Obesity and osteoarthritis


Health Chat with Dr Anthony Leeds Series 3 Episode 7
Guest: Professor Hamish Simpson, University of Edinburgh, Scotland

The number of people with osteoarthritis is increasing because we have ageing populations that are heavier than in the past. There is currently no medication or other intervention proven to slow the disease process. We treat the pain and inflammation but after many years the joint is so badly damaged that surgical joint replacement, total or partial, becomes necessary. Weight reduction is a core feature of osteoarthritis care but is difficult to achieve in those with limited mobility.

Osteoarthritis is a type of damage and inflammation in joints in which the joint cartilage is progressively damaged and nearby bone thickens. Typically, it occurs in middle or old age and causes stiffness, swelling, pain, reduced movement and deformation of the joints.  It commonly affects load bearing joints (hips and knees) but can affect all joints of the body. Heavier people are more likely to get osteoarthritis and losing weight has long been known to reduce pain and improve mobility.  However, losing enough weight and maintaining that weight loss can be challenging.

In this conversation Prof Hamish Simpson, professor of orthopaedic surgery at the University of Edinburgh, Scotland begins by explaining the nature of osteoarthritis and the options for treatment. Symptoms are treated with pain killing drugs, muscle strengthening exercises, and weight reduction where possible until surgical joint replacement becomes necessary.

Dr Leeds then reminded viewers of the description in Episode 4 of Series two by Professor Henning Bliddal, Director of the Parker Institute, the arthritis institute at Frederiksberg hospital in Copenhagen of the work of his team in undertaking an effective weight loss study in people with knee osteoarthritis. The team recruited obese people with knee osteoarthritis (KOA) for weight reduction with a formula diet programme followed by four years of weight maintenance. Average weight loss at the end of 4 months was about 12 kg, most of which was maintained at one year. Four years later the average weight loss maintenance was about 10kg. Joint pain was reduced, and that reduction was largely maintained for four years.

Reducing excess weight has long been an accepted core component of medical management of osteoarthritis but in practice is often not effectively achieved. Professor Simpson then described his work colleagues in Edinburgh and Leeds in England, in devising a feasibility study of a ‘package of care’ for people awaiting knee surgery for osteoarthritis.  This would include options for weight reduction (using the method used in Copenhagen) with improvement of use of pain killing drugs, muscle strengthening exercises and insoles in the shoes to improve the quality and use of walking.

That feasibility study has now been completed successfully, the ‘package of care’ is feasible and now needs to be tested on larger numbers of people in several centres.

Many viewers and listeners may not have access to specialist help so Professor Simpson ended by giving general advice about simple diet and lifestyle changes that can be made.

Web links to useful sources of information are given below.

Information about osteoarthritis for the UK

Exercises for healthy Joints

For Canada

For Pakistan

Arthritis Care Foundation

For the USA


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