When Dr. Elbaridi was practicing as a physical therapist early in his career, he had a patient heading toward her second knee surgery. During one of her treatment sessions, he asked her a question. What do you think would happen if I put a backpack on you and asked you to walk a few flights of stairs? She said it would be very difficult. What if I took the backpack off? She said her knee would feel better.
He never finished the conversation. He was pulled into the office and told the patient had perceived his comment as offensive.
That moment stayed with him. Not because the observation was wrong, but because the system had no structure for acting on it. The weight issue was visible to everyone and addressed by no one.
That is the gap that Episode 5 of Inside the Loop explores. Dr. Elbaridi sat down with the team from Revolution Physical Therapy and Weight Loss, a Chicago-based practice with 13 locations, to talk about back pain and weight loss, why the two cannot be treated separately, and what a program that actually addresses both looks like in practice.
How Extra Weight Puts Pressure on the Spine
The spine is a load-bearing structure. Every pound of body weight above what your frame is built to carry adds mechanical stress to the vertebrae, discs, and the muscles and ligaments that support them.
The relationship is not one to one. Research on joint loading consistently shows that additional body weight multiplies the force placed on weight-bearing joints. The commonly cited figure for the knee is that every pound of body weight translates to roughly four pounds of force on the joint during walking. The lumbar spine operates under similar principles. The further from the spine that weight is carried, particularly in the abdominal region, the greater the leverage effect on the lower back.
What this means clinically is that a person carrying 30 extra pounds is not placing 30 extra pounds of load on their lumbar discs. They are placing significantly more, and that excess load accelerates disc degeneration, compresses nerve roots, and strains the paraspinal muscles that are already working to keep the spine upright.
This is the mechanical side of the connection between back pain and weight loss. Reduce the load, and the structures of the spine have less to contend with.
Will My Back Hurt Less If I Lose Weight?
Yes, with an important qualifier: how you lose the weight matters as much as how much you lose.
Weight loss achieved through caloric restriction alone, without building strength and improving movement patterns, does not necessarily translate to reduced back pain. Patients on aggressive caloric deficits or extended fasting protocols frequently report an increase in lower back pain during the process. The reason is muscle loss. When the body is in a prolonged caloric deficit without adequate protein and resistance training, it breaks down muscle alongside fat. The core and paraspinal muscles that stabilize the lumbar spine weaken, and back pain can worsen even as the number on the scale drops.
Back and hip pain after weight loss, particularly rapid weight loss, is a real and underrecognized pattern. As fat redistributes and muscle mass shifts, movement mechanics change. A spine that was adapted to carrying a certain load for years can respond unpredictably when that load changes quickly without a corresponding change in muscle support.
The spine needs muscular support to function without pain. Weight loss that preserves or builds that support relieves back pain. Weight loss that erodes it can make things worse before they get better, or not better at all.
Does Losing Weight Decompress the Spine?
Yes. Excess body weight, especially abdominal weight, compresses the intervertebral discs and narrows the spaces through which spinal nerves exit. Losing weight reduces that compressive force, which can relieve pressure on discs and nerve roots. This is one reason patients with herniated discs or lumbar stenosis often experience meaningful pain reduction after sustained weight loss, sometimes without any other intervention.
The decompressive effect is most significant at the lumbar level because the lower back bears the greatest proportion of total body weight. For patients with diagnosed disc herniation, degenerative disc disease, or lumbar nerve compression, weight loss is not just a lifestyle recommendation. It is part of the clinical treatment plan.
Why Physical Therapy and Weight Loss Cannot Be Treated Separately
Most patients with back pain who are overweight have seen one of two types of providers: a physician who told them to lose weight without explaining how, or a physical therapist who treated the back without addressing the weight. Both approaches fall short of the same root problem.
Wes Williams, a licensed physical therapist with more than 40 years of experience and COO of Revolution Physical Therapy, explained it this way on the podcast: traditional physical therapy looks at the injury and focuses on recovery. What Revolution does is look at the total body, the injury, the weight, the movement patterns, the lifestyle, and what happens after discharge.
