ARTHRITIS and OBESITY

Arthritis and obesity  is a review of the research by Dr Matthew Constas, PhD.

Obesity-related diseases are becoming a quickly increasing problem in the Western world, the result of an extreme obesity epidemic that now rivals hunger-related health problems as a primary cause of worldwide morbidity and mortality. Many common diseases have been linked to obesity, including osteoarthritis (OA). Although OA is the most prevalent joint disorder, obesity is also known to be a factor in developing other musculoskeletal conditions that can result in joint pain and disability.


Obesity As A Risk Factor For Arthritis


OA is a common condition, affecting 70% of senior citizens who are older than 65. This accounts for a staggering 27 million residents of the United States—12.1% of adult Americans. The world's population is aging and becoming overweight at a fast pace—two of the major risk factors for developing OA. The social and economic burden resulting from the prevalence of OA is distressingly high.

The symptom most strongly associated with OA is joint pain, which is the result of a loss of articular cartilage. Pain is most often experienced in the hip, knee, and hand joints. Those still in the first stages of OA only have pain when they use the affected joint, but as the disease progresses the pain becomes more constant. Eventually sufferers experience pain even when their joints are resting and when they are asleep.


TREATMENT

Arthritis and obesity

Treatments for osteoarthritis are focused on pain relief, and there are both surgical and non-surgical options available. Surgery to treat osteoarthritis is a last resort for those whose symptoms are severe and resistant to other forms of treatment. For most osteoarthritis sufferers, symptoms can be controlled through the use of medication, proper nutrition, acupuncture, and changes in lifestyle.

A pharmacological approach to therapy is common, achieving pain relief through the use of non steroidal anti inflammatories, Advil, Aleve, Orudis and analgesics like tylenol.


However, a number of people experience side effects when using these medications, most frequently gastrointestinal problems.

As an alternative to these medications, increasingly more people are turning to natural formulas for pain relief. The controversial and partially encouraging results of the Glucosamine Chondroitin Arthritis Intervention Trial (GAIT) have spurred on this trend [1]. Dietary supplements containing glucosamine or chondroitin sulphate are now taken by around 5 million Americans.


Obesity and Arthritis : The Link


Numerous research studies have shown that there is a positive relationship between weight and OA. Results of population-based studies have been consistent in finding that overweight people are at an increased risk of developing OA when compared to people from the same population who are not overweight.

A large Australian study found that overweight adults are at double the risk for being diagnosed with OA than adults of a normal weight. This study of 7500 people found the relationship between BMI (a measure of excess weight) and obesity to hold even after adjusting for socioeconomic status, age, and sex.

(Scroll down to calculate your BMI)

A linear relationship between increasing BMI and the relative risk of developing OA of the knee has been demonstrated through large population studies [2]. A 4-year UK study with 830 female middle-aged participants found a strong relationship between BMI and knee OA. Women with a BMI greater than 26.4 were at twice the risk of developing osteophytes than women with a BMI less than 23.4. (Explanations: BMI above 25 indicates overweight; Osteophytes are bony projections that develop in arthritis-damaged joints.)

A survey of 858 people in Scotland found that lower limb joint pain was positively related to obesity; participants who were obese reported twice the frequency of pain in the hips, knees, ankles, and feet. According to a survey of 5000 Americans, the risk of knee OA doubled with every 5 unit increase in BMI.

Additionally, reviews of lists of patients scheduled to receive joint replacement therapy have shown that they tend to weigh significantly more than healthy people of the corresponding age and gender.


Weight's Effect On Knee

OA KNEE ARTHRITIS and OBESITY

The mechanical load experienced by the hip joint is more broadly distributed than that of the knee, meaning that the hip joint is subject to less stress. This explains why obesity appears to have a weaker association with hip arthritis than with knee OA.

One cross-sectional study, consisting of 2358 people, failed to find evidence of any link between obesity and hip OA. Other studies have reported a positive correlation between hip OA and obesity. For instance, information collected in the USA Nurses study found that those with a higher BMI at age 18 were at 5 times the risk of needing hip replacement in the future.


Weight's Effect On Hand OA

HAND ARTHRITIS and OBESITY


A primary explanation for the effects of obesity on OA is that carrying excess weight places more stress on the joints. Since hands are not weight-bearing, it seems logical that hand OA and obesity would not be related. However, being overweight does actually appear to increase a person's risk for developing OA hand arthritis [3]. The implication of this fact is that the increased risk of OA in obese people is not solely the result of mechanical strain. Other causal factors are involved in arthritis and obesity.


