Learn how chiropractic care can support obesity treatment. Embrace a healthier lifestyle through focused chiropractic methods.

Abstract

Obesity in adults aged 60 and older is more than a body-weight concern. Excess body fat can interact with age-related muscle loss, chronic inflammation, metabolic changes, joint stress, poor sleep, reduced mobility, and declining physical conditioning. One important result can be a cycle in which obesity contributes to musculoskeletal pain, pain makes movement more difficult, inactivity accelerates muscle loss, and declining strength makes weight management even harder.

This relationship becomes especially important when sarcopenic obesity develops. Sarcopenic obesity combines excess adiposity with reduced skeletal-muscle mass, strength, or physical function. The condition can make walking, climbing stairs, getting out of a chair, maintaining balance, and remaining physically independent more difficult. Modern consensus recommendations therefore emphasize looking beyond body weight alone and considering muscle function and body composition when evaluating older adults (Donini et al., 2022).

In my integrative clinical approach, I connect obesity management with musculoskeletal care rather than treating it as a completely separate issue. I coordinate nutrition, resistance exercise, aerobic activity, balance training, appropriate medical management, sleep optimization, rehabilitation, and nonsurgical chiropractic care based on the patient’s needs.

Chiropractic care does not treat obesity itself. Its role is to help appropriately selected patients manage mechanical musculoskeletal symptoms such as back pain, stiffness, restricted motion, and movement limitations that may interfere with exercise. The larger goal is to improve mobility and physical capacity so that the patient can participate more comfortably and safely in active rehabilitation.

The objective is not merely a lower number on the scale. It is to preserve muscle and bone, reduce excessive central adiposity, improve mobility, decrease disability, support metabolic health, and help older adults maintain independence and quality of life.

My Integrative Care Model

I am Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST. My clinical background includes chiropractic care, advanced practice nursing, functional medicine, rehabilitation, and neuromusculoskeletal assessment. At Injury Medical Clinic PA in El Paso, Texas, we combine structural and musculoskeletal care with medical oversight.

Our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD, brings more than four decades of internal medicine experience to managing complex medical conditions, medication interactions, metabolic disorders, and age-related comorbidities.

Within this model, medical care can address diabetes, cardiovascular risk, kidney function, metabolic liver disease, sleep disorders, medications, laboratory findings, and other systemic concerns. Chiropractic and rehabilitation services can focus on mechanical pain, mobility, movement tolerance, balance, posture, functional strength, and returning the patient to safe physical activity.

Nutrition and behavioral strategies support the same overall goal.

This team-based model is particularly useful for older adults because obesity rarely exists by itself. It often appears alongside musculoskeletal pain, osteoarthritis, diabetes, reduced cardiovascular fitness, sleep disorders, weakness, and loss of mobility.

Obesity in Older Adults Is About More Than Weight

Obesity remains common in later life. National Health and Nutrition Examination Survey data collected from August 2021 through August 2023 found an obesity prevalence of approximately 38.9% among U.S. adults age 60 and older (Emmerich et al., 2024).

Yet the scale does not reveal what is happening inside the body.

A gradual reduction in skeletal-muscle mass and strength normally accompanies aging. Physical activity may decrease, resting energy needs may fall, and fat distribution can shift toward the abdomen.

This means an older adult may lose muscle while gaining fat without experiencing a dramatic change in overall body weight.

That is why I increasingly focus on body composition and function, rather than body weight alone.

Waist circumference, gait speed, grip strength, chair-rise ability, balance, exercise tolerance, and body-composition testing can add important information to BMI.

Sarcopenic Obesity: When Muscle Loss and Excess Fat Occur Together

Sarcopenic obesity is particularly concerning because it combines two conditions that can reinforce one another.

Excess adipose tissue can be associated with metabolic dysfunction and chronic low-grade inflammation. At the same time, reduced skeletal muscle can lower strength, mobility, glucose-disposal capacity, and physical activity.

The ESPEN and EASO consensus describes sarcopenic obesity as the coexistence of excess adiposity with reduced skeletal muscle mass and function and recommends assessment of both muscle function and body composition (Donini et al., 2022).

An older patient with sarcopenic obesity may experience difficulty with activities that were once routine, including standing from a chair, climbing stairs, carrying groceries, walking across a parking lot, or recovering after an injury.

These functional problems matter because independence in later life depends heavily on strength and mobility.

How Obesity Can Contribute to Musculoskeletal Pain

Musculoskeletal pain deserves much greater attention in obesity care.

