Obesity is a complex disease that is not caused by one single issue. Many things factor into the equation that leads an individual to gain weight to the point of threatening their health, such as the environment they grew up in, underlying medical conditions that prevent them from maintaining a healthy weight, or sedentary lifestyles. Whichever the reason may be, obesity has become a global problem that affects millions of people of varying ages.
Obesity affects everyone around the world with data suggesting that “the number of obese people in the world has tripled since 1975 to roughly 30% of the total population”[1], and this number continues to rise.
Just as there are many causes for obesity, there are also many consequences that may arise if a person is battling with extra weight. This disorder is one of the leading causes of death because it dramatically decreases a person’s life expectancy. Obesity puts people at higher risk for several diseases or illnesses, such as: diabetes, heart disease, osteoarthritis, sleep apnea, strokes, and high blood pressure.
This article will focus on how obesity, more specifically morbid obesity, increases your risk for osteoarthritis and other musculoskeletal disorders, such as knee pain; we’ll also explain what these conditions entail, as well as how to treat and alleviate the symptoms that may present themselves.
Patients from all different backgrounds arrive at LIMARP® because they’re looking to improve their quality of life and embark on a healthier path. Our multidisciplinary team, led by Dr. Liza María Pompa González, offers different health services to help you reach your weight goals and beat obesity: from diet and exercise plans, to psychological guidance and surgical intervention.
Obesity impacts everyone in a different way and the comorbidities that come along with it can vary from person to person, but we still recommend that you talk with your doctor if you start developing any symptoms that are affecting your overall health.
Obesity and Morbid Obesity
We’ve briefly mentioned obesity in this article’s introduction, but we want to dive into what differentiates obesity from morbid obesity, especially since the topic we’re exploring is the knee pain that arises from the latter. It’s important that you’re able to identify one from the other, especially if you’re at a point of preventing the development of morbid obesity. So to begin, let’s learn more about obesity.
Obesity is an abnormal or excessive accumulation of fat that can cause illness and significant risks for your health. Obesity can be calculated by a variety of tests, including simple ones like measuring your body mass index (BMI). Patients with a BMI over 25 are considered overweight and patients with a BMI over 30 are considered obese, a trained physician can help you determine if your weight is at an unhealthy level.
The harsh reality is that obesity is a public health issue that is on the rise worldwide, affecting an increasing number of adults and children every year. Obesity is the result of excess fat stores within the body that cause systemic inflammation, it generally occurs when you consume more calories than you burn through daily physical activity or exercise. Many patients who are overweight or obese also have a genetic predisposition for the disease. A person is more likely to be obese if one of their parents is obese, or if their family has a similar, unhealthy lifestyle.
What makes obesity different from morbid obesity?
Well, morbid obesity is a condition that occurs in patients with a body mass index or BMI of over 40, up to 16 points above the expected range. An individual may also be considered morbidly obese if they are 100 pounds overweight or if they have a BMI above 35 accompanied by unfavorable obesity-related health conditions, such as high blood pressure or diabetes.
The consequences for these types of obesity are basically the same, but they can worsen if the patient has developed morbid obesity. Some of these consequences or complications include: Type 2 diabetes, sleep apnea, heart disease, stroke, cerebral hemorrhage, gallstones, osteoarthritis, infertility, obesity hypoventilation syndrome, and certain cancers.
As you may have noticed, osteoarthritis and musculoskeletal disorders are some of the most common complications that may arise due to morbid obesity, and one of the most recurring symptoms a person can experience is knee pain. Morbid obesity can also result in rheumatoid arthritis and we’ll explore why this happens in the remainder of the article.
Morbid Obesity, Osteoarthritis, and Knee Pain
Although people with healthy weight can also develop osteoarthritis, a study[2] pointed out that only 3.7% are at risk of it, while it affects 19.5% of people with morbid obesity. This is due to the pressure excess weight causes on the joints, more specifically the knees, and can lead to chronic pain and inflammation. These symptoms can be debilitating and limit your ability to stand or move comfortably; the lack of motion can also aggravate a person’s obesity due to the lack of physical activity and overall movement, thus leading to more health complications.
So, why does excess weight impact the knees so severely?
Well, the excess weight a body has is not the full load that the knees really carry. In fact, the load on your knee joints equals four times your body weight, meaning that if you weigh 120 pounds, your knees are really supporting 480 pounds of force when you stand, walk, or carry out any movement like going up the stairs or squatting[3]. This extra load the body deals with can lead to various ailments, such as osteoarthritis, rheumatoid arthritis, and joint damage. A study[4] carried out by the Harvard School of Public Health has pointed out that, due to these damages, 33% of patients who undergo joint replacement surgery are obese or morbidly obese.