The mechanical logic is straightforward. Strengthening the core and the muscles that support the spine reduces pain. Reducing load on the spine through weight loss reduces pain further. Doing both simultaneously produces results that neither approach achieves alone.
The program at Revolution is structured to address all three simultaneously. Patients come in three times per week for physical therapy, which includes manual therapy, corrective exercise, and targeted cardiovascular work calibrated to their individual heart rate zones using VO2 max testing. They also meet weekly with a dietician and weekly with a behavioral health specialist, both conducted virtually to remove the barrier of additional in-office travel.
The GLP-1 Factor: What Semaglutide Patients Need to Know
GLP-1 medications including semaglutide and tirzepatide have become widely prescribed for weight management. Chela Velli, the physician assistant on the episode, noted that many of her patients were referred to Revolution specifically because they were plateauing on GLP-1 medications or had lost weight but had not made the lifestyle changes needed to maintain it.
The concern that Dr. Elbaridi and the Revolution team discussed directly is muscle wasting. GLP-1 medications reduce appetite significantly, which can result in inadequate protein intake and caloric restriction severe enough to cause muscle loss alongside fat loss. This is the same mechanism behind lower back pain during caloric deficit: the spine loses its muscular support as the body sheds lean mass along with fat.
For someone with back pain, losing core and paraspinal muscle while losing overall body weight can limit or counteract the pain relief benefits of weight reduction. The clinical answer is not to avoid GLP-1 medications. It is to pair them with a structured resistance program and adequate dietary protein to preserve lean mass while losing fat.
Revolution is currently conducting a research study in partnership with UIC examining exactly this question: whether patients on GLP-1 medications lose strength compared to those who are not, and how that affects musculoskeletal outcomes. They are tracking body composition using bioelectrical impedance to measure lean muscle mass alongside weight.
If you are currently taking a GLP-1 medication and have chronic back pain, a pain management and physical therapy evaluation can help you understand whether your muscle mass is being preserved and what your movement patterns look like under your current weight.
The Role of Behavioral Therapy in Chronic Back Pain and Weight
One of the most underappreciated elements of any long-term pain or weight management effort is behavioral therapy. At Revolution, the behavioral health specialist is the first person a new patient sees. The intake process starts with a readiness evaluation using cognitive behavioral therapy and motivational interviewing techniques to understand what motivates the patient, what obstacles they face daily, and what behavioral changes are realistic for them.
Zach, Revolution’s exercise physiologist, made the point clearly: you cannot out-exercise a bad diet, and exercise and nutrition alone will not fix chronic weight issues if the underlying behaviors are not addressed. For patients with chronic back pain, the behavioral component matters for an additional reason. Pain shapes behavior. Patients in chronic pain move less, avoid certain activities, and often experience depression and anxiety alongside their physical symptoms. Behavioral therapy that addresses these patterns alongside physical treatment produces better long-term outcomes than physical treatment alone.
Inside the Loop Episode 5: Physical Therapy, Weight Loss, and the Full Picture
Episode 5 of Inside the Loop brought Dr. Elbaridi together with the leadership team from Revolution Physical Therapy and Weight Loss to talk through a model of care that very few practices have built.
Wes Williams is a licensed physical therapist with more than 40 years of clinical experience and the Chief Operating Officer of Revolution Physical Therapy and Weight Loss. He still treats patients regularly.
Zach is an exercise physiologist and the director of Revolution’s lifestyle medicine and weight loss program.
Chela Velli is a physician assistant who serves as the clinical liaison between Revolution’s locations and referring providers.
Revolution Physical Therapy and Weight Loss has 13 locations across Chicago and the surrounding suburbs. They accept all PPO plans, Workers Compensation, Medicare, and Illinois Medicaid.
