How many of the patients you see are obese or morbidly obese? And how do you measure this? Eyeball them? Body mass index (BMI)? Weight?
BMI tables abound and a BMI above 30 is considered obese. If you are like most orthopedic practitioners, you see an awful lot of this (and even higher — in the 40s or 50s) because obesity creates joint stress, and joint stress results in all manner of joint dysfunction and degeneration.
Some surgeons will decline surgery to patients with a BMI over 30 — and some will perform joint replacements up to a BMI of 40. But what do we tell patients we are turning away, or those patients for whom we are deferring surgery due to body size?
Hopefully we’re telling them something to help them get to the next level of care, which includes a frank but gentle discussion of how their obesity is contributing to their pain, and how a change in their body size can significantly improve their pain. Don’t assume they already know. Many patients don’t realize that their knee pain is from the 200- or 300-pound load they have been carrying for 30 years. They’ve heard about the risks of obesity from their primary care practitioners, but many patients don’t realize their obesity may put them in a wheelchair before their time because, at certain sizes, surgery is just not an effective option.
So what do you tell your obese patients? “Can’t help you. Lose weight. Have a nice day”? Hopefully you are the kind of practitioner who cares enough about your patients, their joints and their overall health to find a way to say, “Your body size is really posing a problem for your joints. Even a few pounds of weight loss will be perceived by your joints as a tremendous improvement in load to the joint. Unfortunately, the reverse is also true. A weight gain of just a few pounds is perceived by your joints as a significantly increased load.”
But let’s not stop there. This is where we need to help our obese patients take the next step. Offer a referral back to primary care practitioners for weight loss programming. Or give a “tip of the day” to your obese patients. Encourage water exercise – water therapy for strengthening is a great entrée to this exercise modality. Have the local contact information for Overeaters Anonymous, Weight Watchers, or community education programs. Have a handout. Give them hope on the way out the door.
Above all, be an encouragement to them. All is not lost, but your joints will feel better when even a little weight is lost.
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