Which Comes First: Obesity or OA?

ARTHRITIS and OBESITY

Demonstrating a relationship between obesity and OA isn't enough to prove that excess weight is a cause of OA. For example, an alternative explanation could be that the significant knee pain experienced by OA sufferers reduces their amount of physical activity and leads to weight gain.

This question of causality has been addressed by several studies implementing a longitudinal design [4]. The Framingham Heart Study followed up with 1420 subjects over the course of 36 years. The results showed that those who were overweight when the study began, at age 37, were at an increased risk of developing OA by the end of the study, when they were 73. Since knee OA was extremely rare at the age of 37, this indicates that obesity was the causative factor rather than OA.


In Conclusion

ARTHRITIS and OBESITY

It has been demonstrated that excess adipose tissue is a significant risk factor for OA, with obesity consistently being shown to increase the risk of developing osteoarthritis of the knees. Obesity has a smaller but still notable positive effect on the risk of developing OA of the hand and hip. This provides support for weight reduction as an essential component of OA treatment, along with the use of arthritis medication supplements, especially for those with knee OA.


About the Author

ARTHRITIS and OBESITY


Dr Matthew Constas, PhD, has an extensive background in medical science and is particularly interested in the association between obesity and potentially prevented conditions such as OA. He keeps a close eye on the latest scientific research being conducted on obesity, weight loss, and nutrition. Dr Constas maintains a blog where he offers an eDiets promo code and a diet to go coupon code discount, two leading meal delivery weight loss programs in the US.



REFERENCES @ ARTHRITIS and OBESITY

  1. The NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT). National Center for Complementary and Alternative Medicine. J Pain Palliat Care Pharmacother. 2008;22(1):39-43.
  2. Knee osteoarthritis and obesity. Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C. Int J Obes Relat Metab Disord 2001;25:622–7
  3. Hand osteoarthritis in Chuvashian population: prevalence and determinants. Kalichman L, Kobyliansky E. Rheumatol Int. 2009 Apr 9.
  4. Total hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors Am J Med. 2003 Feb 1;114(2):93-8.. Karlson EW, Mandl LA, Aweh GN, Sangha O, Liang MH, Grodstein F.


USEFUL LINKS


Body Mass Index (BMI)


BMI can be classified as follows:

1. Underweight: BMI less than 18.5

2. Optimal weight: BMI between 18.5 - 24.9

3. Overweight: BMI between 25 - 29.9

4. Obese: BMI over 30

5. Seriously obese: BMI greater than 35. Heart attack, stroke, diabetes, knee and ankle arthritis await you.

To calculate your BMI, just fill in your weight and height at the following link, and you will know the whole truth. It may be painful. Are you literally facing a stroke, death? Am I being overdramatic? No! A good friend right now is in hospital, fighting for his life, after a bypass that went haywire. I've been pleading with him for over twenty years ... he's only 60.



NUTRITIONAL CORNER from Chiropractic Help

ARTHRITIS and OBESITY

1. The omega-3 oil in fatty fish like salmon and mackerel, flax oil and walnuts will to some extent ameliorate the effect of obesity and arthritis.

2. So too, coloured fruits and vegetables like strawberries and broccoli have been shown to reduce the pain of arthritis.



WEIGHT LOSS FOR ARTHRITIS

Part II of a review of the scientific literature by Dr Matt Constas on the relationship between osteoarthritis and obesity. WEIGHT LOSS FOR ARTHRITIS ...



Vegan weight loss

Vegan weight loss is something of an anathema; not many are obese. However we carnivores can learn a lot from our vegetarian friends.

They get most of their protein from pulses; these are legumes that are found in pods and dried for their seeds. It's stretching a point but you could include green beans and peas.

Mostly though we are talking about chickpeas, dried beans and lentils. A meta-analysis of 21 trials found that simply including one helping of pulses daily to your diet would significantly increase your sense of satiety and weight loss. 

If you were to replace a high GI starch such as a helping of potatoes with a pulse, then the effect becomes quite dramatic. This quick hummus recipe is probably my favourite; it's so easy to make and will turn a dull green salad into a treat.

For the chiropractic profession, arthritis and obesity are a serious problem. Unfortunately we can lead you to water, but can't make you drink; at the end of the day each of us is responsible for our own health.



» Obesity



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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

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Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


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The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.