Abstract

Obesity has emerged as a global health epidemic and a major determinant of musculoskeletal (MSK) morbidity 
across the lifespan. This narrative review synthesizes epidemiological, biomechanical, metabolic, and clinical 
evidence to elucidate how excess adiposity affects the structure and function of the musculoskeletal system. 
Obesity is strongly associated with a higher prevalence and severity of osteoarthritis, intervertebral disc 
degeneration, foot and ankle disorders, sarcopenic obesity, and chronic back pain. Mechanical loading alone cannot 
fully explain these relationships, as adipose tissue acts as an active endocrine organ producing adipokines and 
proinflammatory mediators that impair cartilage integrity, alter bone remodeling, and contribute to chronic pain. 
Metabolic comorbidities, including insulin resistance, dyslipidaemia, and systemic inflammation, further 
compromise skeletal homeostasis and muscle quality. Site-specific effects are noted across the spine, hip, knee, 
ankle, and peripheral joints, with the knee demonstrating the most consistent obesity-related structural 
deterioration. The bidirectional nature of obesity and MSK disorders is increasingly recognized, as 
musculoskeletal pain limits physical activity and may reinforce weight gain. Evidence from rehabilitation studies 
demonstrates that tailored exercise interventions, weight management strategies, and targeted nutritional or 
pharmacological therapies can improve pain, function, and overall musculoskeletal health. However, substantial 
gaps remain, including limited longitudinal data, inconsistent measurement of adiposity, and underexplored 
mechanisms linking metabolic syndrome, sarcopenic obesity, and degenerative joint disease. This review 
underscores the need for integrated clinical, public health, and policy interventions to mitigate the burden of 
obesity-related musculoskeletal disorders and improve functional outcomes across populations.