiovascular disease may limit exercise tolerance. Depression may decrease motivation. Peripheral swelling can make walking uncomfortable.
For this reason, coordinate musculoskeletal rehabilitation with the patient’s medical care.
A patient should not simply be told to “exercise more” without asking why movement has become difficult.
Sometimes pain is the barrier. Sometimes weakness is the barrier. Sometimes shortness of breath, poor balance, fear of falling, medication side effects, depression, or lack of safe access to exercise is the barrier.
Effective treatment begins by identifying those obstacles.
Screening for Sarcopenic Obesity
Clinical screening can help identify patients who need additional assessment.
Useful information includes waist circumference, body composition (when available), grip strength, walking speed, chair-rise performance, history of falls, ability to climb stairs, ability to carry everyday objects, and changes in activities of daily living.
The ESPEN and EASO consensus emphasizes both altered body composition and impaired skeletal-muscle function when evaluating sarcopenic obesity (Donini et al., 2022).
A patient who has substantial abdominal obesity but cannot rise easily from a chair may have a very different risk profile from a patient of similar body weight who remains physically strong and active.
This is another reason the bathroom scale should never be the only measure of progress.
Better Measures of Progress
Successful obesity management in older adults can be measured through improvements such as walking farther without discomfort, standing more easily, climbing stairs with greater confidence, sleeping better, performing household tasks independently, improving balance, increasing strength, reducing waist circumference, improving metabolic markers, and participating in activities the person previously avoided.
These outcomes may matter more to the patient than reaching an arbitrary number on the scale.
A patient who loses a modest amount of body fat while increasing strength and regaining the ability to walk through a grocery store independently may have achieved an extremely meaningful health improvement.
Discovering the Benefits of Chiropractic Care- Video
The Importance of a Multidisciplinary Team
Older adults with obesity frequently have several conditions occurring at the same time.
That makes coordinated care especially valuable.
The primary-care provider or nurse practitioner can manage metabolic and medical conditions. A registered dietitian can create a realistic nutrition strategy. A physical therapist can address significant functional limitations or rehabilitation needs. A chiropractor can evaluate and conservatively manage appropriate mechanical musculoskeletal complaints. Mental-health professionals can assist when mood, anxiety, or eating behavior is interfering with progress.
The goal is not for every patient to see every type of provider.
The goal is to give each patient the combination of services needed for their particular barriers.
Treat the Patient, Not Just the Scale
The most successful approach to obesity in older adults is function-centered rather than purely weight-centered.
For some patients, substantial weight reduction may be appropriate. For others, the immediate priority may be stabilizing weight while rebuilding muscle. For a frail patient, preventing further decline may be more important than aggressive weight loss.
Musculoskeletal pain deserves a central place in this conversation.
When the knees, hips, feet, or back hurt, patients naturally become reluctant to move. Unfortunately, inactivity can accelerate the very muscle loss that makes movement more difficult.
Treatment must therefore address both sides of the problem.
We want to decrease excessive metabolic and mechanical stress while simultaneously increasing the patient’s physical capacity to meet the demands of everyday life.
Final Thoughts
Obesity in the aging population is not simply a matter of body size. It is a complex interaction among body composition, inflammation, metabolism, strength, joint loading, pain, physical activity, sleep, nutrition, psychological health, and chronic disease.
The combination of excess adiposity and declining muscle function deserves particular attention because sarcopenic obesity can threaten mobility and independence.
Musculoskeletal pain can accelerate this decline by discouraging physical activity. Increased mechanical loading and inflammatory signaling associated with excess adipose tissue can contribute to joint symptoms, while inactivity can weaken the muscles needed to support painful joints.
This is why a comprehensive strategy matters.
