Chiropractic Care: Seeking Effective Solutions to Reduce Obesity

Uncover the connection between chiropractic care and effective weight management strategies for healthier living and overcoming obesity.

Abstract

Obesity in adults aged 60 and older is much more than a problem involving body weight. Excess body fat can affect metabolism, cardiovascular health, blood sugar regulation, sleep, muscle strength, balance, joint health, and a person’s ability to remain physically active and independent.

One of the most overlooked effects of obesity is its impact on the musculoskeletal system. Extra weight increases mechanical stress on the knees, hips, feet, pelvis, and spine. At the same time, fat tissue can contribute to chronic low-grade inflammation. Together, these changes may increase joint pain, stiffness, osteoarthritis symptoms, low-back pain, reduced mobility, muscle weakness, and difficulty exercising.

This can create a cycle: pain reduces movement, reduced movement contributes to muscle loss and weight gain, and greater body weight can place even more stress on painful joints.

For this reason, obesity care in older adults should not focus only on lowering a number on a scale. The goal should also include reducing pain, preserving muscle, improving mobility, restoring function, and helping patients remain independent.

An integrative approach may combine medical management, functional nutrition, strength training, cardiovascular exercise, balance rehabilitation, and appropriate nonsurgical musculoskeletal care. Chiropractic care does not directly treat obesity. However, for appropriately selected patients, chiropractic treatment and rehabilitation may help address mechanical symptoms that make movement difficult, allowing patients to participate more comfortably in exercise, weight-management, and healthy-aging programs.

Obesity Becomes More Complex as We Age

Aging changes the way the body stores fat and maintains muscle.

A person’s weight may not change dramatically over the years, yet their body composition can change substantially. Adults commonly lose lean muscle while gaining a greater percentage of body fat.

Fat also tends to move toward the abdomen and internal organs. This is known as visceral adiposity.

Visceral fat is metabolically active. It releases inflammatory signaling molecules and is associated with:

• Insulin resistance
• Type 2 diabetes
• High blood pressure
• Abnormal cholesterol
• Cardiovascular disease
• Metabolic liver disease
• Sleep disorders
• Chronic inflammation
• Reduced physical function

At the same time, aging naturally makes maintaining muscle more difficult.

This combination helps explain why evaluating an older adult requires more than simply looking at BMI.

Looking Beyond BMI

Body mass index can be a helpful screening tool, but it cannot distinguish fat from muscle.

This becomes especially important in adults over 60.

An older person can have a relatively normal BMI while having:

• Too little skeletal muscle
• Excess abdominal fat
• Poor strength
• Limited mobility
• Insulin resistance
• Increased fall risk

For this reason, a more complete evaluation may include:

• Waist circumference
• Waist-to-height ratio
• Body composition
• Muscle strength
• Gait
• Balance
• Chair-rise ability
• Physical activity level
• Joint range of motion
• Pain assessment
• Functional limitations

The goal is to understand what the person’s body can actually do, not simply what it weighs.

Obesity and Musculoskeletal Pain: An Important Connection

The musculoskeletal effects of obesity can become particularly important as people age.

Excess body weight influences joints in two major ways.

1. Increased Mechanical Loading

Every additional pound of body weight increases the workload placed on weight-bearing structures.

The knees, hips, ankles, feet, pelvis, and lumbar spine must repeatedly support that additional force during:

• Walking
• Standing
• Climbing stairs
• Getting out of a chair
• Bending
• Lifting
• Exercising

The effect becomes even greater during movement because walking and climbing stairs produce forces several times greater than standing body weight alone.

Over many years, increased loading may worsen symptoms in already vulnerable joints.

2. Chronic Inflammatory Activity

The problem is not only mechanical.

Adipose tissue is biologically active.

Excess visceral fat can release inflammatory chemicals such as interleukin-6 and other adipokines. This may contribute to systemic low-grade inflammation.

Therefore, an older adult with obesity and joint pain may be dealing with both:

Mechanical stress + inflammatory stress

This combination may make musculoskeletal symptoms more difficult to manage.

Common Musculoskeletal Problems Associated With Obesity

People with obesity may experience a wide range of musculoskeletal complaints.

Knee Pain and Osteoarthritis

The knees carry substantial loads during walking, standing, and climbing stairs.

Obesity can increase mechanical stress across the knee while chronic inflammation may influence the tissues surrounding the joint.

