<![CDATA[Low back pain (LBP) and overweight are common health problems that contribute to disability. Obesity may affect the lumbar spine through increased mechanical loading, alterations in sagittal balance, low-grade systemic inflammation, and paraspinal muscle fatty degeneration. This review aims to synthesize the association between overweight or obesity and LBP, particularly based on findings from radiography, magnetic resonance imaging (MRI), and computed tomography (CT). A literature search was conducted using PubMed, ScienceDirect, and Google Scholar for publications from January 2021 to September 2026. Twenty journal articles met the inclusion criteria following screening based on topic relevance, full-text availability, study design, and radiological contributions. The reviewed evidence indicates associations between overweight and intervertebral disc degeneration, reduced disc height, osteophyte formation, Modic changes, facet joint degeneration, spondylolisthesis, spinal stenosis, spinal epidural lipomatosis, and paraspinal muscle myosteatosis. MRI provides the most comprehensive assessment of discs, bone marrow, neural structures, epidural fat, and muscles. Radiography is useful for evaluating alignment and structural changes under weight-bearing conditions, whereas CT excels in depicting bone abnormalities and facet joint changes. However, imaging abnormalities do not always correspond to pain intensity or disability. Modality selection should follow clinical indications, and interpretation should consider anthropometric and functional data. Prospective studies using standardized obesity measures and quantitative imaging are needed to clarify causal and prognostic relationships.]]>
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