As part of Arthritis Awareness Month, it is important to remember that obesity and arthritis are often related diseases, with excess weight worsening joint deterioration and pain from joint disease, leading to weight gain through inactivity.
Arthritis and obesity are also two of the most common diseases in the US. Recently, it was estimated that nearly 1 in 4 adults have arthritis and that 42.4% of adults suffer from obesity.
Arthritis is defined as any inflammation of a joint and the most common form seen is osteoarthritis (OA), otherwise known as “wear and tear arthritis” where cartilage breaks down.
Obesity is defined as a body mass index (BMI) >30, which is calculated using height and weight. In addition to arthritis, obesity is also linked to a large and growing number of diseases—including heart disease, diabetes, and cancer—and is associated with nearly 20% of all deaths in the U.S. between 1986-2006. Unfortunately, the problem of obesity has tripled between 1960 and 2010 and only continues to worsen. Further, obese patients often face a bias in society, as well as the health care system, and are less likely to seek care for existing health problems, such as arthritis, or receive treatment that may prevent death and disability.
Obesity increases the risk of and can accelerate and worsen the changes seen with OA. However, weight loss improves many of the movements and outcomes seen in patients with OA. A study from 2009 looked at the number of years men and women in the U.S. spend disabled by the age of 70, and how much that can be attributed to obesity and arthritis. The study found that men suffered an average of 1.2 years of disability due to arthritis and 1.4 years due to obesity by the time they were 70. This rose even higher for women, with them having 2.1 years of disability due to arthritis and 1.7 years due to obesity by the age of 70.
Fortunately, there are very safe and effective options to treat both OA and obesity. In fact, obesity surgery and joint replacement are some of the safest operations offered to patients, with mortality of 0.1% or less for each type of procedure. Although joint replacement surgery can greatly improve function, obese patients may be too heavy to safely undergo the surgery and their weight will reduce the period of time in which they will observe benefits from the orthopedic surgery. Often, patients with a BMI >40 will need to lose weight in order to be eligible for joint surgery, and they may be referred for obesity surgery or bariatric medicine to improve their risk of complications with surgery and comorbidities. A recent randomized control trial showed a decrease in complications after knee replacement if obesity surgery was performed first.
Obesity surgery, otherwise known as bariatric surgery, is highly effective in reducing weight, helping to resolve or improve high blood pressure, sleep apnea, high cholesterol, joint pain, breathing disorders and diabetes. Furthermore, obesity surgery can reduce a patient’s risk of premature death by 30-50%. Positive changes seen with bariatric surgery depend on long-term changes to dietary intake and hormonal changes in a patient’s body.
The main operations offered are the sleeve gastrectomy, roux-en-Y gastric bypass, and duodenal switch with an average weight loss ranging from 25-40% of a patient’s body weight and 77% excess weight loss within 12 months. Significant and sustained weight loss is seen in up to 85% of patients undergoing bariatric surgery.
For those patients who are unable or unwilling to undergo surgery, weight loss medications can also be effective in weight loss, with new prescription drug options recently made available.
References:
- Adult Obesity Facts. 2021 [cited 2022; Available from: https://www.cdc.gov/obesity/data/adult.html.
- Arthritis Awareness Month: Expanding Interventions for Arthritis. 2022 [cited 2022; Available from: https://www.cdc.gov/arthritis/communications/features/arthritis-awareness.html.
- Obesity in America. 2021; Available from: https://asmbs.org/resources/obesity-in-america.
- The impact of obesity on US mortality levels: the importance of age and cohort factors in population estimates. Am J Public Health, 2013. 103(10): p. 1895-901.
- Weight bias and health care utilization: a scoping review. Prim Health Care Res Dev, 2019. 20: p. e116.
- Obesity and the role of bariatric surgery in the surgical management of osteoarthritis of the hip and knee: a review of the literature. Surg Obes Relat Dis, 2017. 13(1): p. 111-118.
- The impact of obesity and arthritis on active life expectancy in older Americans. Obesity (Silver Spring), 2009. 17(2): p. 363-9.
- How safe is metabolic/diabetes surgery? Diabetes Obes Metab, 2015. 17(2): p. 198-201.
- Effect of Bariatric Surgery on Risk of Complications After Total Knee Arthroplasty: A Randomized Clinical Trial. JAMA Netw Open, 2022. 5(4): p. e226722.
- Quick fix or long-term cure? Pros and cons of bariatric surgery. F1000 Med Rep, 2012. 4: p. 19.
- Prescription Medications to Treat Overweight & Obesity. 2021; Available from: https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity.