Osteoarthritis is one of the main complications which is a disabling degenerative joint disorder characterized by pain, decreased mobility and negative impact on quality of life.
According to one study[5], this disease affects more people than any other joint disease and nearly 10 percent of the population is affected and the prevalence increases with age. While having knee pain doesn’t assure a person has osteoarthritis, it can be a symptom and you should talk to your doctor if the pain becomes unmanageable or if you start experiencing pain in other areas of your body. The pain on your knees and other joints may be due because the excess weight wears down the cartilage at the ends of bones quickly.
A person can also develop osteoarthritis because fat cells release chemicals that cause inflammation; the more fat present in your body, the higher the concentration of these inflammatory factors that can increase joint deterioration[6]. Knee pain can also be a sign of rheumatoid arthritis, which can have a more severe impact on your health. This disease is a chronic autoimmune disease that causes joint inflammation and it affects the hands, wrists, and knees. The chemicals that cause inflammation have a great impact on the joints and in patients with morbid obesity, these factors can worsen their condition.
How to Reduce Knee Pain
If a patient is dealing with morbid obesity, it’s highly likely that their doctor will recommend bariatric surgery if any initial diet and/or exercise plans fail or are insufficient when it comes to seeing results. Each patient’s case is different, so the plans recommended by your doctor and nutritionist may vary from person to person; they might also change according to the changes the body goes through in order to adapt to its new necessities or medical needs.
The surgical options a bariatric doctor may recommend include:
- Gastric sleeve – This procedure reduces stomach size by as much as 80%. The remaining portion of the stomach is shaped into a tube or sleeve, limiting what a patient can eat and providing a faster feeling of fullness. In addition, certain glands are removed along with the stomach, which are responsible for stimulating the production of an important hormone known as the “hunger hormone”. Thus, this surgery provides three potent action mechanisms.
- Gastric bypass – During a gastric bypass, the stomach is divided into two pouches and the intestinal tract is redirected toward the upper part of the stomach, this restriction means there is less room for food. In addition there is less absorption of sugars and fats because of the part of the intestine that is bypassed, giving this surgery two potent action mechanisms.
- Mini gastric bypass – While almost identical to a traditional gastric bypass, this procedure has the advantage of creating a single union between the new stomach and the intestine, it provides restriction and limits the absorption of sugar and fats in the bypassed sections of the intestine, with the advantage of being a faster and technically easier, with one single connection.
- Duodenal switch procedure – This procedure involves doing a gastric sleeve (removing 80% of the stomach) and rerouting the small intestine starting at the duodenum, which makes it a restrictive but highly malabsorptive surgery. The indications for performing it must be well justified.
These weight loss surgeries, aside from removing the extra fat from the body and helping to manage any existing comorbidities, can also alleviate any knee or joint pain that the patient may be experiencing. In more severe cases, joint replacement surgery is a viable, or even necessary option, to repair the damaged and worn out joints. Knee pain can be manageable at first, but it can seriously hinder your movement overtime and affect your health and lifestyle in the long run. If the pain becomes unbearable, contact your doctor as soon as possible so you can receive proper medical assistance and guidance.
Contact Us to Learn More
If you want to learn more about morbid obesity and knee pain, schedule an appointment with one of our doctors. We can help determine the right treatment for you. Contact us online anytime or give us a call at (619) 373-0229.
References
- [1] “Most Obese Countries 2022”. https://worldpopulationreview.com/country-rankings/most-obese-countries. (Accessed September 29, 2022).
- [2] Reyes, C., Leyland, K.M., Peat, G., Cooper, C., Arden, N.K. and Prieto-Alhambra, D. (2016), Association Between Overweight and Obesity and Risk of Clinically Diagnosed Knee, Hip, and Hand Osteoarthritis: A Population-Based Cohort Study. Arthritis & Rheumatology, 68: 1869-1875.
- [3, 6] “Here’s How Your Weight Affects Your Knees”. https://www.jonathanshultsmd.com/blog/heres-how-your-weight-affects-your-knees. (Accessed September 29, 2022).
- [4] “Weight Problems Take a Hefty Toll on Body and Mind”. https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/health-effects/. (Accessed September 29, 2022).
- [5] Brooks PM. Impact of osteoarthritis on individuals and society: how much disability? Social consequences and health economic implications. Curr Opin Rheumatol. 2002;14:573–7.