To examine the association between overweight and health problems of the lower extremities, i.e. osteoarthritis (OA), pain and disability.

Cross-sectional data from the Dutch population-based Musculoskeletal Conditions & Consequences Cohort (DMC3), comprising a random sample from the Dutch population aged >25 years (n 3664), were analysed using multivariate logistic regression. Overweight was defined as BMI ≥ 25·0 kg/m2, moderate overweight as 25·0 kg/m2 ≤ BMI < 30·0 kg/m2 and obesity as BMI ≥ 30·0 kg/m2. Health problems of the lower extremities were: (i) self-reported OA of the hip or knee as told by a doctor; (ii) presence of self-reported chronic pain (>3 months) of the lower extremities; and (iii) disabilities in mobility as measured by the Euroqol questionnaire (EQ-5D).

Moderate overweight was associated with self-reported OA of the hip or knee (OR = 1·7; 95 % CI 1·4, 2·1), chronic pain of the lower extremities at one or more location(s) (OR = 1·6; 95 % CI 1·3, 1·9) and disability in mobility (OR = 1.7; 95 % CI 1·4, 2·0). For obesity these odds were higher: 2·8 (95 % CI 2·1, 3·7), 2·5 (95 % CI 1·9, 3·2) and 3·0 (95 % CI 2·3, 3·9), respectively. Also, among those with OA, moderate overweight and obesity were associated with disability in mobility.

There is a strong association between overweight/obesity and health problems of the lower extremities, i.e. OA, pain and disability. The increasing prevalence of overweight and obesity worldwide urges for public health action not only for diabetes and heart disease, but also OA.