title: Is obesity overrated as a "risk factor" for poor outcomes in chronic occupational spinal disorders?
abstract: METHODS
  Prospective cohort study.
  
  
  OBJECTIVE
  To investigate whether obesity is a risk factor for poor socioeconomic outcomes in patients with chronic occupational spinal disorders beginning an interdisciplinary functional restoration program.
  
  
  BACKGROUND
  Obesity is known as a risk factor for a multitude of physical and mental health disorders. A classification system can define obesity based on body mass index (BMI). Limited evidence is available on the effect of obesity on rehabilitation from chronic occupational spinal disorders.
  
  
  METHODS
  A large cohort of chronic occupational spinal disorder patients with extended disability (average 16 months) following work-related injuries (n = 2483) were divided into 5 groups based on BMI. Socioeconomic outcomes were identified through a 1-year post-rehabilitation structured telephone interview. Patients were also assessed before and after intervention with validated questionnaires measuring pain intensity, functional deficits, and depression. The interdisciplinary functional restoration program was individualized for length of disability and severity of physical and psychological deficits.
  
  
  RESULTS
  The prevalence of obesity in this population was high. Only 22% of patients were "normal" (BMI <25), while 43% were obese (BMI >30). There was a significant linear trend for males to be progressively less represented as obesity increased. There was also a significant trend for hypertension to be associated with greater levels of obesity. However, there were no significant differences in site of injury, disability duration, or attorney representation among the groups. Most importantly, there were no statistically significant differences in all but 1 of the socioeconomic outcomes among any of the obese groups and the normal weight patients. There was a trend toward higher pretreatment and posttreatment functional assessment scores (i.e., greater perception of disability), and a linear trend for higher pretreatment depression ratings across BMI groups, although they all improved at comparable rates after treatment.
  
  
  CONCLUSIONS
  Obesity is more prevalent and severe in chronic occupational spinal disorders when entering a functional restoration program as the final step in a prolonged treatment regimen. We conclude that obesity, even gross obesity, has no significant impact on outcomes of an interdisciplinary functional restoration program for patients disabled an average of 16 months.
authors.affiliation: Department of Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA. tgmayer@aol.com
authors.forename: Tom
authors.initials: T
authors.lastname: Mayer
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Aceska
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gatchel
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology*; D009784:Occupational Diseases / Q000150:complications* / Q000453:epidemiology* / Q000534:rehabilitation; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013122:Spinal Diseases / Q000150:complications* / Q000453:epidemiology* / Q000534:rehabilitation; D016896:Treatment Outcome