For many people, it would seem logical that weight loss would help someone’s knee pain. When we see some patients and they are here to avoid a knee replacement, we suggest to them that weight loss would be beneficial for the repair of their knee. Sometimes the patient will say to us, “my surgeon said we should fix the knee first and then I will be able to lose weight.”
We do understand that for someone in constant knee pain, the inability to exercise or even have enough mobility to do their daily chores makes weight loss a challenge.These type people have heard enough lectures from their health care providers that they need to lose weight, yet few get the help they need and they remain overweight and obese.
There is a debate going on between doctors, surgeons, and health care providers as to the role of weight loss in managing knee pain. Some say let the treatment (typically surgery) fix the knee first and then lose weight, other say – lose weight and reduce inflammation now so the repair will be better. In our practice we fall into the second group – reduce weight and inflammation now and repair with non-surgical regenerative medicine injections.
Let’s look at competing research:
In July 2018, a study from the United Kingdom in the European Journal of orthopaedic surgery & traumatology found surgeons at odds with each other. Investigators sent a survey to surgeon members of the British Association for Surgery of the Knee. The purpose was to explore knee surgeons’ opinions and practices regarding the management of painful knees in obese patients. The survey showed considerable practice variation and divided opinion on the scientific evidence.
The slight majority of surgeons stated that weight loss should be the first-line treatment, 53% and this should ideally be managed by a specialist multidisciplinary service. However, only 24% of the surgeons would be interested in being the orthopedic surgeon in such a multidisciplinary service.(1)
Half of surgeons in this study think people should lose weight. One in 4 want to be part of a program.
It is not just weight – it is inflammation too
The management of inflammation is a very important part of our practice. Not just knee inflammation, but chronic body wide inflammation.
Now here is a December 2018 study (2) which suggests that patients should reduce their Body Mass Index (BMI) with a high fiber diet and thereby reduce C-protein inflammatory markers. This come from researchers at Boston University School of Medicine.
In this study, the researchers wanted to examine the extent to which BMI and dietary fiber influenced the relationship between inflammation and symptomatic knee osteoarthritis.
Who was in the study?
- Men and women (average age 61 years old) with or at risk of knee osteoarthritis
- Two groups: Persons whose fiber intake was more than 21 grams daily were compared with those with intakes were less than 21 grams daily for the overall association with symptomatic knee osteoarthritis.
- The researchers found that dietary fiber or more than 21 grams daily helped reduce body weight and helped reduce inflammation as measured by C-reactive protein declines.
A research team lead by Tufts University and Temple University School of Medicine also found that weight loss could reduce inflammation in older patients suffering with degenerative knee problems. The 2018 study published in BioMed Central musculoskeletal disorders (3) said simply: older and overweight individuals may be more susceptible to osteoarthritis because being older and being overweight alter tissue turnover in the meniscus, articular cartilage, and bone via altered glucose homeostasis (blood sugar regulation) and inflammation. If you manage the blood sugar and you manage the inflammation you can mange knee pain and help repair degenerative knee disease.
How much of quality life is lost to patients with knee pain? To obesity? To a combination of knee pain and obesity?
Researchers writing in the Annals of Internal Medicine (3) sought to answer these questions. They looked at subjects between the ages of 50 and 84 and sought to estimate quality-adjusted life-years lost due to obesity and knee osteoarthritis and health benefits of reducing obesity prevalence to levels observed in the 1990’s when obesity was much less prevalent.
Here is what they found:
- Non-obese patients with knee pain from osteoarthritis – almost 1.9 years quality life-years lost.
- For patients with both osteoarthritis knee pain and obesity 3.5 years of quality life lost.
The benefits of weight loss on inflammation and chronic pain
At the Magaziner Center knee pain is treated with a holistic approach including helping patients lose weight. Weight loss, as you will see in the research below is an important part of healing.
A May 2017 study lead by Alexandra Gersing, MD of the Department of Radiology and Biomedical Imaging at the University of California, San Francisco concluded that overweight and obese people who lost a substantial amount of weight over a 48-month period showed significantly lower degeneration of their knee cartilage. The research was published in the medical journal Radiology.(4)
“The most exciting finding of our research was that not only did we see slower degeneration in the articular cartilage, we saw that the menisci degenerated a lot slower in overweight and obese individuals who lost more than 5 percent of their body weight and that the effects were strongest in overweight individuals and in individuals with substantial weight loss,” Dr. Gersing said.
This study was a continuation of Dr. Gersing’s work on the subject. In 2016 she lead a team of researchers who were able to suggest from findings that: “weight loss has a protective effect on cartilage, which is detected in all (knee) compartments, and that a larger amount of weight loss is more beneficial in obese and overweight subjects in order to slow progression of cartilage matrix deterioration and worsening of clinical symptoms.”(5)
Despite the benefits, weight loss is difficult to achieve.
At the Magaziner Center for Wellness, we take a holistic view of the body, even from an orthopaedic standpoint. We bring a comprehensive understanding of thyroid, hormonal, metabolic and nutritional medicine to our treatment of our patients. Since regular exercise and a healthy diet are crucial when it comes to controlling weight, we speak to each patient about his or her lifestyle habits, as well as his or her biochemistry, in order to create a customized treatment plan.
For the long run, we help our patients understand food choices and their impact on the body. Our goal is to help our patients maintain their weight loss for a lifetime, by educating them on proper nutrition and changing body chemistry to reduce cravings and maintain proper and healthy weight.
If you would like to explore more information, please contact our office so we can start a conversation with you.
1 Hill DS, Freudmann M, Sergeant JC, Board T. Management of symptomatic knee osteoarthritis in obesity: a survey of orthopaedic surgeons’ opinions and practice. European Journal of Orthopaedic Surgery & Traumatology. 2018 Jul 1;28(5):967-74.
2 Dai Z, Jafarzadeh SR, Niu J, Felson DT, Jacques PF, Li S, Zhang Y. Body Mass Index Mediates the Association between Dietary Fiber and Symptomatic Knee Osteoarthritis in the Osteoarthritis Initiative and the Framingham Osteoarthritis Study. The Journal of nutrition. 2018 Dec 1;148(12):1961-7.
3 Stout AC, Barbe MF, Eaton CB, et al. Inflammation and glucose homeostasis are associated with specific structural features among adults without knee osteoarthritis: a cross-sectional study from the osteoarthritis initiative. BMC Musculoskelet Disord. 2018;19(1):1. Published 2018 Jan 5. doi:10.1186/s12891-017-1921-6
4 Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Chanchek N, Guimaraes JB, Mbapte Wamba J, Facchetti L, McCulloch CE, Link TM. Is weight loss associated with less progression of changes in knee articular cartilage among obese and overweight patients as assessed with MR imaging over 48 months? Data from the Osteoarthritis Initiative. Radiology. 2017 May 2;284(2):508-20.
5 Gersing AS, Solka M, Joseph GB, et al. Progression of Cartilage Degeneration and Clinical Symptoms in Obese and Overweight Individuals is Dependent on the Amount of Weight Loss: 48-Month Data from the Osteoarthritis Initiative. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 2016;24(7):1126-1134. doi:10.1016/j.joca.2016.01.984.