Symptoms may include:

• Pain during walking
• Difficulty climbing stairs
• Stiffness after sitting
• Reduced range of motion
• Swelling
• Weakness
• Difficulty rising from a chair

As knee pain increases, patients often become less active. Unfortunately, inactivity can weaken the quadriceps and other supporting muscles, making knee function even more difficult.

Hip Pain

Excess weight can also increase stress across the hip joints.

Pain or weakness around the hips may alter walking mechanics. Patients may shorten their stride, lean to one side, or change how they distribute their weight.

These compensations can affect the:

• Pelvis
• Sacroiliac joints
• Lower back
• Knees
• Feet

This is why musculoskeletal treatment should evaluate the entire kinetic chain rather than looking only at the painful joint.

Low-Back Pain

Obesity can significantly change spinal biomechanics.

Excess abdominal weight may shift the body’s center of gravity forward. The lower back muscles may then have to work harder to maintain an upright posture.

Over time, this can contribute to:

• Muscle fatigue
• Lumbar stiffness
• Altered posture
• Reduced spinal mobility
• Increased stress on spinal joints
• Difficulty bending
• Difficulty standing for long periods

Existing degenerative changes may further complicate these symptoms.

Foot and Ankle Pain

The feet form the foundation of the kinetic chain.

Extra body weight increases loading through the:

• Ankles
• Arches
• Plantar fascia
• Heel
• Midfoot

Foot pain may change how someone walks, which can eventually affect the knees, hips, pelvis, and spine.

Reduced Flexibility

People experiencing chronic pain frequently avoid uncomfortable movements.

Over time, less movement may result in:

• Tight hip flexors
• Shortened hamstrings
• Calf tightness
• Reduced thoracic mobility
• Shoulder stiffness
• Poor posture

Limited flexibility then makes normal activities more difficult.

The Pain-Inactivity-Weight Cycle

One of the most important concepts in obesity-related musculoskeletal care is the pain-inactivity cycle.

It may begin very simply.

A patient develops knee or back pain.

Because movement hurts, the patient walks less.

Reduced activity leads to:

• Lower energy expenditure
• Muscle weakness
• Loss of cardiovascular fitness
• Reduced balance
• Greater stiffness
• Possible additional weight gain

The weaker muscles then provide less support for painful joints.

Pain becomes worse.

The patient moves even less.

This creates a repeating cycle:

Pain → reduced movement → muscle loss → poorer mobility → additional weight gain → greater joint stress → more pain

Breaking this cycle can become one of the most important treatment goals.

Sarcopenic Obesity: Too Much Fat and Too Little Muscle

Older adults face another important condition called sarcopenic obesity.

Sarcopenia refers to age-related loss of muscle mass, strength, and function.

Sarcopenic obesity occurs when excess body fat exists alongside declining muscle.

This combination can be particularly harmful because muscle is essential for:

• Walking
• Balance
• Glucose metabolism
• Joint stability
• Posture
• Fall prevention
• Maintaining independence

A person may therefore have substantial body weight but surprisingly little functional muscle.

That is why weight loss alone should not be the only goal.

An older adult could lose 20 pounds yet become physically weaker if too much of that weight comes from muscle.

A better goal is often:

Reduce excess fat while preserving or rebuilding functional muscle.

Signs That Muscle Loss May Be Becoming a Problem

Clinical warning signs can include:

• Difficulty getting out of a chair
• Slower walking
• Trouble climbing stairs
• Frequent falls
• Poor balance
• Reduced grip strength
• Fatigue
• Progressive weakness
• Reduced ability to perform daily activities
• Difficulty carrying groceries
• Increasing dependence on others

Simple clinical tools such as the SARC-F questionnaire, chair-stand testing, gait-speed testing, grip-strength measurement, and body-composition analysis can help determine whether additional evaluation is appropriate.

Why Musculoskeletal Care Matters During Weight Management

A common recommendation for obesity is simple:

“Exercise more.”

But what happens when exercise hurts?

A patient with knee osteoarthritis, low-back pain, limited spinal movement, hip stiffness, or poor balance may be physically unable to follow a traditional exercise prescription comfortably.

This is where musculoskeletal care can become an important part of a broader obesity-management program.

The first goal may not be strenuous exercise.

The first goal may simply be helping the patient move with less discomfort and greater confidence.

Once movement becomes more tolerable, the patient may gradually become able to:

• Walk farther
• Exercise longer
• Perform resistance exercises
• Participate in physical therapy
• Improve cardiovascular conditioning
• Build muscle
• Increase daily activity

This is an important distinction.

Chiropractic care does not cause weight loss on its own.

