BACKGROUND: Obesity is increasingly being recognized as a significant risk factor for the development and worsening of back pain. In order to make possible adjustments to therapies and lifestyle, the relationship must first be understood. METHOD: This article attempts to explain the relationship between obesity and back pain based on the existing literature. RESULTS: The significant underlying factors are biomechanical overload and altered posture due to increased body fat percentages. Systemic reactions to the adipose tissue itself are also under discussion. Nevertheless, the connections between obesity and back pain are likely to be more complex than previously assumed. CONCLUSION: The relationship between obesity and back pain is multifactorial. Obesity increases the risk of back pain due to biomechanical stress, systemic inflammation, and altered posture. Further research is needed to respond to the anticipated increase in the number of obese patients.