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AN ORTHO-PINION

Michael L. Parks, MD

Any views or recommendations shared in the Ortho-pinions blog are solely those of the authors and do not necessarily represent those of the American Academy of Orthopaedic Surgeons.

Obesity has grown to epidemic proportions in America. Its effect reaches across all segments of our society. Obesity is most prevalent among African Americans and Hispanics — up to 58 percent of those populations are affected. There is a strong association with multiple medical comorbidities including cardiac disease, and stroke, and higher rates of osteoarthritis and diabetes among those with obesity. This cycle of increasing disease burden has become increasingly recognized as a significant public health problem.

As an orthopaedic surgeon who specializes in total joint replacement, it is common for me to see patients who complain of significant limitation from painful arthritic hips or knees. A significant proportion of these patients also are obese. Together, the obesity and painful joints contribute to a vicious cycle of decreased mobility. High rates of diabetes and heart disease are associated with obesity and further complicate the care of these patients. Because the conditions are not painful, some of these patients do not regularly seek medical care. All of these issues must be considered by physicians and other healthcare professionals when evaluating patients with significant obesity.

As mobility specialists, our primary job is to seek to restore our patients' mobility. Joint replacement and nonoperative modes of treatment of arthritis are very successful at relieving pain and allowing patients to regain activity. Unfortunately, several studies have shown that many patients suffering from obesity fail to lose weight after joint replacement. Other studies have indicated higher rates of hospital resource utilization and surgical complications when joint replacement is performed on patients with obesity.

I open a dialogue and encourage my patients to seek help through a variety of sources — their primary care doctor, a nutritionist, an obesity specialist or commercially available nutritional services. I also encourage patients who have not recently seen a primary care doctor to be evaluated, to discuss ways to manage their weight, and to have an open discussion about obesity implications on their general health. The goal is not just weight loss but patient empowerment —to have patients be an active participant in their care.

In my opinion, it is imperative that we as specialists not operate in isolation with bones and joints as the sole area of treatment. We should seek to discuss the issue of obesity in an open and nonjudgmental fashion with our patients. We need to be part of the solution. To ultimately manage this complex problem, it requires teamwork between the patient, the orthopaedist and the primary care doctor. This communication is the best way to provide a safe and satisfactory outcome for our patients.

Learn more about Obesity, Weight Loss and Joint Replacement Surgery

This Ortho-pinion was originally written for A Nation in Motion, the AAOS's award-winning public awareness campaign dedicated to sharing the stories of people whose lives were improved by orthopaedic surgery.