Musculoskeletal pain may be an indication of excessive fat mass, which occurs beyond excessive mechanical loading. This is the first review which revealed a significant connection between increased fat mass and widespread pain, low-back pain, knee pain and foot pain. The results from longitudinal studies portrayed that the elevated body fat may infer to high risk of incident or worsening joint pain. 

Musculoskeletal pain and obesity are strongly linked, but there is rising proof that body fat, not body weight, maybe a better sign of risk. This systematic review assessed the relationship between musculoskeletal pain and obesity.

A total of seven electronic databases were examined from beginning to 8th January 2018 and selected the associated longitudinal and cross-sectional studies. Selected studies were evaluated for methodological severity using the Epidemiology Appraisal Instrument.

A total of 28 unique articles selected after the abstract and full-text review of the selected citations. Meta-analyses were perform with fourteen studies. Persons with knee and low back pain exhibited higher body fat percentage as compared to the asymptomatic controls. An albeit weak, significant connection was seen between the fat mass index and foot pain. Longitudinal studies were irrelevant for meta-analysis, however, were extensively indicative of raised body fat raises the risk of incident and worsening joint pain. Conflicting evidence was noticed between incident low-back pain and body fat percentage. The body fat percentage and fat mass index positively correlated with increased knee pain and incident foot pain. Each study that ranged from 23 to 85% graded as 'yes' in the EAI for the percentage of items, showing the variable methodological quality of the involved studies.

A positive cross-sectional relationship was noticed between enhanced body fat and widespread and single-site joint pain in the knee, low-back, and foot. Longitudinal studies propose raised body fat may indicate an elevated risk of incident and worsening joint pain; however, further high-quality studies are needed.