Discover the connection between chiropractic care and obesity. Find out how chiropractic treatments can support weight loss efforts.

Abstract

Obesity in older adults is not simply about carrying extra body weight. Aging naturally changes muscle mass, bone density, metabolism, balance, and body composition. When excess body fat occurs alongside these changes, older adults can face a greater risk of type 2 diabetes, cardiovascular disease, sleep problems, fatty liver disease, loss of mobility, osteoarthritis, low-back pain, muscle weakness, falls, and reduced independence.

An especially important concern is sarcopenic obesity, which occurs when excess body fat is combined with low muscle mass, reduced strength, or impaired physical function. This combination can create a difficult cycle. Extra weight increases the mechanical demands placed on the knees, hips, feet, and spine. Musculoskeletal pain may then discourage physical activity. Less movement contributes to muscle loss and weakness, which can make exercise and weight management even harder.

Treatment should therefore focus on more than a number on the scale. A well-designed program may combine nutrition, resistance training, aerobic exercise, balance training, sleep improvement, medical management, rehabilitation, and appropriate nonsurgical musculoskeletal care.

Integrative chiropractic care can be one part of this larger strategy. Chiropractic treatment does not treat obesity itself. Instead, appropriate manual therapy, mobility work, corrective exercise, and rehabilitation may help selected patients manage mechanical musculoskeletal symptoms, improve movement, and participate more comfortably in physical activity.

The goal is to help older adults preserve muscle, reduce excessive fat mass, move with less discomfort, improve metabolic health, and maintain independence as they age.

Why Obesity in Older Adults Requires a Different Approach

Aging changes the body even when body weight doesn’t change much.

Skeletal muscle tends to decline with age. Bone density may decrease. Metabolic demands become lower. Physical activity often declines. At the same time, body fat may increase and move toward the abdomen.

This accumulation of abdominal or visceral fat is important because adipose tissue is biologically active. It produces hormones, adipokines, and inflammatory signaling molecules that can influence glucose regulation, cardiovascular health, muscle metabolism, and joint symptoms.

According to recent U.S. National Health and Nutrition Examination Survey data, approximately 38.9% of adults age 60 and older had obesity during August 2021 through August 2023 (Emmerich et al., 2024).

For an older adult, however, body weight tells only part of the story.

Two people may weigh the same but have very different amounts of muscle and fat. One may remain strong, active, and independent. Another may have substantial abdominal fat, weak muscles, poor balance, and difficulty getting out of a chair.

This is why evaluating body composition and physical function becomes increasingly important with age.

Why BMI Does Not Tell the Whole Story

Body Mass Index, or BMI, is useful for general screening, but it cannot distinguish between muscle and fat.

Older adults may lose muscle while gaining fat without seeing a major change on the scale. Some people may therefore have an apparently moderate BMI while still carrying excessive visceral fat and having inadequate muscle mass.

Useful measurements can include:

• Waist circumference
• Waist-to-height ratio
• Grip strength
• Walking speed
• Chair-stand performance
• Balance testing
• Physical activity tolerance
• DXA body-composition testing when appropriate
• Bioelectrical impedance analysis when available

These measurements help clinicians look beyond body weight and ask a more meaningful question:

Is this patient maintaining the strength and physical capacity needed for healthy aging?

Understanding Sarcopenic Obesity

Sarcopenic obesity combines excess adiposity with impaired skeletal-muscle mass or function.

The European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity recommend evaluating muscle function and body composition when sarcopenic obesity is suspected (Donini et al., 2022).

This condition matters in older adults because fat gain and muscle loss can reinforce each other.

Excess adipose tissue contributes to metabolic and inflammatory changes. At the same time, losing skeletal muscle can reduce strength, physical activity, glucose disposal, and overall energy expenditure.

The result can become a repeating cycle:

increased body fat → inflammation and mechanical stress → pain and reduced movement → muscle loss → weakness → lower activity → additional fat accumulation.

Breaking that cycle requires attention to both sides of the problem.

