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Obesity is a prevalent health concern in the modernized world. According to the Centers for Disease Control and Prevention, the incidence of obesity is reported as 39.8% of the population, affecting approximately 93.3 million American adults. Obesity is a known risk factor for many common health concerns, including heart disease and diabetes.  

However, obesity is not only associated with cardiometabolic diseases.  It is also responsible for ailments to the musculoskeletal system. In this article, we’ll discuss a detrimental effect of obesity on our physical body; more specifically, the role that obesity plays in those with osteoarthritis (OA). Osteoarthritis commonly affects a number of our weight-bearing joints and can cause pain, disability and negatively affect our ability to exercise and stay active.  

Osteoarthritis has long been considered as a natural response to aging and although this is true, at least in part, the role that our body composition plays in our joint health requires due consideration.   

But how can we effectively influence our body composition and lose weight, while managing chronic conditions like osteoarthritis? Is it possible to exercise and lose weight with osteoarthritis? Although the situation may seem daunting, hope may still lie ahead. Through this article, we will look at the link between obesity and osteoarthritis, discovering how these conditions affect day to day life and how these challenges can be overcome.

The Link Between Obesity and Osteoarthritis (OA)

Like many common health conditions, a variety of factors contribute to the development of osteoarthritis (or OA as is it is commonly called), including genetic and lifestyle factors.   

Research supports that obesity is a significant risk factor in the development of OA. At first glance, this idea seems relatively straightforward as extra body weight equals increased load on our joints, especially our weight-bearing joints like the hips and knees.  

Increased pressure through our joints, may lead to early “wear and tear” and eventual development of OA. It has been further described in the literature, that these additional pounds may affect our biomechanics and gait patterns, increasing pressure through our joints; which may also contribute to the development of OA.

However, there is more to the story. Obesity has also been shown to be a risk factor even in non-weight-bearing joints. This may be explained if consideration is given to adipose (or fat) tissue itself. Adipose tissue has been found to be endocrinologically active. More than just a passive insulator, adipose tissue is in fact metabolically active and involved in the “secretion of various adipokines and cytokines”, which has been shown to potentially promote an inflammatory process in the body. These pro-inflammatory adipokines and cytokines may have detrimental effects on joint tissue including “damage to cartilage, joint synovium, and subchondral bone”. In other words, the effect of inflammation on the joints in our body may contribute to the development of OA.  

The Joints of Biggest Concern

Although osteoarthritis can ultimately affect any moveable joint in the body, those of biggest concern are those to which we carry the greatest load. Notably, our hips and our knees are of significant concern when considering the impacts of both obesity and osteoarthritis and the interplay between these two conditions.    

Our hips and knees play an essential role during weight-bearing exercise. Keeping these joints healthy is of utmost importance to remain active and live a healthy lifestyle. We will discuss the impact of osteoarthritis in our lower limb joints and the relationship to obesity in more detail later on.

How Can Weight-Loss Help?

There is a significant relationship between your body weight and your risk of developing OA. Research has shown that for every 11 lbs of weight you gain, your relative risk in developing OA is increased by 36%. Obesity has been shown to worsen the severity of OA and increase OA progression compared to those of normal weight. In other words, maintaining a healthy weight can have a substantial positive effect on your joint health.  

Research has further described that not only weight loss, but your body composition also matters. In fact, the reduction of central fat around the abdomen and reductions in girth of our legs has been shown to assist in the “normalization of joint alignment”. To put it another way, the reduction of body fat in our mid-section and thighs has been shown to have positive implications to our joint health, which could potentially influence the impact of osteoarthritis on our weight-bearing joints.    

  • The more weight you gain, the greater your risk of OA.
  • OA is more severe in those with Obesity.
  • OA progresses more quickly in those who are overweight.
  • Weight-loss has positive implications for those with OA.
  • Your body composition matters, with abdominal obesity negatively affecting our weight-bearing joints.
  • Improving your body composition may positively influence your joint health.

Lean Body Mass and the OA Connection

Another important component of body composition worth consideration in relation OA, is the role of Lean Body Mass. In the case of your weight-bearing joints such as your hips and knees, the Lean Body Mass in your lower limbs plays a specific role.  

Individuals with knee arthritis and less lower limb muscle mass may experience more joint pain. Maintaining appropriate Lean Body Mass around the weight-bearing joints then is essential in assisting those living with OA to reduce pain and allow for an active, healthy lifestyle.

Research has also discovered that individuals with a certain collection of physical traits, including higher bone mass, higher fat mass, and a higher Body Mass Index, have a greater incidence of osteoarthritis of the knee. Additionally, they found that those with OA in the knee had proportionally lower total body lean mass than those who did not have OA.

While it has not yet been determined if low lean body mass is the direct cause of OA or a result, maintaining good Lean Body Mass is important to protect your weight-bearing joints and limit pain in those suffering from OA!

Can Exercise be Harmful to Your Joints?

A commonly held belief exists that exercise over time, may in fact be harmful to your weight-bearing joints. Although this statement may seem familiar, there is in fact little evidence to support this idea, for the majority of exercise, for most people.  

