I would think that a belt is better for back pain. A vest puts all the weight on your shoulders, which translates to the back. A belt puts all the weight on your hips, which translate directly to the legs, bypassing the back. One of the major problems for troops (think young, strong, men) is the weight of all the gear on their body armor. Most of it is all on the vest. As a result, they are getting lots of compressed discs. One of the solutions is to support the body armor with hip belts. It is also the same reason why backpacking packs have hip belts, to transfer the load off the shoulders/back, to the hips.
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