If you don’t eat your meat, you can’t have any pudding! How
can you eat your pudding if you don’t eat your meat?
-Pink Floyd, Another Brick In The Wall Pt. 2
Sometimes in the course of a regular day at work, I begin to feel like
I’m playing a game of telephone with certain patients. You remember
the telephone game, don’t you? Where one person says something,
and it is repeated around the circle until the end result bears little
resemblance to the original statement? Kids love this game because what
the last person says is usually ridiculous and nonsensical. Teachers love
this game because it demonstrates the disjointed nature of our communication
and puts into simple terms for kids that what is said and what is heard
is often distorted. Doctors, however, tend to hate when this happens because
it can impair his or her relationship with the patient and do damage to
the treatment process.
The way this “game” usually works in my practice is that I
will recommend to a patient that he or she lose weight, either as a part
of the treatment protocol or to encourage the best outcome prior to surgery.
What a patient will sometimes hear, however, is me calling him or her
fat. The message is distorted between the saying and the hearing. For
the record, I have NEVER called a patient fat and never will. But weight
is a sensitive subject and evokes strong responses in most people. Nobody
wants to think that their choices may be responsible for their pain, but
sometimes weight is the culprit. When I recommend to someone that they
lose weight, it’s not a reflection of his or her physique. It’s
a medical opinion that also happens to be a hot button topic that not
all patients receive well.
There is very extensive and strong evidence to support the case for losing
excess pounds, and the way weight impacts your joints is profound. Obesity
has become a global health issue. Here is the scientific information,
for those of you who like that sort of thing: Obesity is clinically defined
as a body mass index (BMI) of >30kg/m2. In layman’s terms, BMI
is a person’s weight in kilograms (kg) divided by the square of
their height in meters (m2). As BMI values increase, joint pain symptoms
and severity increase. The resultant pain in the joints reflects the progression
of osteoarthritis from increased stress and inflammation in the joints.
Not only does the increased weight put detrimental stress on the joints,
but as a person starts to gain weight, they can lose muscle mass and have
less strength than normal weight patients. Because of this relative weakness
they often compensate by altering their gait, and this can further potentiate
the arthritic process in joints.
Putting it in perspective
For those of you who like their information in layman’s terms, here
it is: when someone walks across level ground, they put 1.5 times their
body weight across the weight bearing joints (hips, knees and ankles).
Add an incline, stairs, or even a light jog, and the force across the
joints is equivalent to four to five times your body weight. This also
includes squatting down or bending over to tie your shoes. So in simple
math, if someone weights 200 pounds, they are placing approximately 300
pounds across their joints when they walk and upwards of 1000 pounds when
they walk up or down stairs or get out of a car. To put this in perspective,
if someone is 100 pounds overweight and takes only 3,000 steps a day (which
is low) they still can place more stress across their joints than a healthy
weight jogger that averages 10 to 15 miles per week. The jogger also has
the added benefit of protecting the joints by having strong muscles around
the joint that can dissipate some of the stress.
Set realistic goals
Losing even a few pounds can be very beneficial to someone’s health.
Previous research has shown that just a 10 to 15 pound weight loss can
significantly reduce joint pain and slow the progression of arthritis.
So how does someone with pain go about losing weight? That’s the
question I am most often asked and is the first step on the path towards
achieving healthy weight loss goals. Being motivated to begin is imperative
to the end result. And my answer is always to begin small and be realistic.
Eat less and move more.
By combining small but realistic exercise and diet goals, weight loss can,
and will, occur. Every pound you are trying to lose represents 3,500 calories.
If someone is trying to lose a half-pound to a pound a week, then they
have to either burn off or cut out an extra 250 to 500 calories a day.
This might be easier to accomplish by burning off 125 calories with exercise
and eat 125 fewer calories each day. Studies have shown that a comprehensive
program that combines diet and multimodal exercise can result in a 5.7
percent loss of body weight within six months. Remember that this works
in reverse, though, so an extra 100 calories from daily snacking or drinking
a Mocha-Frappe-Latte can add an extra 10 pounds by the end of the year.
Just as extra weight can creep up on us over time, taking those pounds
off can also seem interminable. Keep at it, and eventually you will see
and feel the difference. The happy by-product of weight loss is usually