HERNE, Germany (July 1, 2025) – Severe obesity appears to be a significant factor in developing specific spinal changes associated with diffuse idiopathic skeletal hyperostosis (DISH) in individuals with metabolic syndrome (MetS).
Obesity Linked to DISH Spinal Changes in Metabolic Syndrome Patients
New research suggests a strong connection between higher obesity levels and the progression of DISH-related spinal alterations.
What is the main finding of this study?
A recent study indicates that severe obesity is linked to specific spinal radiographic changes in patients diagnosed with metabolic syndrome (MetS).
The study, published online on July 1, 2025, in The Journal of Rheumatology, investigated the impact of obesity on DISH-related spinal radiographic changes compared to degenerative changes in 124 patients diagnosed with metabolic syndrome. These patients had diabetes, hypertension, and a body mass index (BMI) of 25 or higher.
Study Design and Participants
Researchers retrospectively examined the effect of obesity on DISH-related spinal radiographic changes versus degenerative changes in patients with metabolic syndrome. Participants were categorized into four obesity classes based on their BMI: Class 0 (BMI 25.0-29.9), Class I (BMI 30.0-34.9), Class II (BMI 35.0-39.9), and Class III (BMI 40 or higher). Spine and chest radiographs were analyzed to identify both DISH-related “chunky” spondylophytes and degenerative spondylophytes. DISH was diagnosed if spondylophytes spanned at least four contiguous vertebrae.
Key Findings
Among the study participants with metabolic syndrome, a notable 33.9% were diagnosed with DISH. Patients diagnosed with DISH showed significantly more DISH-related chunky spondylophytes (P < .0001) and fewer degenerative spondylophytes (P = .04) when compared to those without DISH.
Furthermore, individuals in obesity classes II and III exhibited significantly more DISH-related chunky spondylophytes than those in classes 0 and I (P = .02). While the number of degenerative spondylophytes was comparable between these groups, DISH patients in the higher obesity classes (II and III) had more DISH-related chunky spondylophytes (14.1) than those in lower classes (9.7), though this specific difference was not statistically significant.
- Over a third (33.9%) of patients with metabolic syndrome in the study were diagnosed with DISH.
- Patients with DISH had substantially more DISH-related chunky spondylophytes.
- Higher obesity levels (Classes II and III) were associated with more DISH-related chunky spondylophytes.
- Weight management might be crucial for mitigating DISH progression in metabolic syndrome patients.
Clinical Implications
The researchers suggest that their findings support the idea that obesity may not only be a co-occurring condition but a primary driver in the formation of DISH-related chunky spondylophytes. They emphasized that the strong link between obesity and DISH-related radiographic changes highlights the critical need to incorporate weight management strategies into the routine care of patients with metabolic syndrome. This approach could potentially help slow down the progression of these spinal changes.
Limitations and Disclosures
The study’s retrospective design may have introduced selection bias. Additionally, the cohort was exclusively comprised of patients with metabolic syndrome, potentially overrepresenting obesity and its related conditions, which could limit the generalizability of the findings to broader populations.
The study received no financial or industrial support, and the authors declared no conflicts of interest.
The study was led by David Kiefer, MD, of Ruhr-Universität Bochum in Herne, Germany.
