ABSTRACT Background Although low back pain and obesity are major health issues for women, our understanding of the relationship between these conditions is limited. This study aimed to investigate the relationship between occupational activities and low back pain and disability in obese and non-obese, middle-aged females. Methods Eighty-nine obese and 56 non-obese participants were recruited for a community-based study of musculoskeletal health. Low back pain intensity and disability were examined using the Chronic Pain Grade Questionnaire and participants were asked about their involvement in occupational activities. Results More manual activity and heavy lifting, bending or squatting were found to be associated with low back pain intensity in obese females (odds ratio (OR) 1.83, 95 confi dence interval (CI) 1.14 ? 2.94; OR 3.02, 95 CI 1.24 ? 7.37, respectively), but not in non-obese females (OR 0.83, 95 CI 0.42 ? 1.63; OR 0.81, 95 CI 0.25 ? 2.6, respectively), after adjusting for age and recreational activity. Similarly, there were also relationships between performance of more manual activity and heavy lifting, bending or squatting and low back disability in the obese (OR 1.68, 95 CI 1.07 ? 2.63; OR 2.79, 95 CI 1.21 ? 6.46, respectively), but not in the non-obese (OR 0.88, 95 CI 0.36 ? 2.13; OR 1.78, 95 CI 0.39 ? 8.22, respectively). Conclusions Obese females who perform predominately manual activity or heavy lifting, bending or squatting at work have high levels of low back pain and disability, independent of their recreational activity. This was not the case for non-obese, female workers. Although longitudinal investigation is needed, these fi ndings highlight the role of obesity in low back pain and disability for middle-aged females in occupational settings.