Years of wear and tear can make people more prone to joint pain as they age. Excess body weight can worsen that process.
As a bariatric surgeon, many of the patients I meet are living with joint pain or arthritis that's worsened by excess weight. That can lead to a difficult cycle: Pressure and stiffness often make it harder to exercise or even perform everyday activities like walking or climbing steps, making it harder for my patients to manage their weight. Without activity, it is extremely difficult to lose weight.
But there's a reason to feel encouraged. After losing significant amounts of weight via bariatric surgery, most of my patients notice that their joints start to feel a lot better. If you or a loved one is considering weight-loss surgery for joint problems or your orthopedic surgeon is recommending weight loss before you can have surgery, here are a few answers to my patients' most common questions.
How Can Excess Weight Cause Joint Pain?
The joints in the lower half of the body, especially the knees and the hips, bear most of our weight as we stand, walk, climb, run, and perform other daily activities. This weight exerts a lot of pressure: For instance, every pound of bodyweight places 4 to 6 pounds of pressure on the knee joint. So the higher a person's weight, the more force gets exerted on their joints.
Over time, the pressure from excess body weight can increase joint wear and tear, leading to aches, pains, and stiffness. A person may also be more prone to musculoskeletal injuries, including ankle fractures, spontaneous knee dislocations, or heel bone fractures.
There's more to the picture. Body fat also creates and releases chemicals that triggers inflammation. This can exacerbate joint problems in the lower extremities and even cause pain in other joints, like the hands or wrists.
What are the Long-Term Effects of Excess Weight on the Joints?
Over time, the added wear and tear on the joints caused by a higher body weight frequently leads to osteoarthritis (OA), a painful joint condition. OA happens when a joint's cartilage "cushion" degenerates, causing bones to rub against each other directly. This can cause severe discomfort, irritation, and swelling.
Because excess weight increases pressure and wear and tear on joints, obesity is a significant risk factor for osteoarthritis. A person maybe 4 to 5 times more likely to develop OA if their body mass index (BMI) is between 30 and 35. The odds for joint problems continue to increase as weight goes up.
In some cases, the wear and tear caused by OA could result in irreversible joint damage that may ultimately require a knee or hip replacement. A person with obesity is up to 20 times more likely to need a knee replacement than someone who is not overweight. They may also be at higher risk for negative outcomes such as postsurgical infections or a prosthetic joint becoming loose or failing. In general, to have an orthopedic procedure or even a hernia repaired, the BMI should be less than 35 to minimize complications.
How Can Bariatric Surgery Help Joint Pain?
Losing weight takes pressure off of sore, overworked joints, which can help relieve pain and stiffness.
I've seen firsthand how patients can benefit from my bariatric surgery practice. Their joint symptoms tend to improve, and everyday activities like walking, standing, or getting up from a chair become easier and more manageable. And though existing joint damage can't be reversed, further joint damage will slow or even stop altogether.
After their surgeries, my patients are often amazed at the effects — and, as they continue to lose weight, the benefits to their joints continue to increase.
Losing body fat also lowers the amount of inflammatory chemicals that the body produces. This can ease joint symptoms elsewhere in the body (like the hands) and reduce activity from inflammatory forms of arthritis, like rheumatoid arthritis.
Some of my patients choose bariatric surgery after being told that a needed joint replacement surgery may be too risky. In these cases, the significant weight loss that follows bariatric surgery also makes the procedure safer — and more effective. It lowers the risk for complications such as infections and blood clots. Additionally, it reduces the risk of joint dislocations and failed implants and may help speed recovery after the surgery. I find that many of my patients can go on to have successful joint replacement surgery in as little as 6 to 12 months after undergoing bariatric surgery. And in some cases, losing weight helps to prevent or delay the need for joint replacement surgery.
How Can I Stay Active While I Work Toward Losing Excess Weight?
Regular physical activity is essential to any weight-loss program, including for people who have undergone bariatric surgery. But it can be hard to exercise when your joints ache.
There are treatments patients can utilize to manage their joint pain and remain as active as possible. We will communicate with your other doctors to come up with a plan that’s right for you, which can include:
- Oral or topical anti-inflammatory pain relievers
- Prescription musculoskeletal pain-relievers
- Pain-relieving injections, such as corticosteroids or viscosupplementation
- Radiofrequency ablation, an outpatient procedure that can improve knee pain for up to a year
In addition to pain relief, it helps to take a joint-friendly approach to exercise. I often recommend low-impact activities like swimming, water aerobics, or walking laps in a pool. Water-based exercises provide resistance to help you burn calories while taking weight off of your joints to minimize discomfort. If exercising in the water isn't feasible, bicycling or using an elliptical machine are other good options.
I also encourage patients to pay attention to their posture during exercise and throughout the day. Standing up straight reduces strain in the neck, hip, and knee joints, easing some pressure and discomfort.
How Can I Take the First Step?
If you're considering bariatric surgery to manage your joint pain, learn more by registering for one of Temple's free bariatric surgery informational seminars.
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