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KNEE

Weight Gain and Osteoarthritis (OA)

by Cory Calendine, MD, Orthopedic Surgeon, Hip and Knee Specialist

Obesity impacts the lives of more than 40% of Americans,  and many experience knee pain with weight gain. In most cases, losing weight can help reduce joint pain and slow the progression of osteoarthritis (OA). Maintaining a healthy weight has many health benefits, including reducing joint wear and tear, reducing inflammation, and reducing the risk of other life-altering diseases.

X-ray changes associated with knee arthritis.

Body Mass Index, or BMI, is used as a screening tool for being overweight or obese. Body Mass Index (BMI) is a person’s weight in kilograms divided by the square of height in meters. A high BMI can be an indicator of high body fatness and risk for joint pain. According to one study, nearly 20 percent of individuals with moderate obesity(BMI of 35–39.9) have osteoarthritis of the knee versus only 3.7 percent of people with a healthy weight (BMI 18-25).

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Obesity and Osteoarthritis

Carrying additional weight puts extra pressure on our knees that can result in chronic pain and joint damage, including osteoarthritis. Being overweight or obese is proven to increase the risk of hand, hip, and knee osteoarthritis, with the greatest risk in the knee - and the risk increases proportionally with BMI. Increased body weight causes an exponential increase in pressure on the knees. Each additional pound of bodyweight can increase the dynamic load on the knee joints by more than 4 pounds. Of course, that also means that if you lose 10 pounds (4.54 kg), there will be 40 pounds (18.14 kg) less pressure on your knees with each step.

Each (1) pound of bodyweight produces (4) pound increase on knee impact pressure.

A comprehensive osteoarthritis treatment plan should recommend weight loss as a strategy for managing and reducing knee pain. Less pressure means less wear and tear on the knees and a lower risk of osteoarthritis. According to the American College of Rheumatology/Arthritis Foundation, losing just 5 percent of your body weight can have a positive effect on both knee function and treatment outcomes.

Weight Gain and Inflammation

Recent research suggests that inflammation may be a risk factor (rather than just a consequence) in the development of osteoarthritis. Obesity is associated with chronic low-grade inflammation in which there are elevated circulating inflammatory markers in the body. Although it is unclear exactly how obesity triggers inflammation, we know that excess weight gain increases total body inflammation and likely contributes to the increased risk of joint pain. Losing weight can reduce this inflammatory response. Studies have confirmed that weight loss of as little as 2 pounds (0.91 kg) a month can significantly decrease markers of inflammation in the body.

Osteoarthritis Link with Metabolic Syndrome

The association physicians have found with central obesity (elevated waist circumference), Type 2 diabetes, and cardiovascular disease risk factors (raised triglycerides, reduced high-density lipoproteins, and/or hypertension) is referred to as metabolic syndrome. All these disease processes involve high levels of inflammation, and there is growing evidence linking osteoarthritis with metabolic syndrome. The increased prevalence of osteoarthritis with obesity has long been established, with up to two thirds of the elderly obese population affected by osteoarthritis of the knee. Newer research confirms that abnormal cholesterol, elevated blood sugar, and even hypertension can contribute to the chronic inflammation seen in osteoarthritis.

The linked disease processes of metabolic syndrome -all associated with increased inflammation

These discoveries reaffirm the role weight loss plays in the management of osteoarthritis. Following a diet that reduces excess weight will help slow the progression of metabolic syndrome, while also reducing the joint pressure and inflammation associated with osteoarthritis.

Maintaining a recommended body weight (BMI 18.5-25), nutritious diet and high activity level has many health benefits, including:

  • reduced pressure and wear and tear on the knees
  • reduced joint inflammation
  • reduced risk of other diseases (diabetes, hypertension, hyperlipidemia)

Osteoarthritis, Nutrition and Exercise

It is important to discuss your diet and any weight changing goals with your physician or other qualified professional. Basic healthy diet guidelines include eating fresh foods that are high in nutrients, with a focus on fresh fruits and vegetables, fiber-rich foods, and healthy fats while limiting highly processed foods high in added sugar, saturated/trans fats and salt.