Reducing excess adiposity matters, but preserving muscle and restoring movement are equally important.

Obesity and Musculoskeletal Pain: An Important Comorbidity

One of the most important additions to the obesity conversation is musculoskeletal health.

Older adults with obesity may experience pain involving the:

• Lower back
• Knees
• Hips
• Ankles
• Feet
• Shoulders
• Pelvis
• Muscles and connective tissues

Obesity can influence musculoskeletal symptoms through several pathways.

Increased Mechanical Stress on Joints

Additional body mass increases the amount of force the musculoskeletal system must manage during standing, walking, climbing stairs, squatting, and getting out of a chair.

Weight-bearing joints such as the knees and hips are particularly affected.

The lumbar spine must also manage changing loads while stabilizing the trunk during movement.

Over time, excessive mechanical loading may contribute to joint irritation, altered movement patterns, physical fatigue, and worsening symptoms in people who already have degenerative joint conditions.

Adipose Tissue and Inflammation

The relationship between obesity and joint pain is not purely mechanical.

Adipose tissue functions as an active endocrine tissue. In obesity, dysfunctional adipose tissue can contribute to systemic inflammation and altered immune signaling.

A 2024 review in Nature Reviews Rheumatology reported that obesity-related osteoarthritis pain involves not only mechanical loading but also adipose-tissue dysfunction, metabolic changes, inflammatory cytokines, adipokines, and mechanisms involving pain sensitization (Binvignat et al., 2024).

This helps explain why obesity can influence musculoskeletal symptoms in ways that extend beyond simple joint loading.

Obesity and Low-Back Pain

Low-back pain is another major concern.

The lumbar spine supports the upper body while allowing bending, twisting, walking, lifting, and stabilization.

Excess abdominal weight may change the body’s center of mass and increase mechanical demands on the lumbar spine and pelvis.

At the same time, people who have been inactive because of pain may develop weakness in the muscles that stabilize the trunk, hips, and pelvis.

A meta-analysis found an association between overweight or obesity and a greater likelihood of low-back pain, including chronic low-back pain and seeking medical care for back symptoms (Shiri et al., 2010).

Body weight is not the only cause of back pain. Low-back symptoms can also involve previous injuries, degenerative changes, occupational stress, muscle weakness, poor conditioning, sleep problems, psychosocial factors, or other medical conditions.

That is why a thorough evaluation matters.

The Pain-Inactivity-Weight Cycle

Musculoskeletal pain can become one of the greatest barriers to successful weight management.

Consider an older adult with painful knees.

Walking hurts, so the patient begins walking less.

Because the patient walks less:

• Leg strength declines.
• Cardiovascular fitness decreases.
• Balance may worsen.
• Daily calorie expenditure falls.
• Confidence in movement decreases.
• Body fat may increase.
• Getting out of a chair becomes harder.

The weaker the patient becomes, the more difficult movement feels.

The same pattern can happen with back, hip, or foot pain.

This creates the pain-inactivity-weight cycle:

Pain → less activity → muscle loss → poorer movement → weight gain → more joint loading → more pain.

An integrative treatment plan should attempt to interrupt this cycle at several points instead of relying on a single intervention.

Discovering the Benefits of Chiropractic Care- Video

How Chiropractic Care May Fit Into an Integrative Plan

Chiropractic care should not be presented as a treatment for obesity.

Its potential role is different.

For appropriately selected patients with mechanical musculoskeletal complaints, chiropractic care may be incorporated into a broader program to address pain, stiffness, joint mobility, movement limitations, and functional barriers that make exercise difficult.

Depending on the patient’s diagnosis, health status, and tolerance, conservative care may include:

• Spinal manipulation or mobilization
• Extremity joint mobilization
• Soft-tissue techniques
• Myofascial therapy
• Mobility exercises
• Corrective exercises
• Core stabilization
• Postural training
• Balance exercises
• Gait and movement education
• Ergonomic recommendations
• Progressive home exercise

The World Health Organization includes spinal manipulative therapy among the physical interventions that may be offered as part of care for adults, including older adults, with chronic primary low-back pain. The recommendation is conditional, and WHO emphasizes integrated, person-centered care rather than relying on a single treatment (World Health Organization, 2023).