Instead, appropriate chiropractic and rehabilitative care may help remove musculoskeletal barriers that keep a patient from moving.

The Role of Chiropractic Care

For properly evaluated patients, conservative chiropractic treatment may form one component of an integrated musculoskeletal program.

Depending on the patient’s condition, care may include:

Chiropractic Adjustments

Appropriately selected spinal or extremity manipulation may help improve joint movement and address mechanical restrictions.

Treatment should always be individualized according to:

• Age
• Bone health
• Medical history
• Imaging findings when indicated
• Neurological examination
• Joint condition
• Medication use
• Functional tolerance

Older patients may require gentler techniques than younger or athletic patients.

Joint Mobilization

Low-force mobilization can be useful when a patient has stiffness or restricted motion and more forceful techniques are not appropriate.

The goal is to help restore comfortable motion while respecting the patient’s limitations.

Soft-Tissue Therapy

Muscles often become tight or overworked when the body compensates for painful joints.

Soft-tissue techniques may be incorporated to address muscular tension and improve movement tolerance.

Spinal Decompression

In appropriately selected patients with certain spinal conditions, nonsurgical decompression may be incorporated into a broader conservative treatment program.

Use it based on clinical findings, not simply because a person has back pain.

Therapeutic Exercise

Exercise is one of the most important parts of long-term musculoskeletal care.

The objective is not simply to make a painful area feel better temporarily.

The objective is to improve the body’s ability to support itself.

Exercises may target:

• Core stability
• Hip strength
• Gluteal strength
• Quadriceps strength
• Posture
• Spinal mobility
• Balance
• Coordination
• Flexibility

This helps transition patients from passive care toward active rehabilitation.

Chiropractic Care as a Bridge to Exercise

For many older adults with obesity, conservative musculoskeletal treatment may work best when viewed as a bridge to greater physical activity.

Consider an individual with knee pain who can walk only five minutes before symptoms become uncomfortable.

If an integrated treatment program improves mobility and reduces symptom severity enough for that person to walk 10 or 15 minutes, this represents meaningful functional progress.

Improved movement can open the door to:

• More daily steps
• Resistance training
• Aquatic exercise
• Cycling
• Walking programs
• Physical therapy
• Balance exercises
• Recreational activities

This increased activity can then support metabolic health and weight management.

The goal is therefore not simply “pain relief.”

The larger objective is:

Pain reduction → improved movement → greater activity → stronger muscles → better function → greater independence

Resistance Training Is Especially Important

Resistance training is one of the most valuable interventions available for older adults with obesity.

It provides the mechanical stimulus the body needs to maintain muscle.

Appropriate strength training may help improve:

• Leg strength
• Joint stability
• Walking ability
• Balance
• Glucose use
• Bone health
• Functional independence

Exercises can be modified for people with joint pain.

Options may include:

• Resistance bands
• Chair-based strengthening
• Supported squats
• Machine exercises
• Water resistance
• Body-weight movements
• Light free weights

The starting point should match the patient’s abilities.

Progress is more important than intensity.

Low-Impact Cardiovascular Exercise

Cardiovascular exercise is also important, but running is not required.

For many older patients, lower-impact options are more appropriate.

These may include:

• Walking
• Swimming
• Water aerobics
• Stationary cycling
• Elliptical exercise
• Recumbent cycling
• Low-impact fitness classes

For a severely deconditioned patient, even five minutes of walking can be a reasonable starting point.

The body can gradually adapt.

Balance Training and Fall Prevention

Obesity and sarcopenia can both affect balance.

Poor balance combined with weak muscles and painful joints may increase fall risk.

Balance training may include:

• Supported single-leg standing
• Heel-to-toe walking
• Step exercises
• Sit-to-stand exercises
• Controlled weight shifting
• Tai chi
• Appropriate yoga
• Proprioceptive rehabilitation

The goal is to help patients feel safer and more confident during daily movement.

Flexibility and Mobility

Chronic inactivity can gradually reduce range of motion.

Flexibility work can target common areas of restriction such as:

• Hip flexors
• Hamstrings
• Calves
• Chest
• Shoulders
• Thoracic spine

Mobility exercises should complement strengthening, not replace it.

The best functional programs combine:

Mobility + strength + balance + cardiovascular activity

Nutrition Must Protect Muscle

Approach weight loss in an older adult differently than in a younger person.

Severe calorie restriction can cause significant muscle loss.

That is exactly what we want to avoid.

Nutritional planning should therefore prioritize nutrient-dense foods and sufficient protein.