Excess body weight can affect the musculoskeletal system through both mechanical and metabolic pathways.

Mechanically, greater body mass increases the force joints and supporting muscles must manage during standing, walking, stair climbing, lifting, bending, and rising from a chair.

The knees, hips, feet, ankles, pelvis, and lumbar spine may experience greater loading.

Metabolically, adipose tissue is biologically active. It releases signaling molecules that can contribute to systemic inflammation and may influence joint tissues and pain processing.

A 2024 review in Nature Reviews Rheumatology describes obesity-related osteoarthritis pain as a condition influenced by both increased mechanical loading and adipose-tissue dysfunction, including inflammatory and metabolic pathways (Binvignat et al., 2024).

For this reason, obesity-related musculoskeletal pain should not be viewed simply as “too much weight on the joints.”

It is more complex.

Obesity, Osteoarthritis, and Mobility

Osteoarthritis can become one of the most important barriers to exercise in an older adult.

A patient may know that physical activity is important but avoid walking because every step causes knee or hip discomfort.

Unfortunately, avoiding movement can weaken the quadriceps, gluteal muscles, trunk muscles, and other stabilizers.

The weaker these muscles become, the more difficult normal movement may feel.

Exercise and weight management are considered core conservative treatments for people with knee or hip osteoarthritis who also have overweight or obesity. The American College of Rheumatology and Arthritis Foundation strongly recommend exercise and weight reduction in this population (Kolasinski et al., 2020).

This illustrates why musculoskeletal and metabolic care should work together.

Obesity and Back Pain

The lower back is also affected by the interaction between weight, muscle function, posture, and physical activity.

The lumbar spine must support the upper body while controlling bending, rotation, walking, lifting, and balance.

Greater abdominal mass may change the mechanical demands on the lumbar spine and pelvis. If the patient also has weak trunk and hip musculature, the spine may have less muscular support during daily movement.

Pain can then lead to guarding and activity avoidance.

Body weight is only one possible contributor to back pain. Previous injuries, degenerative changes, repetitive occupational stress, sleep problems, muscle weakness, physical inactivity, psychosocial factors, and other medical conditions may also be involved.

A complete examination is necessary before deciding on the appropriate treatment.

The Pain-Inactivity-Sarcopenia Cycle

One of the most important concepts in older-adult obesity care is what I call the pain-inactivity-sarcopenia cycle.

An older adult develops knee, hip, foot, or back pain. Because movement is uncomfortable, walking decreases. As physical activity declines, muscles weaken. Cardiovascular conditioning falls. Balance may become poorer. Daily energy expenditure decreases.

The patient then has more difficulty controlling body weight.

More body weight can increase mechanical stress during movement, while worsening conditioning makes ordinary activities feel even more demanding.

The cycle can continue:

Excess adiposity increases mechanical and inflammatory stress, which leads to musculoskeletal pain, decreased activity, muscle loss and weakness, poorer mobility, and greater difficulty managing weight.

Successful treatment often means interrupting several parts of this cycle at once.

Where Chiropractic Care Fits

Chiropractic treatment should not be described as a direct treatment for obesity.

Its value within an integrative obesity program is primarily musculoskeletal.

A chiropractor can evaluate spinal and extremity mobility, mechanical pain, posture, gait, muscular imbalances, movement patterns, and functional limitations.

Depending on the patient’s diagnosis and overall health, conservative care may include spinal manipulation or mobilization, soft-tissue treatment, stretching, corrective exercise, mobility training, postural education, balance work, and home exercises.

The World Health Organization’s guideline for chronic primary low-back pain states that spinal manipulative therapy may be offered as part of care for adults, including older adults. WHO emphasizes coordinated and person-centered management rather than reliance on a single intervention (World Health Organization, 2023).

The evidence also requires appropriate perspective. A 2026 Cochrane review of 76 randomized trials found that spinal manipulative therapy may improve pain or function compared with sham or no treatment, while differences compared with other conservative treatments were generally smaller. The certainty of evidence was low to very low (de Zoete et al., 2026).

For that reason, chiropractic care is most appropriately used as one component of a larger active-care strategy.

Pain Relief Should Lead Toward Movement

The purpose of conservative treatment is not simply to make a patient dependent on passive care.

For many older adults, the more meaningful objective is to decrease a pain barrier enough that the patient can begin moving again.

For example, a patient with mechanical low-back discomfort may initially tolerate only short walks and gentle mobility exercises.

