Brunilda Nazario, MD
It makes perfect sense if you think about it: carting around extra weight in
your middle, for example, places a burden on your knees and hips. And study
after study shows that this extra stress can put you at risk for developing
osteoarthritis (OA), the wear-and-tear form of the disease. Being overweight or
obese will also amplify your pain and make it harder for you to remain active
and independent if you've already got OA.
With obesity rates soaring, it's no wonder that 27 million Americans now
have OA, according to the Arthritis Foundation. But modest weight loss --
dropping just 10 to 15 pounds -- can make a huge difference in your knee and
hip OA pain, and may even postpone or prevent joint replacement surgery.
As of now, there are no medications that can help modify or stop the OA
disease process once it has started, so weight loss and exercise have become
"Being overweight puts too much pressure on the joint, and stresses the
tendons and a number of other structures around the joint like your muscle,"
explains Emilio B. Gonzalez, MD, chief of rheumatology at University of Texas
Medical Branch in Galveston. "Overweight people usually develop accelerated
osteoarthritis in their weight-bearing joints like hips and knees, so one of
the treatment strategies is to lose weight."
"Any weight loss can make a difference in pain control and delaying the
progression of the condition," Gonzalez says. "In some cases, we can prevent
the need for surgery, but this depends on how advanced the OA is."
Many orthopaedic surgeons won't even do the surgeries if you are overweight,
so there is really no way to feel better without first slimming down, he says.
Being overweight increases the risk of any surgery, including joint
His prescription? "Lose weight if you can, and exercise a little bit," he
suggests. "The best exercise is aquatic because your body floats and there is
no extra pressure placed on the joints and muscles."
Walking can also aid weight loss efforts. "The best surface to walk on is grass
or a softer surface because pounding on concrete can increase tendon damage,"
"If you achieve significant weight loss, you will get symptomatic relief,"
says Michael Parks, MD, an assistant attending orthopaedic surgeon at the
Hospital for Special Surgery in New York City."There is no hard and fast
number," Parks says. "It varies from patient to patient."
"If you decrease your body size, the load on your knees will go down,"
agrees Laura Thorp, PhD, an OA researcher at Rush University Medical center in
Chicago. Higher than normal knee loads are characteristic of knee OA and
progression, she explains. A study in Arthritis & Rheumatism showed
that losing just 1 pound resulted in a fourfold reduction in knee joint load
among overweight and obese people with knee osteoarthritis.
But if losing weight were really so easy, wouldn't more people do it?
Yes, says David Felson, MD, a professor of medicine and public health at
Boston University School of Medicine. "If we could only get people to adhere to
weight loss and exercise regimens, we could forestall and even prevent the need
for total knee replacement," he says. "Weight loss and exercise are the initial
therapies for OA and the thing we speak to everyone about."
The trick is to set people up to succeed, not fail, he says.
"I usually tell my OA patients to lose 10 to 15 pounds," Felson says. "I do
not want to create an impossible goal because unless they have bariatric
surgery, losing 50 pounds is probably not reasonable."
"I say, 'look, let's keep this reasonable: how can we help you lose 10 to 15
Being more active is just one part of the equation, he says. "I may
recommend a nutritionist to help with diet, and then I will review their
favorite foods and their calories and healthier substitutes with them."
Choosing whole-grain over white-bread products is a good place to start.
Whole-grain products such as oatmeal and whole-wheat bread and pasta are better
sources of fiber than their refined counterparts (white bread and white pasta).
The more fiber a food has, the more full you feel, and the less likely you are
SOURCES:Emilio B. Gonzalez, MD, chief, rheumatology, University of Texas Medical
Branch, Galveston.Michael Parks, MD, assistant attending orthopaedic surgeon, Hospital for
Special Surgery, New York City.Laura Thorp, PhD, assistant professor, anatomy and cell biology, Rush
University Medical Center, Chicago.David Felson, MD, professor, medicine and public health, Boston University
School of Medicine.Messier S.P., Arthritis & Rheumatism, 2005; vol 52: pp
2026-2032.Arthritis Foundation web site: "OA Basics: Who is at Risk?"
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