That distinction is important.

The most appropriate approach is usually not:

“chiropractic instead of exercise.”

Rather, it may be:

chiropractic care + exercise + rehabilitation + nutrition + appropriate medical management.

Reducing Pain Can Help Patients Become More Active

For some patients, pain is the main reason they cannot follow an exercise program.

Telling someone with severe knee or back discomfort to “exercise more” may not solve the problem.

First, clinicians need to understand why movement hurts.

When appropriate musculoskeletal treatment makes symptoms more manageable, the patient may be able to participate more successfully in active rehabilitation.

A patient might progress from:

short supported walks → longer walks → resistance-band exercises → chair squats → progressive resistance training.

This is where conservative musculoskeletal treatment can bridge the gap to movement.

Passive treatment should not become the endpoint. The longer-term objective is to help the patient regain strength, confidence, movement tolerance, and independence.

Weight Management May Also Help Musculoskeletal Symptoms

The relationship works in both directions.

Improving musculoskeletal symptoms may make activity easier, while reducing excess body weight may decrease some of the mechanical demands placed on painful joints.

A systematic review examining weight-loss interventions among people with knee or hip osteoarthritis or spinal pain found evidence of improvements in pain and disability in some groups. However, the strength and quality of evidence varied among studies (Robson et al., 2020).

This supports a combined approach.

Instead of treating obesity and joint pain as completely separate conditions, clinicians can address them together.

Resistance Training Is Central to Healthy Weight Management

For older adults, losing weight without protecting muscle can create another problem.

Weight reduction can involve losses of both fat and lean tissue.

An older person who loses significant weight but also loses substantial muscle may become lighter while simultaneously becoming weaker.

That is not the outcome we want.

Resistance training is therefore one of the most important tools available for older adults with obesity.

Resistance exercise can help support:

• Muscle strength
• Lean body mass
• Functional capacity
• Balance
• Bone loading
• Glucose metabolism
• Ability to perform daily activities
• Confidence with movement

The National Strength and Conditioning Association identifies resistance training as an effective strategy for countering age-related declines in muscle strength and physical function (Fragala et al., 2019).

Combining Aerobic and Resistance Exercise

Aerobic activity and resistance training provide different benefits.

Aerobic activities such as walking, cycling, swimming, or aquatic exercise can improve cardiovascular fitness and endurance.

Resistance exercise primarily helps preserve and improve strength and muscle function.

Villareal and colleagues studied older adults with obesity who participated in weight management combined with different types of exercise. The combination of aerobic and resistance exercise produced particularly great improvements in physical function, while resistance-containing programs helped limit lean-mass loss during weight reduction (Villareal et al., 2017).

For many older adults, the best exercise plan therefore includes:

• Resistance training
• Aerobic activity
• Balance training
• Flexibility and mobility work

Adjust the program to the patient’s starting ability.

Start Where the Patient Is

An older adult who has been sedentary for several years should not be expected to start a demanding fitness program immediately.

Sometimes the first goal is:

• Walk to the mailbox.
• Perform five controlled chair stands.
• Complete a few resistance-band rows.
• Practice supported balance exercises.
• Walk for five minutes twice daily.

Small improvements matter.

The LIFE randomized clinical trial demonstrated that a structured physical-activity program containing walking, resistance exercises, flexibility exercises, and balance work reduced major mobility disability among older adults at risk for disability (Pahor et al., 2014).

Progress can then be made gradually as strength, confidence, and endurance improve.

Nutrition Must Protect Muscle

Older adults generally need to think about nutrient quality, not simply calorie restriction.

A highly restrictive diet can result in inadequate:

• Protein
• Vitamins
• Minerals
• Essential fats
• Overall energy

That becomes particularly dangerous when the patient already has reduced muscle mass.