Let me explain…

For the vast majority of people, most types of exercise have not been shown to cause harm to our joints. In fact, exercise offers a host of benefits, including benefits for our joint health.  

As discussed in the review article above, some individuals do need to approach with caution, such as those individuals who have had a prior injury to their joint, such as a knee injury, where stabilizing structures have been affected. Those with a prior joint injury should further consult a medical practitioner for advice in this area.

Another vulnerable group with regard to exercise are those athletes where exercises are particularly repetitive or high intensity, with high impact forces through the affected joints. This notion is especially true in sports where there is a “high associated risk of injury”, such as contact sports. Sports injuries affecting the stabilizing structures of the joints may affect the way you move or may change the way normal forces are translated through the joints, potentially increasing the risk of OA.  

For the majority of people, however, regular exercise has not been shown to be a major risk factor in developing OA. For weight maintenance goals alone, exercise is an essential component, as we will further discuss.

So Just How Does Exercise Help?

Exercise is an essential component of any healthy lifestyle and plays a key role in maintaining Lean Body Mass and positively affects our body composition. Exercise should be a key component of any weight-management program and can help support the proper stabilization and alignment of our weight-bearing joints, promoting joint health.

A study describing the effects of exercise and weight-loss in those with hip OA showed favorable outcomes. After participating in an 8-month exercise program, study participants who were overweight and obese reported a 32% improvement in self-reported physical function, with significant improvements seen in pain and walking abilities. Participants in this study also experienced significant improvements in overall body composition, including decreases in body mass and body fat percentages.  

In those suffering from OA of the knee, a clinical review of the literature on this subject showed that there is solid evidence for the benefit of exercise therapy in those suffering from knee OA and some indication that it is underused as a treatment modality. The article further supported that ‘moderate exercise did not lead to the acceleration of knee arthritis’.

Exercise is an essential part of any healthy lifestyle and should be a part of any program to support weight management. In those with OA, exercise is no less important, especially when considering the effects of excessive weight on our weight-bearing joints. Exercise has been shown to have considerable benefits in those with OA in their knees and hips.  

In those with OA, a low impact exercise program is recommended and may include activities such as walking, biking, swimming or other aquatic exercises. The effects of aquatic exercise or those involving a seated bicycle are good options as they can lessen the impact on our weight-bearing joints while offering the protective effects of exercise.

The Combination Effect

Exercise and weight loss, together, have been shown through research to be the optimal approach for those living with OA. Studies have described that although dietary changes, such as caloric restriction can result in weight loss, in those with OA, exercise is required to help with mobility, self-reported function and pain.   

Long-term weight management in those with OA is complicated by the effects of OA itself including pain and disability. Greater initial weight loss in those with OA, has been shown to be associated with better compliance to treatment and a better long-term prognosis.    

Weight loss and weight maintenance, in general, can be complex when considering chronic health conditions such as OA. Reaching initial weight loss goals continued goal setting, healthy eating patterns such as eating nutrient dense meals and monitoring caloric intake may offer further assistance in this area.  

Regular exercise also helps to promote Lean Body Mass itself. In those who lose weight to lessen the symptoms of knee OA, it is recommended to include an exercise regimen in order to add or restore lower body muscle mass. The intention of this recommendation is to help maintain functionality in the joint, especially for elderly individuals.

Additionally, research supports that maintaining Lean Body Mass can help promote healthy weight management after weight loss. A loss of Lean Body Mass has been shown to be a risk factor for weight-regain and increased body fat, not only due to negative effects on metabolism and deficits but also because of the body’s attempt to replace lost Lean Body Mass by overeating.   

So not only can exercise help to support our body composition by helping to maintain our Lean Body Mass, but the effect of Lean Body Mass itself helps to regulate our metabolism, further supporting weight management goals. Lean Body Mass, and specifically lower limb Lean Body Mass, has been shown to offer a protective effect on our weight-bearing joints, potentially lowering your risk of developing OA,

The Big Picture

Obesity has been shown to be a significant risk factor for the development of osteoarthritis, not only due to the effects of extra weight on our joints, but also as a result of the associated pro-inflammatory effects of adipose tissue itself. Our hips and knees, being your weight-bearing joints, are of greatest concern.  

Body composition factors including excessive adipose tissue on our midsection and legs have been shown to negatively impact our weight-bearing joints. Promoting Lean Body Mass and encouraging weight loss may potentially lower your risk of OA and improve the quality of life for those managing this condition.

Exercise is generally regarded as safe for those individuals with OA and should be a key component for those individuals looking to improve their body composition, reduce Body Fat Mass, improve Lean Body Mass and promote a healthy weight.  

In addition to the many positive benefits that exercise promotes for those living with OA, exercise has a positive effect on our Lean Body Mass, supporting weight management goals by offering positive effects on metabolic regulation and helping to improve the symptoms of OA for day to day life for those who live with OA. For those with osteoarthritis, improving our body composition and utilizing exercise as a key component in weight management can have a direct and positive effect on our joint health.


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