High-quality protein sources may include:

• Eggs
• Poultry
• Lean beef
• Fish
• Greek yogurt
• Cottage cheese
• Legumes
• High-quality protein supplements when appropriate

Protein requirements should be individualized based on body composition, kidney function, medical conditions, activity level, and treatment goals.

Resistance exercise and adequate protein work together to protect lean tissue.

Vitamin D and Musculoskeletal Health

Vitamin D plays an important role in:

• Bone health
• Muscle function
• Neuromuscular control
• Strength

Older adults with obesity can be at greater risk of low vitamin D availability.

Other nutrients important to healthy muscle and bone function may include:

• Calcium
• Magnesium
• Vitamin B12
• Vitamin B6
• Omega-3 fatty acids

Supplementation should be individualized according to nutritional intake, laboratory findings, medical history, and medication use.

Obesity Is Also a Metabolic Condition

The musculoskeletal consequences of obesity should not distract us from its broader effects.

Obesity can contribute to multiple interconnected conditions, including:

• Type 2 diabetes
• Hypertension
• Cardiovascular disease
• Abnormal cholesterol
• Obstructive sleep apnea
• Metabolic liver disease
• Chronic inflammation
• Depression
• Reduced mobility
• Osteoarthritis
• Frailty
• Sarcopenia

These conditions can interact.

For example, poor sleep may increase appetite and fatigue. Fatigue can reduce physical activity. Reduced activity can contribute to muscle loss. Muscle loss can decrease metabolic capacity and make movement more difficult.

This is why effective obesity treatment often requires several healthcare disciplines working together.

Medical Weight-Management Options

Some patients may also benefit from medically supervised treatment.

Depending on the individual, treatment may include lifestyle modification alongside medications used for chronic weight management.

Options may include medications such as:

• Orlistat
• Phentermine/topiramate
• Naltrexone/bupropion
• Liraglutide
• Semaglutide
• Tirzepatide

Medication selection requires individualized assessment because older patients may have:

• Kidney disease
• Cardiovascular conditions
• Multiple medications
• Dehydration risk
• Gastrointestinal sensitivity
• Sarcopenia
• Nutritional deficiencies

A key concern during substantial weight reduction is preserving lean body mass.

For patients using GLP-1-based or related therapies, the treatment plan should not focus solely on how quickly body weight decreases.

Muscle preservation should remain a major priority through:

• Sufficient protein
• Resistance training
• Appropriate calorie intake
• Hydration
• Micronutrient assessment
• Regular functional testing
• Monitoring of body composition when available

Sleep Is Part of Weight and Pain Management

Sleep is another frequently overlooked part of musculoskeletal and metabolic health.

Poor sleep can affect hormones involved in:

• Hunger
• Satiety
• Stress
• Recovery
• Muscle repair

Poor sleep can also make chronic pain feel more intense.

Someone who sleeps poorly because of back or joint discomfort may become more fatigued the next day, move less, and rely more heavily on calorie-dense foods for energy.

Obstructive sleep apnea is also more common in people with obesity and should be appropriately evaluated when symptoms are present.

Improving sleep can therefore support both pain management and metabolic health.

Discovering the Benefits of Chiropractic Care- Video

Breaking the Cycle With Integrative Care

A patient with obesity, knee pain, weakness, and limited mobility may not benefit from addressing these problems separately.

An integrated plan might proceed like this:

Step 1: Identify the pain generator

Evaluate the spine, hips, knees, feet, gait, balance, muscle strength, and neurological function.

Step 2: Reduce mechanical barriers

Appropriate conservative care may include chiropractic treatment, mobilization, soft-tissue therapy, decompression when clinically indicated, and corrective exercise.

Step 3: Restore movement

Gradually improve joint mobility, walking tolerance, flexibility, and confidence.

Step 4: Build strength

Introduce progressive resistance training to preserve or increase muscle.

Step 5: Improve metabolic health

Use individualized nutrition, sleep optimization, and medical management when appropriate.

Step 6: Increase activity

As movement becomes easier, gradually increase walking and other forms of cardiovascular exercise.

This transforms treatment from simply “losing weight” into restoring function.

A Practical Example

Consider a 68-year-old woman with abdominal obesity, type 2 diabetes, hypertension, and knee osteoarthritis.

Her knee pain has gradually caused her to stop walking for exercise.

Over time, she loses leg strength.

Getting out of a chair becomes more difficult.

She becomes less active and gains additional fat while losing muscle.