As symptoms become more manageable, the patient may progress to chair squats, resistance bands, core stabilization, longer walking periods, balance exercises, or supervised resistance training.

In that sense, appropriate chiropractic care can sometimes bridge pain and active rehabilitation.

The long-term gains come from rebuilding physical capacity.

Resistance Training Protects Muscle

Resistance exercise is one of the most important interventions for healthy aging.

Age-related reductions in strength are not inevitable or uniform for everyone. Resistance training can improve skeletal-muscle strength, function, and physical capacity even in older adults.

The National Strength and Conditioning Association position statement identifies resistance training as a powerful strategy for addressing age-related losses in muscle mass, strength, mobility, independence, and physical function (Fragala et al., 2019).

Resistance exercises may use machines, free weights, resistance bands, body weight, or carefully modified functional movements.

The starting level should match the patient’s ability.

A frail or deconditioned patient may begin with supported chair rises and resistance bands rather than heavy weights.

The important principle is progressive loading.

Aerobic and Resistance Exercise Work Together

Aerobic and resistance exercise offer different benefits.

Walking, swimming, cycling, and other aerobic activities improve cardiovascular fitness and endurance.

Resistance exercise is particularly valuable for strength and lean-mass preservation.

A randomized trial involving adults aged 65 and older with obesity compared aerobic, resistance, and combined exercise during weight reduction. The combined aerobic-plus-resistance program produced the greatest improvement in overall physical function, while resistance-containing programs better limited lean-mass loss than aerobic training alone (Villareal et al., 2017).

This supports a balanced program rather than focusing on only one type of exercise.

Mobility and Independence Matter

Exercise does not need to begin at an advanced level to matter.

The LIFE Study showed that a structured program involving walking, strength, balance, and flexibility activities reduced major mobility disability in at-risk older adults (Pahor et al., 2014).

For one patient, success may initially mean walking around the block.

For another, it may mean standing from a chair without using the arms.

For someone else, it may mean returning to gardening or walking through a grocery store without needing frequent rest.

View these functional gains as meaningful health outcomes.

Discovering the Benefits of Chiropractic Care- Video

Nutrition Should Protect Muscle

Weight reduction in an older adult should never focus only on cutting calories.

Aggressive calorie restriction can worsen muscle loss and potentially increase frailty.

Protein becomes especially important because older skeletal muscle becomes less responsive to normal anabolic signals.

The PROT-AGE Study Group recommends approximately 1.0 to 1.2 grams of protein per kilogram of body weight per day for many healthy older adults, with higher intake often considered for active individuals or those with acute or chronic illness. People with significant kidney disease may need different recommendations and should have individualized protein intake (Bauer et al., 2013).

Combine protein with resistance exercise whenever possible.

The exercise provides the stimulus to maintain or build muscle, while nutrition provides the amino acids needed to support that process.

A Mediterranean or DASH-Style Approach

A healthy eating pattern should emphasize nutrient density rather than simply restriction.

Mediterranean-style and DASH-style eating patterns provide useful frameworks because they emphasize vegetables, fruits, legumes, whole grains, lean proteins, nuts, seeds, and healthier fats while reducing excess sodium, added sugars, and heavily processed foods.

For older patients, the nutrition plan should also consider chewing ability, swallowing problems, appetite, finances, cultural preferences, cooking ability, food access, medications, and chronic disease.

A plan that looks ideal on paper but cannot be followed in daily life has limited value.

Weight Loss Should Be Function-Centered

Not every older adult needs aggressive weight reduction.

The decision should consider central adiposity, metabolic health, strength, frailty, bone health, physical function, medical conditions, medications, and personal goals.

For many patients, the desired outcome is not simply “lose as much weight as possible.”

A better goal may be:

reduce excessive fat while maintaining or improving muscle strength and physical function.

That distinction becomes especially important when using medications that significantly reduce appetite.

Pharmacotherapy and Older Adults

Modern anti-obesity medications have changed weight-management care.

GLP-1 receptor agonists and related incretin-based medications can substantially reduce body weight and improve several cardiometabolic measures.

The SELECT trial enrolled 17,604 adults with established cardiovascular disease and overweight or obesity but without diabetes. Semaglutide 2.4 mg reduced the incidence of the trial’s major cardiovascular endpoint compared with placebo, with a hazard ratio of 0.80 (Lincoff et al., 2023).

For older adults, however, medication management should include more than monitoring weight.