Together with healthy dietary choices, exercise can help with weight loss and reduce joint pain. Stay as active as possible with lower-impact activities including:

  • walking
  • cycling
  • weight training
  • water-based activities
  • tai chi
  • yoga

As well as contributing to weight loss, these can improve strength and flexibility, improve joint function and even reduce stress (an additional culprit of increased inflammation).

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General Weight Loss Tips

Safety and avoiding extremes should always be a part of any weight loss strategy. Set your goals based on gradual, daily improvements. Here are (5) evidence-based weight loss tips to start with:

  1. Drink water, especially before meals. Drinking water can boost metabolism by 24–30% over a period of 1–1.5 hours, helping you burn off a few more calories . One study showed that drinking a half-liter (17 ounces) of water about half an hour before meals helped dieters eat fewer calories and lose 44% more weight, compared to those who didn’t drink the water.
  2. Use smaller plates. Using smaller plates has been shown to help some people automatically eat fewer calories. However, the plate-size effect doesn’t appear to affect everyone - those who are overweight seem to benefit more.  
  3. Cut back on Added Sugar. (I know – way to obvious – but just a reminder) Added sugar is one of the worst ingredients in the modern diet and most of us consume way too much. Studies show that sugar (and high-fructose corn syrup) consumption is strongly associated with an increased risk of obesity, as well as conditions including type 2 diabetes and heart disease. Make sure to read labels, even so-called health foods can be loaded with sugar.
  4. Start lifting weights. One of the worst side effects of dieting is that it tends to cause muscle loss and metabolic slowdown, often referred to as starvation mode. One effective way to prevent this is to include resistance exercises like lifting weights. Studies show that weight lifting increases metabolism longer than aerobic exercise and can help prevent lean muscle mass loss.
  5. Chew more slowly. When it comes to feeling full, it takes some brains longer to register we’ve had enough to eat. Some studies show that chewing more slowly can help you eat fewer calories and increase the production of hormones linked to weight loss. Studies show that increased chewing may reduce calorie intake at a meal.
Watch for additional research-proven weight loss tips in upcoming blog post.

These are a few evidence-based basics that can help with weight loss, and there are many more – improving sleep, increasing fiber, etc. We’ll follow-up soon with a blog post dedicated to weight loss strategies. If you are overweight and suffering with osteoarthritis, your doctor may suggest setting a goal to lose 10 percent of your weight and aiming for a BMI of 18.5–25, which may help reduce knee pain and prevent joint damage from getting worse. Focus on eating healthy versus a crash diet. If anything, people who diet tend to gain more weight over time, and studies show that dieting is a consistent predictor of future weight gain. Make daily changes that have been proven to reduce weight gain, limit joint pain and improve your quality of life.

Summary

There is a link between weight gain, obesity, and osteoarthritis. A high body weight or body mass index (BMI) can put additional pressure on your knees, increase inflammation and increase your risk of joint damage and pain. Taking the necessary steps to manage your weight can help protect your knees from joint pain and reduce your risk of osteoarthritis. If you're suffering with joint pain and looking for answers please contact our office. Subscribe to blog for regular bone and joint health news and updates and follow us on social media. Click Contact Button at top of page to schedule appointment today.

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Cory Calendine, MD is an Orthopaedic Surgeon and founding partner of the Bone and Joint Institute of Tennessee at Williamson County Hospital in Franklin, TN. Dr. Calendine is an expert in Joint Replacement, specializing in Hip and Knee Surgery. From diagnosis through treatment, the Orthopaedic Surgical experts at the Bone and Joint Institute use the latest techniques and technology to improve care for people with musculoskeletal problems. For more information, please contact our office or schedule your appointment today.  
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