Obesity and Orthopedics – Dr. Gregory Lee

Obesity is a problem that affects more than 100 million Americans and is generally defined as a condition in which an individual is carrying more weight than is advisable when considering that individual’s stature or height. Body Mass Index, frequently referred to as BMI, is the most widely accepted measure of obesity and is calculated by measuring a person’s weight in kilograms and dividing that number by the individual’s height in centimeters squared. While this sounds complicated, BMI “calculators” are readily available through an internet search and will provide a BMI calculation with the simple entry of a person’s weight in pounds and height in feet and inches. An individual with a BMI in excess of 35 is considered obese. Obesity is linked to a large number of health problems that include diabetes, heart disease, and cancer. It is also a direct contributor to many painful conditions of the muscles and joints.

How Does Obesity Contribute to Orthopedic Problems?

Recent research has shown that fatty tissue, also called adipose tissue, releases chemicals that cause inflammation throughout the body. Included in these inflammatory chemicals are molecules that cause the nervous system to activate nerves called nociceptors, which send signals to the brain causing the brain to perceive pain. Excess fatty tissue in the body leads to higher concentrations of these chemicals in the bloodstream, increased nociceptor activity, and a resultant tendency for the obese body to experience higher levels of pain. It is likely that obesity contributes to the development of many chronic pain disorders.

Obesity and the Joints

Obesity also has a direct mechanical effect on the weight bearing joints of the body, such as the hips, knees, and ankles. Biomechanical studies have shown that the forces of weight carried in the trunk and upper body are magnified as the weight passes down through a joint such as the knee, which has a small surface area roughly equivalent to that of a closed fist. In fact, one pound of weight carried in the hips or abdomen applies four pounds of pressure through the knee. Obesity therefore places the joints of the legs under extreme stress and often triggers a failure, from mechanical overload, of the shock absorbing cartilage layer that lines and protects the ends of the bones coming together at a joint. It is well known that obesity places a person at risk of developing painful arthritis at a very young age, a problem that does not have an easy solution.

Obesity and Surgery Complications

Obesity is also known to increase the risk of adverse events after surgery. Obese patients have higher rates of infections due to poor healing of surgical incisions, more frequent lung complications such as pneumonia, and increased risks of falling after leg surgery such as knee replacement. Aware of the increased risk of complications after hip and knee replacement surgery performed on obese patients, many orthopedic experts recommend that such surgery be avoided in persons with BMIs greater than 40-45. 

What are the Orthopedic Benefits of Weight Loss?

Although it is a difficult task, accomplishing lasting weight loss is critical for an obese individual and will result in fewer chronic medical problems, lower overall levels of bone and joint pain, and a diminished risk of arthritic destruction of the joints of the legs. When considering the science behind overcoming obesity, it is known that approximately 70% of weight loss comes from improvements in one’s diet, that is reducing the overall amount of calories and improving the type of calories that are put into the body on a daily basis. The other 30% of accomplished weight reduction comes from burning calories stored in the body’s fatty tissue through exercise.

Importance of Exercise Towards Weight Loss

Regular exercise is critically important for the human body. Exercise increases the metabolism of the body and breaks down and reduces adipose tissue, converting the fatty tissue to energy to be used by the exercising muscles. As the body’s fat stores are reduced, less inflammatory chemicals are released, resulting in a reduction in the pain signals being sent to the brain. An added benefit to exercise involves the release into the bloodstream, by the exercising body, of a different class of chemicals known as endorphins. Endorphins are a naturally occurring chemical that blocks the nervous system’s transmission and perception of pain signals.

Role of the Physician Towards Weight Loss

The most important factor in accomplishing weight loss is the desire and determination of the person afflicted by obesity to make lifestyle changes that, with hard work, will lead to improvements in physical and psychological wellbeing. The medical profession can help a person in this endeavor. A primary care physician can help coordinate nutritional counseling to provide education on strategies for planning healthier dietary choices. General surgeons who specialize in bariatric surgery can provide information on the risks and benefits of surgical procedures designed to facilitate weight loss. Finally, an orthopedic surgeon can provide education and physical therapy services designed to instruct a person on safe techniques for exercise and can utilize short courses of anti-inflammatory medications and periodic therapeutic joint injections to help extinguish flares of intense muscle and joint pain. Best of luck in your fitness endeavors!

About Dr. Greg Lee

Dr. Gregory Lee, the author of this article, is one of our Fellowship-Trained orthopaedic surgeons at OrthoGeorgia. He completed his fellowship in Sports Medicine at the University of Virginia, Charlottesville, and also specializes in total and partial knee replacements. His special interests are sports injuries, arthroscopy of the knee and shoulder, ACL reconstruction (primary and revision), shoulder instability, rotator cuff pathology, and fracture care. He is also certified to perform Mako Robotic Arm Assisted Knee Surgery for partial knee replacements. Dr. Lee is board-certified by the American Board of Orthopaedic Surgery and is a member of the Medical Association of Georgia, Georgia Orthopaedic Society, and Bibb County Medical Society, 

Comprehensive Orthopaedic Care and Services in Central GA

At OrthoGeorgia, we are proud to be leaders in orthopaedics and provide comprehensive, world class care to all patients who come to see us. All of our orthopaedic surgeons are board-certified or board-eligible and include surgeons fellowship-trained in spine, hand, sports medicine, foot and ankle, and total joint. We see patients at our locations in Macon, Warner Robins, Kathleen, Milledgeville, Dublin, and Hawkinsville, and proudly provide services such as Orthopaedic Urgent Care, Physical and Occupational Therapy, Diagnostic Centers with Digital X-Ray and MRI/CT Technologies, Full Retail Pharmacy, Durable Medical Equipment, a comprehensive Workers’ Compensation program, a Bone Health Clinic, and two Surgery Centers. We put each patient first and will choose the treatment and rehabilitation plan that is best suited to you and your needs. To learn more about orthopaedic health and wellness or to schedule an appointment with one of our orthopaedic specialists in Central GA, please contact us today!