Association between body mass index and musculoskeletal disorders among agricultural workers: a systematic review

Increasing Body Mass Index (BMI) is a global health concern associated with adverse health outcomes. Musculoskeletal disorders (MSDs) are prevalent among agricultural workers and substantially impair quality of life and work productivity. However, evidence on the association between BMI and MSDs in farming populations remains limited. This systematic review examines the relationship between BMI and MSDs among farmers to inform targeted occupational health strategies. A systematic review was conducted across three electronic databases (PubMed, Embase, and SCOPUS) from their inception to May 23, 2025, in accordance with the PRISMA 2020 guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The review included cross-sectional, cohort, and case-control studies that investigated the association between BMI and MSDs among farmers. Studies were required to report adjusted effect estimates, including odds ratios (OR), prevalence ratios (PR), hazard ratios (HR), or relative risks (RR). The quality of the selected articles was appraised using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools. A total of 19 studies were included in this review. The majority of evidence suggests that an elevated BMI is associated with an increased risk of MSDs, particularly in the back, pelvic, and lower extremities among farmers. Conversely, two studies identified higher BMI as a protective factor against MSDs in the upper body and back region. The proportion of items in the NHLBI ranged from 36% to 78%, indicating variable methodological quality of the included studies. Higher BMI is significantly associated with an increased risk of MSDs among farmers, particularly in the back, pelvic region, and lower extremities. Therefore, MSDs prevention and early intervention should be prioritized to reduce disease incidence. Furthermore, improved understanding of the biomechanical and physiological mechanisms linking excess BMI to MSDs may inform clinical management and guide appropriate treatment strategies.