Protein is especially important because aging muscle becomes less responsive to the anabolic signals that normally stimulate muscle-building.

The PROT-AGE Study Group recommended approximately 1.0 to 1.2 grams of protein per kilogram of body weight per day for many healthy older adults, with higher amounts often considered for active older adults or those dealing with illness. At the same time, people with significant kidney impairment require individualized recommendations (Bauer et al., 2013).

Nutrition should therefore be individualized according to:

• Kidney function
• Medical history
• Activity level
• Current muscle mass
• Appetite
• Weight-management goals
• Medications
• Swallowing ability
• Food access
• Financial resources

Mediterranean and DASH-Style Eating Patterns

Diet quality matters as much as calorie intake.

Mediterranean-style and DASH-style eating patterns emphasize many of the foods that support metabolic and cardiovascular health:

• Vegetables
• Fruits
• Beans and legumes
• Whole grains
• Lean proteins
• Fish when appropriate
• Nuts and seeds
• Healthy fats
• Lower amounts of heavily processed foods
• Reduced excess sodium and added sugar

For an older adult trying to reduce body fat while preserving muscle, the goal is not starvation.

The goal is a sustainable eating pattern that provides adequate protein and micronutrients while supporting gradual improvement in body composition.

Cardiometabolic Comorbidities

Obesity rarely exists in isolation.

Older adults with obesity may also be managing:

• Type 2 diabetes
• Insulin resistance
• Hypertension
• Dyslipidemia
• Cardiovascular disease
• Heart failure
• Sleep apnea
• Metabolic liver disease
• Reduced kidney function
• Depression
• Osteoarthritis
• Frailty

These conditions can affect exercise tolerance and influence the safest treatment plan.

A person with diabetes and peripheral neuropathy, for example, may require different exercise precautions than someone whose primary limitation is mechanical low-back pain.

A patient with heart failure may require medically supervised exercise.

A patient with painful knee osteoarthritis may initially benefit from low-impact activities such as cycling, water exercise, or carefully progressed resistance training.

Treatment should match the person, not simply the diagnosis.

Pharmacotherapy and Muscle Preservation

Medications are increasingly important in modern obesity treatment.

GLP-1 receptor agonists and dual incretin therapies can substantially reduce body weight and improve several metabolic measures.

The SELECT trial also demonstrated that semaglutide reduced major cardiovascular events in adults with established cardiovascular disease and overweight or obesity who did not have diabetes (Lincoff et al., 2023).

For older adults, however, clinicians should not rely solely on weight loss.

Providers should also monitor:

• Protein intake
• Strength
• Physical performance
• Hydration
• Appetite
• Muscle mass when possible
• Fall risk
• Medication tolerance
• Nutritional status

Medication works best as one part of an integrated treatment plan rather than as a replacement for movement, nutrition, and resistance exercise.

Sleep, Pain, and Metabolic Health

Sleep is another piece of the puzzle.

Musculoskeletal pain can make it difficult to find a comfortable sleeping position. Poor sleep may then contribute to fatigue, lower exercise participation, impaired glucose regulation, and changes in appetite.

This creates another cycle:

pain → poor sleep → fatigue → less movement → poorer metabolic health → more difficulty managing weight.

Addressing mechanical pain, improving sleep habits, treating sleep apnea when present, maintaining regular sleep-wake times, and encouraging daytime physical activity may all support better overall function.

When conservative musculoskeletal care reduces nighttime discomfort for an appropriate patient, improved sleep can become another pathway toward better participation in rehabilitation.

Screening for Sarcopenic Obesity

Sarcopenic obesity should be considered when an older adult has excess adiposity along with signs of declining strength or function.

Possible warning signs include:

• Repeated falls
• Difficulty rising from a chair
• Slow walking speed
• Increasing fatigue
• Difficulty climbing stairs
• Reduced grip strength
• Trouble carrying groceries
• Reduced participation in normal activities
• Long periods of inactivity
• Recent hospitalization
• Progressive weakness

The ESPEN and EASO consensus recommends assessing skeletal-muscle function first, then evaluating body composition when indicated (Donini et al., 2022).

