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The AAOS public service announcement “Sedentary” put the spotlight on how the lack of exercise contributes to the growing numbers of patients who are obese.

AAOS Now

Published 2/1/2014
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Leon S. Benson, MD; Michael L. Parks, MD

Weighty Bone and Joint Issues

Volunteer workgroup addresses the impact of obesity

Chunky. Hefty. Big-boned. These are adjectives often used to describe those who are affected by excess weight or obesity. It may be easy to quickly assess those patients and tell them to exercise more and eat healthier, but as healthcare practitioners, orthopaedic surgeons need to better treat the entire patient and steer patients toward tools that they can use as solutions.

Weight bias—negative stereotypes directed toward individuals affected by excess weight or obesity—often leads to prejudice and discrimination, even in the healthcare setting. Orthopaedic surgeons, considered the primary care physicians of patients’ musculoskeletal systems, should regard individuals as patients first to treat the disease of obesity.

We are not talking about the 15 pounds freshmen gain during their first year away from home or the 10 pounds many people gain during the holiday period—although these are significant numbers and should be addressed. We are talking about the prevalence of obesity in the United States and throughout the world—and the impact this has on orthopaedic care and outcomes.

Obesity has long been an issue for orthopaedists because it can seriously affect patients’ bones, joints, and muscles and contribute to a multitude of other health issues, including diabetes, heart disease, high blood pressure, lung disease, and sleep apnea. These comorbidities often have deleterious consequences for patients considering surgical procedures.

The statistics are overwhelming: One in three U.S. adults is affected by obesity. Additionally, a recent study by the University of Massachusetts Medical School found that twice as many total knee arthroplasty (TKA) patients younger than age 65 were morbidly obese (body mass index greater than 40) compared to patients ages 65 and older (11 percent versus 5 percent). This means that obesity among younger patients is contributing to the increased number of TKAs being performed. As the rate of obesity continues to increase, the number of TKAs—especially among younger patients—is likely to increase as well.

Communicating with patients
At the 2013 AAOS Annual Meeting in Chicago, the AAOS Now-sponsored educational forum on “Obesity, Orthopaedics, and Outcomes” drew attention to this issue. Subsequently, the AAOS was contacted by the Obesity Action Coalition (OAC), a national nonprofit organization dedicated to giving a voice to those affected by obesity.

The AAOS agreed to partner with OAC and formed a workgroup to address the impact of obesity on the provision of orthopaedic care. Your Academy is committed to educating members to help orthopaedic surgeons recognize and support patients affected by obesity and enable them to talk to patients about their condition without labeling them.

The first challenge that the AAOS workgroup volunteers plan to address is a cultural change of semantics: patients first. Rather than treating “the obese,” orthopaedists treat individuals with obesity or excess weight. To help guide orthopaedic surgeons in this endeavor, the OAC is offering AAOS members free samples of their brochure “Weight Bias in Healthcare—A Guide for Healthcare Providers Working with Individuals Affected by Obesity” as well as other resources. This information can help our members better communicate with patients about the impact obesity has on all stages of life.

We know that every pound of weight gained puts an extra four pounds of pressure on a patient’s knee joints. We know that excess weight and obesity can lead to arthritis or bursitis. And we know that patients affected by excess weight are subject to greater likelihood of postsurgical site infections.

But many of us may not realize that patients affected by obesity often feel stigmatized in healthcare settings. Some studies have even shown that individuals afflicted by excess weight or obesity are less likely to seek—and more likely to delay—medical care. This is a factor that we can change.

Sometimes, the disease can make it too difficult or simply impossible to do what we do best. But how do we address such “weighty” bone and joint issues with affected patients?

Look for topic-related patient education materials from the Academy throughout the next few months. These materials will be geared toward children and adult audiences to help facilitate “weighty” bone and joint conversations with patients.

Leon S. Benson, MD, is vice-chair of the AAOS Communications Cabinet, and Michael L. Parks, MD, is chair of the Communication Cabinet’s Workgroup on Obesity.

Free Resources Available
In partnership with the AAOS, the OAC is offering a free sample of educational resources on how healthcare providers could work with patients affected by obesity. Bulk orders of materials are available for healthcare practices and professionals for a nominal charge. To request your free sample, contact the OAC at (800) 717-3117 or visit
www.ObesityAction.org

In addition, a free symposium on “Obesity, Orthopaedics, and Outcomes” will be held during the 2014 Annual Meeting, on Wednesday, March 12, from 10:30 a.m. to 12:30 p.m. Insights and techniques for dealing with patients who are obese will be provided.