Obesity Treatment in Orthopaedic Surgery

Abstract and Introduction

Abstract

According to the World Health Organization, obesity is a global health epidemic, which has nearly tripled in prevalence since 1975. Worldwide in 2016, 13% of adults 18 years and older had obesity (body mass index ≥ 30 kg/m²) and 39% were overweight (body mass index 25.0 to 29.9 kg/m²). In the United States, approximately 35% of adults have obesity and 31% are overweight. Obesity increases stress throughout the musculoskeletal system and carries a higher risk for the development of osteoarthritis and various other musculoskeletal conditions. When patients with obesity undergo orthopaedic procedures, weight loss is a critical aspect to appropriate preoperative counseling and treatment. Weight loss can improve obesity-related comorbidities such as metabolic syndrome, diabetes, cardiovascular disease, and obstructive sleep apnea, which in turn may reduce complications, minimize long-term joint stress, and improve outcomes among patients undergoing orthopaedic procedures. The effects of obesity on patients undergoing total joint arthroplasty has been previously described, with reported associations of increased risk of infection, revision, blood loss, venous thromboembolism, and overall costs. The purpose of this article was to provide orthopaedic surgeons with strategies for obesity treatment.

Introduction

According to the World Health Organization, obesity is a global health epidemic, which has nearly tripled in prevalence since 1975. Worldwide in 2016, 13% of adults 18 years and older had obesity (body mass index [BMI] ≥ 30 kg/m²) and 39% were overweight (BMI 25.0 to 29.9 kg/m²). In the United States, approximately 35% of adults have obesity and 31% are overweight.^[1] BMI is a person's weight in kilograms (or pounds) divided by the square of height in meters (or feet). Obesity increases stress throughout the musculoskeletal system and carries a higher risk for the development of osteoarthritis and various other musculoskeletal conditions. Sarcopenic obesity is associated with an increased risk of all-cause mortality, new-onset depression, gastric cancer, insulin resistance, vitamin D deficiency, and inflammation.^[2] Treatment of sarcopenic obesity includes strength training exercise programs. When patients with obesity undergo orthopaedic procedures, weight loss is a critical aspect to appropriate preoperative counseling and treatment. Weight loss can improve obesity-related comorbidities such as metabolic syndrome, diabetes, cardiovascular disease, and obstructive sleep apnea, which in turn may reduce complications, minimize long-term joint stress, and improve outcomes among patients undergoing orthopaedic procedures.^[3] The effects of obesity on patients undergoing total joint arthroplasty has been previously described, with reported associations of increased risk of infection, revision, blood loss, venous thromboembolism, and overall costs.^[2] When initiating care for patients with obesity, surgeons should involve primary care practitioners and refer patients to registered dietitians and other weight loss specialists in an attempt to optimize BMI before scheduling surgery.

The purpose of this article was to provide orthopaedic surgeons with strategies for obesity treatment. The following sections will highlight nutritional quality, caloric reduction, exercise, bariatric surgery, pharmacotherapy, lifestyle, genetics, weight gain prevention, postoperative weight management, endocrine, and orthopaedic outcomes as they relate to weight reduction and obesity treatment. Where indicated, we have provided take away points and action items that will allow orthopaedic surgeons to more easily implement these findings into their practice. In addition, we have created a patient handout that summarizes these points, which is included in the Supplementary Data File, https://links.lww.com/JAAOS/A844.

J Am Acad Orthop Surg. 2022;30(24):e1563-e1570. © 2022 American Academy of Orthopaedic Surgeons