Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review

Abstract

Obesity is widely acknowledged as a risk factor for both the incidence and progression of osteoarthritis, and has a negative influence on outcomes. Loss of at least 10& of body weight, coupled with exercise, is recognized as a cornerstone in the management of obese patients with osteoarthritis, and can lead to significant improvement in symptoms, pain relief, physical function and health-related quality of life. However, questions still remain surrounding optimal management. Given the significant health, social and economic burden of osteoarthritis, especially in obese patients, it is imperative to advance our knowledge of osteoarthritis and obesity, and apply this to improving care and outcomes. This paper overviews what is already known about osteoarthritis and obesity, discusses current key challenges and ongoing hypotheses arising from research in these areas, and finally, postulates what the future may hold in terms of new horizons for obese patients with osteoarthritis.

Factors influencing Health-related Quality of Life in Older Adults with Osteoarthritis: Based on the 2010-2011 Korea National Health and Nutrition Examination Survey

“…규칙적인 운동은 관절에 과도한 기 계적 부하를 경감시키고 관절 주변의 근력을 강화시켜 관절의 통증완화 및 기능향상에 도움이 된다 (Zhang et al, 2008). 그 에 반해 비만은 관절주변의 근육감소와 과도한 지방의 축적으 로 걷기 등 일상생활의 제한을 야기하고 전신적, 국소적 염증 으로 관절퇴화와 통증을 유발하기 쉽다 (Bliddal, Leeds, & Christensen, 2014). 한편 흡연과 골관절염의 발생과의 관계에 대해서는 아직 의견이 분분하지만 (Ding, Cicuttini, Blizzard, & Jones, 2007;Juhakoski et al, 2009;Mnatzaganian, Ryan, Reid, Davidson, & Hiller, 2013), 골관절염 환자를 대상으로 한 선행연구에서 흡연자는 비흡연자에 비해, 음주자 는 비음주자에 비해 건강 관련 삶의 질이 낮은 것으로 알려져 있다 (Jiang & Hesser, 2006;Park & Lee, 2012 (Jhun et al, 2010;Kim, 2013;Lee, 2014) …”

Obesity, Osteoarthritis and Pain

“…In addition, educational efforts directed towards providing obese osteoarthritis patients with a better understanding of how some of their pain is likely to be produced by chemicals in fatty tissue [35], as well, providing an understanding of how obesity can increase the risk for heart disease, diabetes, and hypertension or worsen these pre existing conditions as well as pain would seem helpful. Explaining that joint replacement surgery designed to reduce pain and disability is often complicated by the presence of obesity, and that those with lower body weights suffer less pain than those with higher body weights may be useful as well [1,12,36]. That is in addition to structured weight loss directives, preventative attempts to control pain plus the provision of thoughtful educational efforts that places emphasis on the benefits of weight loss including the lowered risk of excess osteoarthritis disability, and inflammatory body responses due to fatty tissue may prove highly successful.…”

“…At the same time, since being overweight even in the absence of pain is associated with increases in the amount of force across a weight-bearing joint [1], activity limitations, fatigue and muscle weakness [11] and the development of inflammatory products [1], and all these factors alone can hasten joint destruction the importance of reducing excess weight among overweight adults with this condition cannot be underestimated, especially in the early phases of the disease process [12]. Furthermore given that excess weight is strongly linked to osteoarthritis pain in a dose dependent fashion, even though the cause effect relationship between these variables may not be conclusive [13], the finding that the morbidly obese patient commonly has worse pain relief after total knee joint replacement surgery [14] and arthroscopy [15] and patients continue to use addictive opioids to relieve their pain [16] implies concerted efforts to effectively minimize the presence of excess body weight and pain among people with painful disabling osteoarthritis in a timely way is crucial.…”

Untitled

“…At the same time, since being overweight even in the absence of pain is associated with increases in the amount of force across a weight-bearing joint, 1 activity limitations, fatigue and muscle weakness 11 and the development of inflammatory products, 1 and all these factors alone can hasten joint destruction the importance of reducing excess weight among overweight adults with this condition cannot be underestimated, especially in the early phases of the disease process. 12 Furthermore given that excess weight is strongly linked to osteoarthritis pain in a dose dependent fashion, even though the cause effect relationship between these variables may not be conclusive, 13 the finding that the morbidly obese patient commonly has worse pain relief after total knee joint replacement surgery 14 and arthroscopy 15 and patients continue to use addictive opioids to relieve their pain 16 implies concerted efforts to effectively minimize the presence of excess body weight and pain among people with painful disabling osteoarthritis in a timely way is crucial. This brief describes some recent research concerning the link between obesity and painful osteoarthritis, and in light of the compliance challenges associated with dietary restriction, 17 plus enormous length of time and resources required to do this effectively the writer proposes a more comprehensive and timely strategy for fostering weight reduction and minimizing functional declines attributable to the overall disease process among obese osteoarthritis sufferers based on the available research.…”

“…Explaining that joint replacement surgery designed to reduce pain and disability is often complicated by the presence of obesity, and that those with lower body weights suffer less pain than those with higher body weights may be useful as well. 1,12,36 That is in addition to structured weight loss directives, preventative attempts to control pain plus the provision of thoughtful educational efforts that places emphasis on the benefits of weight loss including the lowered risk of excess osteoarthritis disability, and inflammatory body responses due to fatty tissue may prove highly successful. As well efforts to minimize stress may enable more optimal energy balance and activity levels, and may also reduce the risk of excess truncal obesity due to high cortisol levels, 10 plus the risk of depression that can foster weight gain.…”