The Link Between Obesity and Osteoarthritis

According to the World Health Organization (WHO), the worldwide prevalence of overweight and obesity has nearly tripled since 1975. One of the results of this drastic increase is a marked rise in health conditions like cardiovascular disease, type 2 diabetes, and some forms of cancer. Much of this is due to the effects of obesity on the circulatory system, metabolism, and other biochemical systems. Yet one effect of obesity that also has a strong correlation is more mechanical in nature: osteoarthritis. 

What Is Osteoarthritis?       

Osteoarthritis (OA) is a degenerative joint disease in which the cartilage and bones of the joints degrade and break down over time. Affecting over 30 million adults in the United States annually, osteoarthritis is the most common form of arthritis and one of the most common causes of disability in the general population. Unlike some other forms of arthritis, however, osteoarthritis is primarily caused by mechanical stress on the joints over a long period; this is also why it tends to occur much more frequently in older people.  

Articular cartilage is the soft tissue that covers the surfaces of bone where they come together at the joints. This tissue acts as a cushion and support for bones and allows joints to function without bones directly touching. When this cartilage starts to degrade, though, the bones start rubbing up against each other. In addition to causing a variety of symptoms related to joint movement, the bones themselves will eventually start to wear down. Below are some of the most common symptoms of osteoarthritis:

• joint pain
• stiffness
• tenderness 
• loss of flexibility 
• sensation of grating at the joints along with popping or crackling noises
• swelling in the tissue around the joint 
• bone spurs can form on the bones around the joint

What Are the Risk Factors for Osteoarthritis?   

Osteoarthritis is sometimes referred to as a “wear-and-tear” disease because of the fact that it is caused by mechanical forces. But it’s important to note that it generally isn’t caused by regular physical activity or exercise without injury. The stresses that lead to losing cartilage may be, for example, from a misalignment of bones, an injury, or the loss of strength in the muscles that support a joint. (It also can’t happen because of cracking your knuckles too much.) However, there are some risk factors that increase the likelihood of developing the condition: 

• Age: 88% of people with osteoarthritis are over the age of 45, but the onset tends to be more prevalent from ages 55-64.  
• Gender: Osteoarthritis is more common among men younger than 45 but is more common among women over the age of 45. Overall, women account for 62% of cases.
• Injury: Injury—such as from playing sports or a car accident—can make osteoarthritis more likely. Even injuries from years earlier that have seemingly healed can cause a misalignment or another problem that leads to osteoarthritis.
• Repetitive stress: Properly performed weight lifting and exercise are not known to contribute to osteoarthritis directly, but repetitive stress from physical activity experienced long enough can put you at higher risk of OA.  
• Genetics: You are more likely to develop osteoarthritis if you have family members who also have it. Also, congenital defects in bones or joints can create the circumstances for stresses that make it more likely.   

How Are Obesity and Osteoarthritis Connected? 

Of course the other main factor that increases the risk for osteoarthritis is being overweight or obese. Some of the earliest data for this came from the Framingham Knee Osteoarthritis study, a population-based study that observed patients over several decades. The 1990 Framingham study showed that obesity has a strong tendency to precede and increase the risk of developing knee osteoarthritis (knee OA). More recent research has further shown that people with a body mass index (BMI) of 30 or more are 6.8 times more likely to develop knee OA. 

The fact that obesity is a significant factor for specifically knee osteoarthritis and not hip or hand osteoarthritis (hand OA) suggests that one of the main reasons is because of mechanical loading; in other words, the stress of literal additional body weight makes it more likely. Yet there are potentially a number of other ways obesity is also connected to osteoarthritis: 

• Joint loads: At a certain point (that is different for everyone), excess weight can begin to put a lot of stress on weight-bearing joints. With every step, shifting weight puts pressure and stress on joints. Any kind of misalignment can increase this effect, even for people who aren’t overweight or obese. The same cartilage exposed to increasing pressure will eventually start to degrade. 
• Inflammation: Obesity in general is considered a low-grade inflammatory state that has a negative impact on many body systems. This inflammation comes from proteins called adipokines that are released from adipose tissue (body fat). One common adipokine is leptin, a protein involved in satiety that is also known to promote the creation of pro-inflammatory cytokines that can contribute to tissue degradation. This means that being an obese individual can compound the effects of extra body weight on joints by additionally making the tissues more likely to degrade.  
• Faster disease progression: Obesity is a risk factor for developing osteoarthritis, but it is also a factor in the more rapid progression of the disease. Obese patients will experience a faster degradation of their joints and are thus more likely to require total knee replacement or another type of joint replacement surgery. 
• Worsens other health problems: The connection between obesity and a number of other health conditions is well documented; both obesity and osteoarthritis are linked to heart disease, stroke, depression, metabolic syndrome, and type 2 diabetes. This is largely due to the inflammation related to adipose tissue, and it can make a person even more susceptible to other health problems and require additional healthcare interventions. 

The Benefits of Losing Weight 

A clear link has been established between osteoarthritis of the knee and weight gain; obese people (and particularly obese women) are more likely to develop knee OA that leads to knee pain, loss of flexibility, and other symptoms that can negatively affect a person’s quality of life. Because of this, and because of the comorbidities associated with being obese, one of the most effective treatments for osteoarthritis is weight loss. In addition to relieving pressure on knee joints, it can lead to overall more positive health outcomes.    

In the Framingham study noted above, the researchers also looked at the potential effects of weight loss on osteoarthritis. They found that for older patients who were able to reduce their BMI from obese (30 or over) to overweight (26-29.9) or from overweight to normal weight (less than 26), there would be a 20-30% reduction in knee osteoarthritis and related symptoms. Depending on a person’s height and weight, that means even a moderate reduction in body weight could make a significant difference in osteoarthritis.  

How to Achieve Sustainable Weight Loss

If you have osteoarthritis, losing weight is one of the best things to do to ease symptoms and improve your quality of life. That’s typically easier said than done, though. The truth is that most people struggle to lose even a little bit of weight. And even when they do, the pounds tend to come back after a couple months. It can feel like an endless cycle of highly restrictive dieting and often punishing exercise routines followed by overeating. 

At True You Weight Loss, we understand how challenging it can be to make progress on your weight loss journey. That’s why we are proud to offer a new approach that can help you break the cycle and find the freedom you’ve been looking for. With non-surgical endobariatric procedures like ESG, you’ll get the help you need to make permanent changes so you can lose the weight and keep it off. If you’d like to learn more about True You, please contact us today to request a consultation.