Clinicians should also watch appetite, hydration, protein intake, muscle strength, functional performance, medication interactions, gastrointestinal tolerance, fall risk, and overall nutritional status.

Resistance exercise and adequate nutrition remain important even when medication is effective.

Cardiometabolic Conditions and Obesity

Older adults living with obesity frequently have hypertension, insulin resistance, type 2 diabetes, dyslipidemia, cardiovascular disease, or reduced kidney function.

These conditions can affect how aggressively a patient should exercise or lose weight.

For example, hypoglycemia can increase fall risk. Orthostatic blood pressure changes may produce dizziness. Heart failure may limit exercise tolerance. Neuropathy may affect balance.

This is why medical oversight is an important part of the program.

The safest treatment plan connects metabolic care with physical function.

Musculoskeletal Pain Should Be Treated as a Barrier to Health

It is easy to tell a patient, “You need to exercise.”

It is more useful to ask:

What is preventing you from exercising?

For many patients, the answer is pain.

A painful knee can stop walking.

A painful lower back can make resistance exercise frightening.

Foot discomfort may limit standing.

Shoulder pain can interfere with upper-body strength training.

Treating these barriers can turn an obesity program from advice into something the patient can actually do.

Osteoarthritis and Conservative Care

For adults with osteoarthritis and excess body weight, conservative management commonly emphasizes weight management, exercise, strengthening, neuromuscular training, self-management, and other individualized nonsurgical strategies (Kolasinski et al., 2020).

Chiropractic care may complement this approach when a patient also has mechanical spinal pain, stiffness, restricted movement, or other neuromusculoskeletal problems that fall within the clinician’s scope.

The key is coordination.

Chiropractic treatment should support exercise and function rather than replace them.

Sleep and Recovery

Sleep should also be part of obesity management.

Poor sleep can influence appetite, fatigue, glucose regulation, mood, recovery, and willingness to exercise.

Musculoskeletal discomfort may also interrupt sleep.

An older adult who sleeps poorly because of back or joint pain may wake up exhausted, exercise less, and rely more heavily on convenient foods.

Screening for obstructive sleep apnea is also important because obesity is a major risk factor and weight management is considered a central component of care for adults with obesity-related sleep apnea.

Sleep treatment, pain management, physical activity, and nutrition can therefore support one another.

MASLD and Metabolic Health

Metabolic dysfunction-associated steatotic liver disease, or MASLD, frequently accompanies obesity and other cardiometabolic disorders.

Current guidance emphasizes multidisciplinary management, including nutritional assessment, physical activity, treatment of metabolic risk factors, and appropriate weight management (Kanwal et al., 2024).

For older adults, the same muscle-preservation principles apply.

Improving metabolic health should not come at the cost of significant lean-tissue loss.

Measuring Progress Beyond the Scale

The scale is useful, but it should not be the only measure of progress.

I prefer to monitor changes such as waist circumference, walking tolerance, chair-rise ability, gait speed, grip strength, balance, daily activity, pain interference, sleep quality, metabolic laboratory markers, and the patient’s ability to perform normal activities.

A patient who loses a modest amount of body fat but becomes substantially stronger may be doing better than someone who loses more weight while becoming frail.

Function matters.

Fall Prevention and Healthy Aging

Falls can dramatically change an older person’s life.

Reduced leg strength, impaired balance, pain, deconditioning, neuropathy, medications, poor vision, and fear of falling may all contribute.

Fall prevention may therefore involve strength training, balance exercises, gait work, medication review, home-safety assessment, vision care, appropriate footwear, and treatment of painful musculoskeletal limitations.

Chiropractic and rehabilitation care can contribute by addressing appropriate movement restrictions and helping patients practice safe movement, while medical providers address systemic and medication-related fall risks.

Personal Injury and Recovery

Obesity and sarcopenia can also complicate recovery from musculoskeletal injury.

An injury may temporarily reduce physical activity. For an older adult with limited muscle reserve, even a short period of inactivity can accelerate deconditioning.

Pain control should therefore be combined with a plan to restore activity.

Depending on the condition, this can involve conservative chiropractic care, physical rehabilitation, strengthening, walking progression, nutritional support, and medical evaluation.

The goal is not merely to reduce symptoms but to restore function.

An Integrative Step-by-Step Roadmap

A practical older-adult obesity program begins with assessment, not assumptions.

First, evaluate body composition and metabolic risk using measures such as waist circumference, appropriate laboratory testing, blood pressure, and medical history.