Nutrition can help reduce excessive fat while supplying the nutrients needed to maintain muscle and bone. Resistance exercise protects strength. Aerobic activity improves endurance and cardiometabolic health. Balance and mobility training can support safer movement. Appropriate medical care addresses metabolic conditions. Nonsurgical musculoskeletal treatments, including appropriately selected chiropractic care, may help some patients manage mechanical pain and improve function so they can participate more comfortably in active rehabilitation.
The goal is not simply weight loss.
The goal is better movement, better strength, less disability, greater independence, and a healthier quality of life as a person ages.
References
- Binvignat, M., Sellam, J., Berenbaum, F., & Felson, D. T. (2024). The role of obesity and adipose tissue dysfunction in osteoarthritis pain. Nature Reviews Rheumatology, 20(9), 565–584.
- de Zoete, A., Innocenti, T., Petrozzi, M. J., van Middelkoop, M., Assendelft, W. J. J., de Boer, M. R., van Tulder, M. W., & Rubinstein, S. M. (2026). Spinal manipulative therapy for adults with chronic low back pain. Cochrane Database of Systematic Reviews, 2026(1), CD008112.
- Donini, L. M., Busetto, L., Bischoff, S. C., Cederholm, T., Ballesteros-Pomar, M. D., Batsis, J. A., Bauer, J. M., Boirie, Y., Cruz-Jentoft, A. J., Dicker, D., Frara, S., Frühbeck, G., Genton, L., Gepner, Y., Giustina, A., Gonzalez, M. C., Han, H.-S., Laviano, A., Lenzi, A., et al. (2022). Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Clinical Nutrition, 41(4), 990–1000.
- Emmerich, S. D., Fryar, C. D., Stierman, B., & Ogden, C. L. (2024). Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023. NCHS Data Brief, No. 508. National Center for Health Statistics.
- Robson, E. K., Hodder, R. K., Kamper, S. J., O’Brien, K. M., Williams, A., Lee, H., Wolfenden, L., Yoong, S., Wiggers, J., Barnett, C., & Williams, C. M. (2020). Effectiveness of weight-loss interventions for reducing pain and disability in people with common musculoskeletal disorders: A systematic review with meta-analysis. Journal of Orthopedic & Sports Physical Therapy, 50(6), 319–333.
- Shiri, R., Karppinen, J., Leino-Arjas, P., Solovieva, S., & Viikari-Juntura, E. (2010). The association between obesity and low back pain: A meta-analysis. American Journal of Epidemiology, 171(2), 135–154.
- Shumnalieva, R., Kotov, G., Ermencheva, P., & Monov, S. (2024). Pathogenic mechanisms and therapeutic approaches in obesity-related knee osteoarthritis. Biomedicines, 12(1), 9.
- Villareal, D. T., Aguirre, L., Gurney, A. B., Waters, D. L., Sinacore, D. R., Colombo, E., Armamento-Villareal, R., & Qualls, C. (2017). Aerobic or resistance exercise, or both, in dieting obese older adults. The New England Journal of Medicine, 376(20), 1943–1955.
- Vincent, H. K., Vincent, K. R., & Lamb, K. M. (2010). Obesity and mobility disability in the older adult. Obesity Reviews, 11(8), 568–579.
- World Health Organization. (2023). WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. World Health Organization.
Disclaimer
This article is intended for educational and informational purposes only. It is not a substitute for individualized medical advice, diagnosis, or treatment. Obesity, chronic pain, sarcopenia, osteoarthritis, cardiovascular disease, diabetes, and other chronic conditions require individualized evaluation.
Chiropractic care and other conservative musculoskeletal treatments may be appropriate for certain conditions but are not appropriate for every patient or every cause of pain. Older adults with new or severe symptoms, progressive neurological changes, significant trauma, unexplained weakness, bowel or bladder changes, fever, or other concerning findings should receive appropriate medical evaluation.
Weight-management, exercise, nutrition, medication, and rehabilitation plans should be individualized with qualified healthcare professionals based on the patient’s medical history, medications, functional capacity, laboratory findings, and treatment goals.
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