Watch the full episode:
About our guests:
Revolution Physical Therapy and Weight Loss
When to See Dr. Elbaridi for Back Pain
Dr. Elbaridi evaluates and treats back pain when the source involves the spinal structures, nerve roots, or musculoskeletal system, and when conservative treatment alone has not provided adequate relief.
Consider scheduling an evaluation if:
- You have chronic low back pain and have been told that losing weight would help, but you are not sure where to start
- You are currently on a GLP-1 medication and experiencing persistent back pain despite weight loss
- Your back pain is limiting your ability to exercise or engage in a weight loss program
- You have had physical therapy before but the results did not last
- You were injured at work or in an accident and are managing both pain and weight-related complications
Loop Medical Center treats patients across all insurance types, including Workers Compensation and Personal Injury cases. Same-week appointments available at both Chicago locations.
Frequently Asked Questions
What can cause weight loss and back pain at the same time?
Several conditions can cause both simultaneously. Aggressive caloric restriction or fasting can lead to muscle loss in the core and paraspinal muscles that support the spine, increasing back pain even as body weight drops. Inflammatory conditions, hormonal changes, and spinal degeneration can also produce both symptoms. If you are losing weight without trying and experiencing new or worsening back pain, a clinical evaluation is warranted to rule out an underlying condition.
Will my back hurt less if I lose weight?
In most cases, yes. Excess body weight increases mechanical load on the lumbar spine, compresses intervertebral discs, and strains the muscles that support the back. Losing weight reduces that load. However, the way you lose weight matters. Weight loss that includes core strengthening and adequate protein intake to preserve muscle is significantly more effective at reducing back pain than weight loss through caloric restriction alone, which can weaken the very muscles the spine depends on.
Does losing weight decompress the spine?
Yes. Excess weight, particularly in the abdominal region, compresses the intervertebral discs and narrows the spaces through which spinal nerves exit. Reducing body weight decreases that compressive force, which can relieve pressure on discs and nerve roots. Patients with herniated discs, degenerative disc disease, or lumbar stenosis often experience meaningful pain reduction after sustained weight loss as a direct result of reduced spinal compression.
Why does my lower back hurt more when I am in a calorie deficit?
Lower back pain during a caloric deficit is typically caused by muscle loss. When caloric intake drops significantly without adequate protein and resistance training, the body breaks down muscle tissue alongside fat. The core and paraspinal muscles that stabilize the lumbar spine weaken, increasing mechanical stress on the discs and joints. This is especially common with extended fasting or very low calorie diets. A structured program that pairs caloric reduction with resistance training prevents this pattern.
I am taking semaglutide or another GLP-1 medication. Should I be doing physical therapy at the same time?
Yes, and this is particularly important. GLP-1 medications can cause muscle loss alongside fat loss when protein intake is insufficient or caloric restriction is severe. For patients with back pain, losing core muscle mass while losing body weight can limit or counteract the pain relief that weight reduction would otherwise provide. A structured physical therapy program that includes resistance training, coordinated with your dietary plan, helps preserve lean muscle while you lose fat.
Is a combined weight loss and physical therapy program covered by insurance?
In many cases, yes. When weight is a contributing factor to a musculoskeletal condition such as back pain, the physical therapy component is typically covered by most PPO plans, Workers Compensation, Medicare, and in some cases Medicaid. Loop Medical Center works with most major insurance types and can clarify what your plan covers before your first appointment.
Ready to Talk About Your Back Pain?
If your back pain has not responded the way you expected, or if you know your weight is part of the picture and you are not sure what to do about it, the right next step is a conversation with Dr. Elbaridi.
He will review your history, examine what is actually happening in your spine and the surrounding structures, and tell you honestly what is driving the pain and what the most effective path forward looks like.
Call or text: (312) 414-1088
South Loop: 1921 S Michigan Ave, Chicago, IL 60616
Streeterville: 432 E Grand Ave, Suite A, Chicago, IL 60611
Medically reviewed by Dr. Nidal Elbaridi, Interventional Pain Management Physician, Loop Medical Center, Chicago. Last updated: July 2026.