If you have an orthopedic injury or disease that requires surgery, your overall health is a factor that helps determine how well you will recover from that injury or surgery. Certain health problems can negatively affect your outcome, including peripheral vascular disease, diabetes, osteoporosis, and obesity. Most of these health issues can improve with treatment. Since many orthopedic surgeries are non-emergent, I recommend that these health problems be addressed prior to any elective orthopedic surgery.
One of the most common health issues associated with orthopedic problems is obesity. Obesity is a medical diagnosis, and is defined as having a Body Mass Index (BMI) > 30.0. BMI is calculated as follows:
Obesity is frequently subdivided into categories:
- Class 1: BMI of 30 to < 35
- Class 2: BMI of 35 to < 40
- Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity.
Not only can obesity contribute to the development of degenerative arthritis and other orthopedic problems, it can also lead to significant complications during or after orthopedic surgery, such as joint replacement surgery. Complications could include anesthesia-related events, such as trouble establishing an IV or maintaining an open airway, or requiring large doses of medication to achieve adequate anesthesia. Surgical complications might include longer operative times, increased blood loss, surgical infection, blood clots in the legs that can travel to the lungs, and wound healing problems. These complications can be life or limb threatening, so decreasing the risk of having such a complication is of paramount importance.
If you are considering an orthopedic procedure such as joint replacement surgery, and you carry a diagnosis of obesity, your doctor might recommend or require weight loss prior to your procedure, especially if you have Class 3 obesity. Your doctor realizes that weight loss is not easy, but they also want to “first do no harm.” Your doctor wants to prevent complications as much as possible and ensure that you have a successful recovery. While it might be frustrating to have your surgery postponed until you are healthy enough, it is in your best interests to lower your risk of having a bad outcome by losing weight prior to your procedure.
Obesity is a multi-factorial disease, so there is no single right (or easy) way to lose weight. Some patients think that exercise is the key to losing weight, but there is a lot of truth to the saying, “You can’t out-exercise a bad diet.” Many people with orthopedic conditions have difficulty exercising anyway. If you are able to exercise, it’s best to do low-impact exercises such as using an elliptical machine, stationary bike, indoor rower, or doing water exercises. While exercise will help you burn calories, it is rarely effective as a weight loss method if not combined with dietary changes.
So, weight loss depends mostly on your diet. The best way to start losing weight is to make changes in your diet that can be sustained over a long period of time. Sometimes, it’s just a matter of eliminating sugary drinks like soda, or high calorie substances like alcohol or candy.
Some people have good results with specific diets like the Ketogenic Diet, Paleo Diet, Weight Watcher’s, or Jenny Craig. Others see success with physician-monitored weight loss or consulting a dietitian. Still others might require bariatric surgery if they are severely obese and have failed other methods. Perhaps the ”simplest” weight loss method is to keep a food log and count calories. There are several phone apps that can make this an easier task, such as MyNetDiary or MyFitnessPal. The key is to find something that you can live with over the “long haul” and that fits into your lifestyle. Rapid weight loss is not advisable, as it can result in loss of muscle mass or malnutrition, and the resulting weight loss is harder to maintain. A reasonable goal would be to lose 1-2 points a week. If you accomplish this, you will lose anywhere from 25 to 50 pounds in 6 months!
Patients who need orthopedic surgery, especially joint replacement surgery, often say they will lose weight after their surgery. However, studies show that very few patients with obesity are successful in losing weight after joint replacement.
Therefore, I advise you to establish a healthier lifestyle now, even before you need surgery. Losing weight and reducing your BMI will decrease your risk for complications and increase the likelihood of a successful surgical outcome. It also may decrease your pain to the point where surgery could be postponed or be avoided altogether. If you need help losing weight, discuss it with your primary care physician or surgeon, and they can assist you in finding the help you need.