Simply telling her to “exercise more” does not address the reason she stopped exercising.

A better approach begins by evaluating her musculoskeletal limitations.

Her program might incorporate:

• Gentle conservative care for painful mechanical restrictions
• Knee and hip mobility work
• Progressive quadriceps and gluteal strengthening
• Balance training
• Seated exercises initially
• Gradual walking
• Water exercise if available
• Individualized nutrition
• Adequate protein intake
• Medical management of diabetes and blood pressure

As her pain improves and her legs become stronger, walking may become easier.

She may then tolerate longer periods of activity.

That increased movement can support further improvements in metabolic health and weight management.

The treatment is not based on one therapy.

A combination of pain management, movement restoration, nutrition, muscle preservation, and medical care creates the opportunity for meaningful change.

The Goal Is Functional Longevity

For adults over 60, successful obesity treatment should not be measured only by pounds lost.

Important outcomes include:

• Walking farther
• Getting out of a chair more easily
• Climbing stairs
• Sleeping better
• Experiencing less musculoskeletal discomfort
• Improving balance
• Maintaining muscle
• Reducing fall risk
• Becoming more physically active
• Performing daily activities independently

A smaller number on the scale means very little if the patient becomes weaker in the process.

The better goal is improved body composition and improved function.

An Integrated Medical and Chiropractic Model

At Injury Medical Clinic PA in El Paso, we emphasize collaboration between disciplines.

As a chiropractor and advanced practice provider, I evaluate the relationship between metabolic health, biomechanics, neurological function, musculoskeletal pain, nutrition, and physical activity.

Working within an integrated medical model allows providers to consider obesity-related health concerns from several perspectives.

Medical providers can evaluate metabolic disease, cardiovascular risk, medications, laboratory findings, and medical weight-management options.

Chiropractic and rehabilitation care can focus on:

• Spinal and joint mobility
• Mechanical pain
• Movement limitations
• Posture
• Strength
• Balance
• Functional rehabilitation

Nutrition and lifestyle interventions can address:

• Dietary quality
• Protein intake
• Muscle preservation
• Hydration
• Sleep
• Physical activity

These approaches should complement, not replace, one another.

Conclusion: Treat the Patient, Not Just the Weight

Obesity in older adults is a complex condition involving far more than excess body fat.

It can contribute to metabolic disease while simultaneously affecting muscles, joints, mobility, balance, physical activity, and independence.

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

When pain prevents movement, inactivity may lead to additional muscle loss and functional decline. That weakness makes exercise more difficult, potentially contributing to further weight gain and additional stress on painful joints.

This cycle can be interrupted.

For appropriately selected patients, nonsurgical chiropractic and rehabilitative care may help reduce mechanical symptoms, improve mobility, restore function, and create a better foundation for physical activity.

The goal is not to present chiropractic treatment as a weight-loss therapy.

The goal is to recognize something much more practical:

A person who moves with less pain may be better able to exercise. A person who exercises can better preserve muscle. Preserving muscle improves function. Better function supports independence and healthier aging.

For adults over 60, successful obesity care should therefore focus on much more than the scale.

It should focus on helping people move better, feel better, remain strong, protect their joints, preserve their independence, and improve their overall quality of life.

References

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• Cruz-Jentoft, A. J., Bahat, G., Bauer, J., et al. (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Aging, 48(1), 16-31.
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• Franceschi, C., Garagnani, P., Parini, P., Giuliani, C., & Santoro, A. (2018). Inflammaging: A new immune-metabolic viewpoint for age-related diseases. Nature Reviews Endocrinology, 14(10), 576-590.
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• Messier, S. P., Mihalko, S. L., Legault, C., et al. (2013). Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis. JAMA, 310(12), 1263-1273.
• Nicklas, B. J., Chmelo, E., Delbono, O., Carr, J. J., Lyles, M. F., & Marsh, A. P. (2015). Effects of resistance training with and without caloric restriction on physical function and mobility in overweight and obese older adults. American Journal of Clinical Nutrition, 101(5), 991-999.
• Pahor, M., Guralnik, J. M., Ambrosius, W. T., et al. (2014). Effect of structured physical activity on prevention of major mobility disability in older adults: The LIFE study randomized clinical trial. JAMA, 311(23), 2387-2396.
• Rojano-Ortega, D., Perea-Carrasco, R., Jiménez-Pavón, D., et al. (2022). Association of movement behaviors with cardiometabolic risk factors, and the mediating role of adiposity markers in older adults. Nutrients, 14(19), 4011.
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