Obesity and Osteoarthritis

Facts to Know Before We Start

• Worldwide statistics show that obesity is on the rise having tripled since 1975.
• Alarmingly, in India, childhood obesity too is on the rise and this is predicted to increase further.
• In many a case, obese children turn into obese adults.
• When it comes to adults in India, 1 in 4 adults are obese.
• Women with obesity increase their risk for knee osteoarthritis by 4 times compared to women who are normal weight.
• For men who are obese, the risk of knee osteoarthritis rises by 5 times.

Understanding Obesity

Obesity is a common long-term condition that affects children and adults. Obesity means having an excess of body fat. Body mass index (BMI) is often used as a standard to diagnose obesity. Going by the WHO’s definition, a person with a BMI of 25 or more is overweight while a person with a BMI of 30 or more is obese.

Though BMI is a commonly used tool to categorize a patient’s weight, it is not always accurate as it does not take into account a person’s muscle mass. For example, a highly muscular athlete might not have his BMI in the normal range but this does not mean he is obese.

The fundamental cause for obesity is the difference between the calories consumed and the calories burnt. This can be due to many factors:

• The food choices we make – increased intake of high fat or high energy foods increases the probability of obesity.
• For the sake of convenience, a lot of regular activities have been made easier thanks to technology be it online shopping or taking the elevator instead of the stairs. This reduces the number of calories we burn.
• Lifestyle choices and physical inactivity too have a telling effect on obesity.

Unlike alcohol or smoking, the above factors do not have a social stigma attached to them. But this does not mean that done on a long-term basis, they are any less detrimental to our health.

What Is Osteoarthritis?

The most common manifestation of arthritis, osteoarthritis is a degenerative condition that affects joints. It commonly affects the knees, hips, hands and spine. Other joints may also get osteoarthritis if risk factors like previous injury, cartilage disorder, etc. are present. But unlike rheumatoid arthritis, osteoarthritis does not affect other organs in the body.

The Basics

• The ends of our bones are covered in cartilage.
• This cartilage is rubbery and flexible in nature and its function is to facilitate smooth joint movement.
• When affected by osteoarthritis, the cartilage loses its flexibility and becomes stiff. As a result, it becomes susceptible to injury.
• As the cartilage wears away, smooth, friction-free movement is compromised and with time the bones may start to rub against each other.

Causes

• Obesity increases the risk of osteoarthritis of weight bearing joints, especially the knees.
• The condition could even be hereditary.
• Injury to joints increases the probability of developing osteoarthritis.
• Repetitive movements that place stress on the joints increase risk of osteoarthritis.
• Increasing age and gender (women are more likely to develop osteoarthritis) also play a role.
• Those with rheumatoid arthritis are likely to develop osteoarthritis.
• Conditions like diabetes which result in inflammation in the body can increase osteoarthritis risk.

Symptoms

• Joint pain during repetitive movement.
• Joint pain after a period of prolonged inactivity.
• Decreased flexibility after rest.
• Inflammation at the joints.
• The joint may also feel warm.
• Bone spurs at joints.
• In severe cases, the joint pain will be present even while at rest.

It should be kept in mind that symptoms vary from patient to patient. While some may find the condition disabling, others might be able to carry on with their daily activities. The pain may also be intermittent, flaring up in intervals.

For knee osteoarthritis, as the condition progresses, the knees will gradually bend outwards and the patient might limp while walking. As cartilage degeneration progresses, the limp will worsen.

Diagnosis & Treatment

• Diagnosis involves a physical examination and imaging tests. There is no blood test to diagnose osteoarthritis but a doctor might recommend a blood test to rule out other possible conditions.
• Treatment involves medication that will help ease pain along with physiotherapy. Joint replacement surgery is suggested as a last option.

Obesity and Osteoarthritis – The Link

• There is no doubt that there is a clear link between a person’s body weight and his risk of developing osteoarthritis (especially of the knee).
• Extremely obese individuals’ risk of developing knee osteoarthritis increases by a whopping 10 times.
• Even a small reduction in weight can have a great effect on a person’s probability of developing knee osteoarthritis.
• Studies have found that in women with a BMI >= 25, a weight drop of around 5 kg (in terms of BMI, a reduction of 2 BMI units) lessens knee osteoarthritis risk by 50%.
• For patients who already have the condition, weight loss will lead to pain reduction.
• For elderly men who are obese and overweight, weight loss which moves them to a lower weight category would decrease knee osteoarthritis risk by 21.5%.
• Similar changes in weight in elderly women would lower the risk by 33%.

Combating Obesity

Obesity as a problem has slowly grown over the years and has become intertwined with the way we live which makes it a lot more difficult to manage. To really control obesity, involvement of the entire society is needed. Starting from schools and workplaces to the government, obesity is something which we need to fight collectively. It involves creating an environment where by default we choose healthy options.

• Often, we think twice about walking to a place nearby due to the absence of footpaths or alternatively badly maintained, dirty footpaths. Similarly, absence of paths meant exclusively for cyclists translates to people preferring their cars. If local authorities could pay attention to these things, people will get an opportunity to increase their activity level.
• Considering the amount of time people spend at their workplace, it would be ideal if the workplace provided some kind of activity area for the employees. Programs on healthy eating and access to a nutritionist are other measures that can be considered.
• Schools need to make sure their cafeterias do not serve any kind of junk food. Students and staff should have access to only healthy options. Physical education classes should be given importance and made enjoyable so that students look forward to them.
• By increasing access to healthy food items and by increasing taxes on unhealthy food items, the government can push people towards healthy eating.