For the past several weeks I have been going to the physical therapy clinic in a large teaching hospital in Boston. A partially-slipped disc made learning how to "engage my core" and overcome bad posture in front of the computer screen an imperative. While waiting in the crowded waiting room, I noticed that the majority of patients were obese. My physical therapist confirmed this. She told me that many had knee or hip replacements, or were suffering from orthopedic ailments either brought on or exacerbated by their weight. "It's a terrible problem," she said, "They can't exercise without pain before the operation, but if they don't lose weight, their new knee or hip will wear out and they may develop other orthopedic problems."
My physical therapist's thoughts were echoed in a recent article in the June 15 edition of JAMA (Journal of the American Medical Association) on the prevalence of obesity among adults with arthritis. This article found an amazing and alarming incidence of obesity among adults with arthritis. The prevalence of obesity was 54 percent higher among individuals with arthritis compared to adults without arthritis. People with arthritis suffer from joint pain and limited mobility. Obesity, as this report points out, can increase the pain because extra weight places mechanical stress on the joints and may even indirectly increase the degeneration of cartilage.
When both obesity and the pain of arthritis limit physical activity, then weight loss becomes difficult. Many people with arthritis have difficulty walking, ascending or descending inclines, and climbing steps. Many arthritis sufferers are unable to utilize much of the equipment in a gym and even walking, recommended in all weight-loss programs, is not an option.
As the article mentions, too little has been done to help the obese arthritic patient lose weight. Even a small amount of weight loss will relieve stress on the joints and bones, but patients are not getting the personal and community-based weight loss help they need to accomplish this necessary goal.
The obese with arthritis, even more than the typical obese population, needs an enormous amount of nutritional, emotional and social support. There must be a weight-loss program tailored to fit their particular needs. Chronic pain, sleepless nights due to discomfort, lack of social interactions because mobility is so limited, the absence of much pleasure and distraction except eating, are all factors that must be considered. Just telling people to eat more vegetables and fewer cookies is not sufficient.
Are there hospital or community-based programs specifically for people with arthritis? According to the JAMA article, there are not enough, since the prevalence of obesity among people with arthritis is rising rapidly. And opportunities to exercise to strengthen muscles and burn off calories are probably even more limited. Exercising in water, according to my physical therapist, is effective for people with weight and physical limitations (she told me about a patient who needed a knee replacement who lost over 250 pounds walking in water). Still, as she acknowledged, very few of her patients had access to a pool and even if one were available, their handicaps made it almost impossible to enter and exit the water.
One of the problems with reading a report such as the one published in JAMA is that it is too easy to overlook the fact it addresses individuals and not statistics. The obese woman who had to be helped into a wheelchair because she could not walk to the physical therapy room, the very overweight man whose daughter had to support his weight so he could walk across the hall, the colleague who told me that she feels she has to starve herself to lose weight because she can't exercise off the calories: These individual -- and so many more -- deserve an effective way to lose excess weight, decrease their pain and improve the quality of their lives.
Year ago when it was discovered that exercise was important in maintaining cardiac health after bypass surgery, cardiac rehabilitation units developed specific exercise programs for the recovering patient. Now we take for granted the physical activity component of the post-operative regimen, but it had to be researched, tested and taught to health care providers who then monitored their patients.
Specific programs for the obese arthritic patient also need to be developed. Physical therapy is not sufficient since its intent is not to produce weight loss but rather to increase mobility and protection of orthopedically-stressed areas. Let us hope that articles such as the one in JAMA will be a catalyst to developing weight-loss and exercise programs for this underserved population.
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