Next, evaluate function. Can the patient rise from a chair? How fast can the person walk? Is balance impaired? Is pain limiting movement?

Then identify barriers.

Pain may require musculoskeletal treatment. Poor nutrition may require dietitian involvement. Weakness requires progressive resistance exercise. Sleep apnea requires appropriate medical treatment. Medication side effects may require adjustment. Social or financial barriers may require community resources.

Once you identify these factors, you can layer treatment gradually.

The most sustainable plan is usually the one the patient can continue.

A Function-First Example

Consider an older adult with central obesity, knee discomfort, mechanical low-back pain, poor sleep, and weakness.

Prescribing calorie restriction alone may lead to additional muscle loss.

A more complete approach might begin with evaluation of the knee and lumbar spine, appropriate conservative treatment for mechanical pain, and gentle mobility exercises.

Nutrition can then emphasize adequate protein and nutrient-dense foods.

The patient may begin with chair rises, supported balance work, resistance bands, and short walks.

As pain and confidence improve, the patient can increase resistance training and walking volume.

The patient may lose some body fat, but the more important changes could be increased strength, better sleep, improved walking tolerance, and greater independence.

That is the type of outcome healthy-aging care should pursue.

The Role of the Collaborative Medical Team

Older-adult obesity care works best when patients don’t have to choose between structural care and medical care.

An internist or advanced practice provider can evaluate cardiometabolic disease, medications, renal function, glucose management, sleep disorders, and other medical concerns.

A chiropractor can address appropriate mechanical and neuromusculoskeletal barriers.

A physical therapist or rehabilitation professional can provide additional functional rehabilitation when needed.

A registered dietitian can personalize nutrition.

Behavioral-health professionals can assist when depression, anxiety, or behavior patterns interfere with progress.

The disciplines should communicate rather than compete.

Clinical Perspective: Treat the Barrier to Movement

One of the most practical lessons from integrative care is that movement becomes easier when we identify why it is difficult.

Sometimes the barrier is weakness.

Sometimes it is pain.

Sometimes it is fear of falling.

Sometimes it is poor cardiovascular endurance.

Sometimes it is an uncomfortable joint.

Sometimes it is sleep deprivation.

Sometimes it is a medication side effect.

The treatment plan should target the actual barrier.

Chiropractic Care as Part of Nonsurgical Management

For selected patients, chiropractic care can help address mechanical pain and movement restrictions without surgery.

Depending on the diagnosis, care may incorporate spinal mobilization or manipulation, soft-tissue techniques, movement education, mobility exercises, postural strategies, corrective exercise, and gradual return to activity.

Current evidence supports using spinal manipulative therapy as one possible component of conservative chronic low-back-pain care rather than presenting it as superior to all other therapies (de Zoete et al., 2026; World Health Organization, 2023).

The patient should also be screened for conditions requiring medical evaluation or referral.

The goal is responsible, integrated care.

Breaking the Cycle

Obesity and musculoskeletal pain can reinforce one another.

The negative direction looks like this:

Excess adiposity increases joint and spinal demands, leading to pain and stiffness, which reduces activity, causes muscle loss and deconditioning, and worsens mobility, leading to greater difficulty managing weight.

The therapeutic goal is to move the cycle in the opposite direction:

Appropriate pain management can improve movement tolerance, enabling progressive exercise that builds strength and function, increases activity, and supports healthier body composition and metabolic health.

This is why nonsurgical musculoskeletal care can have an important supporting role in a broader obesity program.

Conclusion: Healthy Aging Is About Capacity

Obesity management in older adults should not revolve exclusively around weight.

The real goals are broader.

We want to preserve muscle, maintain bone health, reduce excessive central adiposity, lower cardiovascular and metabolic risk, improve sleep, control musculoskeletal symptoms, prevent falls, and help patients keep participating in the activities that give their lives meaning.

Sarcopenic obesity reminds us why this balance matters.

A patient can lose weight but still become less healthy if they lose substantial muscle and function at the same time.

That is why nutrition and resistance exercise remain central.

Musculoskeletal pain should also be addressed rather than ignored. When pain prevents walking, strengthening, or normal activity, appropriate nonsurgical care can help remove a barrier to rehabilitation.

Within an integrated model, chiropractic care can complement exercise, rehabilitation, nutrition, and medical management by helping selected patients manage mechanical pain and improve movement.

The goal is not simply to help an older adult weigh less.

The goal is to help that person move better, become stronger, experience fewer functional limitations, maintain independence, and age with greater resilience.

References

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