# Abdominal Adiposity Increases Lordosis and Doubles the Risk of Low Back Pain
## 4 Discussion
### Back Pain  
Epidemiological studies have found a strong relationship between low back pain and pathological angular values, both for below-normal, kyphosis, and lumbar rectification [34] and for increased degrees of lumbar curvature [35]. In this study, LBP was associated with increased lumbar curvature and abdominal obesity regardless of the subjects' age, sex, and level of physical activity. Furthermore, low back pain has been associated with increased lumbar curvature and abdominal obesity. An excessive accumulation of abdominal fat may be indicative of disharmony in the control of abdominal muscles, which would explain the association with low back pain [36].  
The relationship between excess weight and general back pain has also been explained by the effects of mechanical loading [37]. The connection between abdominal obesity and low back pain may be explained by the biomechanical tension exerted by the weight of the abdomen on the lower part of the spine [37]. The weight and expansion of the abdomen cause a change in the position of the center of gravity and the positioning of the spine, which implies multiplying the force required in carrying out the efforts of daily activities and postural changes. This repeated increase in effort on the lower area of the spine may increase episodes of pain. In subjects with abdominal obesity, the effects of overload are cumulative and are further influenced by behaviors and habits associated with lifestyle [38].  
Regarding neck and dorsal pain, the results did not show an association with vertebral curvatures or with indicators of weight and adiposity, except for W/HT risk values, which seem to have a protective effect against neck pain. This opens up new questions for future work regarding the effects of the relationship between height and abdominal obesity on neck pain.  
By advancing research on the effects of obesity on vertebral morphology and musculoskeletal disorders, health professionals are learning which types of intervention are advisable and how to advance toward other therapeutic strategies [37]. Therefore, in clinical practice, anthropometric monitoring is preferred in place of repeated radiographic exposure in treating postural attitudes, such as kypholordosis or lumbar rectification.  
This study serves to provide useful data in this regard and contributes toward a better understanding of the association between obesity, sagittal alignment, and back pain. However, in the face of a diagnosis, it must be considered that there is no consensus onthe critical values or standard references of vertebral curvatures and that only the extreme limits are useful for the appreciation of curves as excessive, insufficient, or inverted [33]. One potential cause of these limitations may be that currently, not a single non-invasive postural test is professionally recognized as the gold standard, which is the reason why the evidence provided is often incomparable. The procedure used in this study constitutes a simple, practical, objective, and low-cost tool for a noninvasive evaluation of postural analysis of the spine.  
According to previous transversal studies, which evaluate a characteristic that had accumulated in the past, it is possible to establish reference tables of the sagittal plane curve for standing subjects examined from the side [7; 8; 9; 10; 11; 12; 13; 14; 15; 16; 17; 18; 19; 20; 21; 22; 23; 24; 25; 26; 27; 28; 29; 30; 31; 32]. In this way, an easily replicable standard posture is determined. However, it is relevant for future projects to carry out longitudinal studies to observe the evolution of sagittal curves over time.