Arthritis is one of the major causes of morbidity, or the rate of disease, in people struggling with obesity. Osteoarthritis is a leading cause of joint disorders with symptoms of degeneration occurring in the hips, knees, back, neck and hands. With increasing obesity rates in the United States, which has doubled compared to the obesity rate in the 1980’s, the prevalence of arthritis is also increasing.  Common symptoms of arthritis include joint pain, swelling, and stiffness leading to impaired mobility that affects the quality of many people’s lives.  Most people with arthritis are managed primarily with medications. The most commonly used medications include NSAIDS, which not only reduce inflammation, but long-term use is also associated to gastritis, peptic ulcers, and kidney disease. Moderate to severe cases of arthritis are managed with surgery such as a joint replacement.

The exact correlation between obesity and osteoarthritis is still unclear, but being overweight increases the load on the major joints like knees and hips, which increases the rate of normal wear/tear of cartilages at joints(1).  Obesity alone can cause three to six times one’s body weight to press down on the knees while walking (2).  Data from the National Health and Nutrition examination survey shows that obese women had nearly four times the risk of knee arthritis as compared to non-obese women; that risk is five times greater in obese men (6). The Framingham Study done by Boston city hospital showed that people with obesity, but without arthritis in their thirties, had an increased risk of arthritis later in life(7).  That risk is ten times higher for knee arthritis in obese individuals.  Furthermore, it’s clear from multiple studies that weight and osteoarthritis are associated, and similarly, a reduction in weight has shown significant improvements in a person with osteoarthritis symptoms.  Framingham and Felson et al studies noted for a person of normal height, a weight reduction of 11 lbs reduced the risk of knee arthritis by 50%.  For obese elderly men (body mass index >30) who drop their body mass index to 25-29.9 (overweight category), the risk of arthritis drops to 21.5%.  Similarly, in the same case for women, the risk of arthritis drops to 33%.

Science has determined that long-term weight loss can be only achieved by bariatric surgery or metabolic surgery, which not only reduces weight but also significantly improves or resolves diabetes mellitus, hypertension, hyperlipidemia, sleep apnea, and arthritis, along with extending one’s life span and overall quality of life.  A study published by Finland in 2013 on patients after bariatric surgery showed that people who had gastric bypass had an average weight loss of 27.3 kg, and had improved physical functions including improving the stiffness in the knee from osteoarthritis.  Another benefit of bariatric surgery in patients with end stage arthritis who are awaiting knee or joint replacements is having a decreased financial burden overall. The savings from an improved quality and quantity of life resulting from bariatric surgery include less money spent on doctor’s visits, prescriptions, surgeries, food and more.

Another variety of arthritis is rheumatoid arthritis, which is caused by inflammatory systemic factors in the blood of the affected individual. Bariatric surgery not only decreases the disease activity, it also decreases inflammation overall, which results in less usage of rheumatoid arthritis medications. Brigham Hospital and Harvard Medical School concluded these findings in a 2015 study:  Their findings determined after one year following bariatric surgery, patients with severe rheumatoid arthritis dropped to 6% from the baseline of 57% of patients, and after 5 years 74% were in remission.  Current medical literature supports both nonoperative and operative bariatric weight loss surgery to improve arthritis symptoms such as knee pain and joint function, but to achieve long-term weight loss bariatric surgery is the only solution. Many of the mentioned studies use gastric bypass as the golden standard for improving arthritis.  Although long-term research on the sleeve gastrectomy and arthritis has not been published, it also dramatically decreases a person’s weight after the surgery, which can also lead to alleviation of arthritis and weight on the joints.

In summary, the benefit of weight loss regarding arthritis improvement is like a small car carrying too large of a load, leading to transmission and axle damage. The solution is to take the excess weight off the car to avoid replacing the axle or transmission.  Similarly, weight loss is the best factor in treatment of arthritis, especially in osteoarthritis.

  1. Creamer P, Hochberg MC: Osteoarthritis. Lancet1997;350:503-508.
  2. Felson DT: Weight and osteoarthritis. J.Rheumatol.1995;43:7-9.
  3. Anderson J, Felson DT: Factors associated with osteoarthritis of the knee in the First National Health and Nutrition Examination (HANES). Am.J.Epidemiol.1988;128:179-189.
  4. Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF: Obesity and knee osteoarthritis: The Framingham study. Ann.Int.Med. 1988;109:18-24.
  5. Sparks JA et al. Impact of Bariatric Surgery on Patients With Rheumatoid Arthritis. 2015 Dec;67(12):1619-26. doi: 10.1002/acr.22629
  6. Iossi MF et al . Musculoskeletal function following bariatric surgery. Obesity (silver spring).2013 Jun;21(6):1104-10. doi: 10.1002/oby.20155. Epub 2013 May 13
  7. Lyytinen T, Liikavainio T, Paakkonen M, Gylling H, Arokoski JP. Physical function and properties of quadriceps femoris muscle after bariatric surgery and subsequent weight loss. J Musculoskelet Neuronal Interact. 2013;13(3):329–338.
  8. Julia C, Ciangura C, Capuron L, et al. Quality of life after Roux-en-Y gastric bypass and changes in body mass index and obesity-related comorbidities. Diabetes Metab. 2013;39(2):148–154.
  9. McLawhorn et al. Cost-Effectiveness of Bariatric Surgery Prior to Total Knee Arthroplasty in the Morbidly Obese: A Computer Model-Based Evaluation. Journal of Bone & Joint Surgery – American Volume: 20 January 2016 – Volume 98 – Issue 2 – p e6
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