Obesity can cause big orthopedic problems
By Shannon Harsh, The Review, Published April 18, 2012
Obesity can lead to a variety of different illnesses, but it can also do structural damage to our bodies. Orthopedic surgeon Dr. Michael Necci, of Alliance Institute of Musculoskeletal Medicine (AIMM), said obesity can weaken bones and damage joints -- sometimes leading to the need for surgical replacement.
Necci said in the early 1970s, 3 percent of all total joint replacements were caused primarily by obesity, but today, that number has increased sevenfold, to more than 20 percent. He said most joint replacements he performs are on obese patients, but they are performed for a variety of reasons. However, he said even though obesity is not always the primary cause, it is often a factor. "Obesity is playing into accelerating the arthritic processes," he noted.
When it comes to our joints, Necci said obesity affects them in two ways. First, in a purely mechanical way, he said more weight going through a joint leads to increased wear and tear. Second, which he said is probably more important, obesity tends to lead to a more sedentary life with less exercise and less movement, which also affects the joints.
"The cartilage inside our joints does not have a blood supply in and of itself. It gets nourishment from moving the joints and circulating the fluid throughout the joint," he said. "So, when you're more sedentary, that fluid isn't being moved around, the cartilage is not being replenished and nourished, therefore it's not as healthy and can deteriorate quicker. You add that with the extra weight and you can see how obesity and arthritis is becoming more and more of a factor here in America."
He said in addition to helping burn calories and possibly lose weight, exercise helps replenish the joints and also increases the muscle tone around the joints, which helps protect them. "When you have increased muscle tone around the joints, the muscle takes the brunt of the force going through the joint," he explained.
While you can't reverse the damage already done to the joint, specifically the arthritis that sets in, Necci said exercise can help slow down the deterioration. "If for years and years you were leading a sedentary lifestyle and you were overweight and putting an increased load (on your knees), the cartilage itself is going to be less healthy, but it has the ability to become healthy or stay healthy from that point on by circulating that joint fluid and building up the muscles around the joints to take the load off of them," he explained.
Obesity and a sedentary life affect bones in a similar way, Necci said. According to Wolff's Law, he explained, when bone has compression across it from activity, it increases its density, which strengthens the bone. "Patients that are not as active tend to have poorer bone densities than active patients. So, not only is exercise and activity good for the joints, but it's good for the bones as well," he said. "When we are active and putting weight across the joints and the bones, it increases bone density and increases bone health."
Necci said low bone density increases your risk for future fractures, which he said are especially common in the elderly population. He said having good bone density and stronger bones can help prevent these breaks from happening in some cases.
"If you sustain a fall hard enough and you land the right way, you're going to break no matter how healthy your bone is, but if you can build up your bone density and make it as strong as you can for your age, then that's just one more thing you can do to prevent these kind of injuries," he said.
Necci said an exercise program can help with the health of joints and bones. He recommends things that are easier on joints for those with arthritis, such as swimming, aquatic exercises, elliptical machines or a stationary bike.
"The easiest thing to do -- and you don't need a doctor, a physical therapist or an athletic trainer -- is to just walk. We walk all the time, every day, just living life," he said. "So, the easiest thing to do starting out is just increase your walking. Once you get to a certain point and you want to start doing more exercise and whatnot, definitely talk with your primary care physician about starting a program that may be more strenuous then walking, specifically for people with heart or lung problems. Therapists, athletic trainers, your local gyms, those are all good resources for getting on an exercise program."
Necci acknowledged that becoming more active can be a difficult change for some people. "The hardest part when someone has been accustomed to a sedentary lifestyle is getting started, and then maintaining it," he said. "Any patient that I have that falls into this category, I tell them to just take baby steps."
He advises these people to start small, sometimes with walking laps in their house or up and down their driveway for five to 10 minutes a few times a day. Once they are able to do that easily and are ready, they can increase it from there.
"The key is making small changes over a period of time so that way the things stick," he said. "It's the same thing as people who do extreme dieting. If you want to lose weight, the thing that's not smart to do is just stop eating because it's not realistic that you're going to continue that for an extended period of time. It's the same thing when changing your lifestyle -- and that's what it really is, it's a lifestyle change. Just make baby steps."