Clinical tools may include SARC-F screening, grip-strength testing, gait speed, chair-stand testing, waist circumference, DXA, or BIA.

Measure Function, Not Just Weight

The scale should not be the only measure of success.

For an older adult, meaningful progress may include:

• Walking farther
• Standing from a chair more easily
• Climbing stairs with less difficulty
• Sleeping more comfortably
• Experiencing fewer pain-related limitations
• Increasing daily steps
• Improving grip strength
• Improving balance
• Maintaining muscle while losing fat
• Reducing waist circumference
• Improving blood pressure
• Improving glucose control
• Returning to hobbies
• Remaining independent

These outcomes often matter much more to patients than achieving a particular BMI.

An Integrative Chiropractic and Medical Model

At Injury Medical Clinic PA in El Paso, Texas, integrative care aims to evaluate the entire clinical picture rather than isolate individual symptoms.

Musculoskeletal care can be coordinated with medical oversight, nutritional guidance, rehabilitation, and specialty referrals when needed.

An individualized plan may include:

Chiropractic and Musculoskeletal Care

Appropriate manual therapy, joint mobilization, soft-tissue treatment, movement assessment, and corrective exercise may address selected mechanical pain and mobility problems.

Progressive Rehabilitation

Resistance exercise, balance work, flexibility, aerobic conditioning, and functional movements can be gradually increased as the patient’s capacity improves.

Nutritional Support

Adequate protein, hydration, nutrient-dense foods, and sustainable calorie management help protect muscle while addressing excess adiposity.

Medical Management

Diabetes, cardiovascular conditions, blood pressure, lipid disorders, hormonal issues, medication interactions, kidney function, and other medical concerns require appropriate medical evaluation.

Sleep and Recovery

Evaluate sleep quality, sleep apnea, circadian patterns, pain at night, and recovery when they interfere with metabolic health or physical activity.

Social and Environmental Factors

Transportation, food affordability, family support, safe walking areas, exercise access, and fall hazards can determine whether even the best clinical plan succeeds.

Breaking the Cycle

One of the most useful ways to think about obesity and musculoskeletal health is to recognize how each condition can influence the other.

The negative cycle may look like this:

Obesity → increased joint loading and inflammation → pain → reduced movement → loss of muscle → poorer balance and metabolism → further difficulty managing weight.

A comprehensive treatment strategy tries to reverse that direction:

Pain management → better movement → progressive exercise → stronger muscles → improved function → greater activity → healthier body composition → less mechanical stress.

Not every patient will move through these steps at the same speed.

That is why individualized care matters.

Final Thoughts

Obesity in older adults is much more complex than excess body weight.

It involves interactions among adipose tissue, muscle, metabolism, joint health, physical activity, sleep, cardiovascular health, nutrition, medications, and the person’s ability to perform everyday activities.

Sarcopenic obesity deserves special attention because the combination of excess fat and declining muscle function can rapidly threaten mobility and independence.

Musculoskeletal pain can worsen that problem.

When back, knee, hip, foot, or other mechanical pain discourages movement, muscle strength can decline. Reduced strength makes physical activity more difficult, which can further contribute to poor metabolic health and excessive fat accumulation.

That is why an integrated treatment plan can be valuable.

Appropriate chiropractic care and other nonsurgical musculoskeletal treatments may help selected patients manage pain and movement restrictions. Exercise can rebuild strength. Nutrition can protect muscle while supporting healthier body composition. Medical treatment can address metabolic and cardiovascular conditions. Sleep and behavioral strategies can improve recovery and adherence.

The primary goal should not simply be to lose pounds.

The larger goal is to reduce symptoms, preserve muscle, improve mobility, increase strength, support metabolic health, reduce disability, and help older adults remain active and independent for as long as possible.

References

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• 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. doi:10.1038/s41584-024-01143-3.
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