Obesity and Osteoarthritis

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Across the world obesity rates are increasing dramatically and unfortunately this is no different for us here in New Zealand. We currently have the third highest rate of obesity in the OECD and one in three adult New Zealanders are classified as obese(1). Obesity is well known to be associated with health conditions such as Type 2 diabetes, stroke and several cancers, however, it’s less well known that Osteoarthritis is also heavily associated with Obesity. In New Zealand, 370,000 people (10% of the population) live with osteoarthritis(2) and international research estimates that 90% of Osteoarthritis patients are Obese or overweight(3). In New Zealand between the 2010-2017, the average BMI for patients undergoing a knee replacement was 31.2kg/m2 classifying them as Obese(4).

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Obesity is the number one modifiable risk factor for Osteoarthritis, for example, weight loss strategies targeting females over the age of 50 could reduce the prevalence of osteoarthritis by 48% (2). However, for many patients weight loss is sadly not front of mind in their battle with Osteoarthritis. It was recently estimated in Australia that only 25% of patients requiring advice around weight loss received the necessary care(5) and only 8% of patients reported trying to lose weight as part of their OA treatment(6).

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How does it work and how much weight loss is needed?

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For those living with the Osteoarthritis, weight loss has shown substantial benefits for pain and function, it is clear that if you are overweight or obese the more weight you lose the better - in your management of Osteoarthritis.

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In basic terms the more excess weight you are holding the more force that is being applied the knee, with each additional kilogram of body mass it increases the compressive load over the knee by roughly 4kg(7). A reduction in 5% of body weight has shown to lead to a 30% improvement in pain and function, whilst a 10% reduction in body weight leads to a 50% improvement in pain and function(8). It is recommended for clinically meaningful benefits, patients who are overweight or obese should aim to lose over 7.5% of their body weight(8). Not only does a reduction in weight improve pain and function it has also shown to have structural modifying effects. Studies have consistently shown body weight loss in those overweight is associated with a slower progression of cartilage loss in the knee(9).

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Inflammation and Obesity?

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Inflammation occurs in obese individuals through the accumulation of adipose tissue (fat cells), in the obese adipose tissue is the most significant endocrine organ in the body, which releases inflammatory mediators into the blood. With Obesity these inflammatory mediators can be produced to a high enough level over time to cause systemic or low-grade inflammation(10). With Osteoarthritis, obesity also causes metabolic like inflammation from the biomechanical loading of weight-bearing joints. In obese patients, this combination of inflammation has shown to accelerate the osteoarthritis development and increases the risk of joint pain by meta-inflammation ( a combining of these two inflammatory pathways) (11).

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What can I do about it?

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At Axis we offer a true multi-disciplinary approach to your treatment, I can provide you with a specific weight loss plan that is sustainable and specific to you and the way you want to live your life. Although fad diets can provide rapid weight loss at times, sustained weight loss which is vital for Osteoarthritis treatment requires an approach that is achievable and liveable day to day. Long term weight loss should be a prioritised approach for overweight patients in their osteoarthritis management.

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Axis Arthritis Clinic

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Are you or one of your patients suffering from osteoarthritis? Is the pain, swelling, stiffness, or potentially worse, symptoms significantly impacting your ability to undertake physical activity? Our specialist Arthritis Clinic could provide you with improvements you’ve been searching for.

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Our clinic brings together a range of medical and allied health specialists to provide a comprehensive treatment plan, looking to optimise the non-surgical management (including exercise and diet) of osteoarthritis.

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If this sounds like something you or your patient could benefit from, make an appointment to come in and see us.

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To make an appointment call 09 521 9846

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1. Ministry of Health. Annual Update of Key Results 2016/2017: New Zealand Health Survey..(2017)
2. Baldwin, J., Briggs, A., Bagg, W., Larmer, P. An osteoarthritis model of care should be a national priority for New Zealand. (2017). New Zealand Medical Journal. 130 (1467).
3. Hunter, D. Osteoarthritis Management needs a paradigm shift. Presentation. http://www.adma.org.au/Day1/Prof%20David%20Hunter.pdf
4. New Zealand Orthopaedic Association. New Zealand Joint Registry 17 Year Report: Jan 1999 to Dec 2015 2016. Available from: http://nzoa.org. nz/nz-joint-registry
5. Li LC, Sayre EC, Kopec JA, Esdaile JM, Bar S, Cibere J. Quality of nonpharmacological care in the community for people with knee and hip osteoarthritis. (2011) Journal of Rheumatology.;38(10).
6. Australian Institute of health and welfare. Australians Welfare Report (2017).
7. Messier, S. P., Gutekunst, D. J., Davis, C. & DeVita, P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. (2005). Arthritis & Rheumatology. 52, 2026–2032.
8. Atukorala, I., et al., Is There a Dose-Response Relationship Between Weight Loss and
   Symptom Improvement in Persons With Knee Osteoarthritis? (2016). Arthritis Care & Research (Hoboken) 68(8): p. 1106-14.
9. Leticia. A,. Deveza, Z.D., Hunter, D.J. The relationship of weight loss to structure modification in knee. Osteoarthritis and Cartilage (2019) Ahead of print .
10. Calder, P.C et al. Dietary factors and low-grade inflammation in relation to overweight and obesity. (2011). British Journal of Nutrition (106).
11. Stannus, O.P., et al., Associations between serum levels of inflammatory markers and change in knee pain over 5 years in older adults: a prospective cohort study. (2013) Annals of Rheumatic Diseases. 72(4).

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