More than just a number on a scale: The musculoskeletal impact of obesity
Obesity is more than just a number on a scale; it is a complex, chronic disease characterized by an excess of body fat that negatively impacts various aspects of health.
One significant, yet often overlooked, effect of obesity is its impact on musculoskeletal health. The intricate relationship between obesity and musculoskeletal conditions emphasizes the need for comprehensive obesity treatment to effectively address both issues.
Overweight and obesity are independent risk factors for multiple musculoskeletal conditions, including arthritis and low back pain. The additional load on the skeletal system from excess weight alters body mechanics, adversely affecting joint function. Addressing obesity through weight management and lifestyle changes can reduce the risk and severity of musculoskeletal conditions, emphasizing the importance of considering fat mass-related disease when managing obesity-related health issues.
Obesity contributes to musculoskeletal complications primarily through biomechanical stress and adiposopathic chronic inflammation, leading to conditions like osteoarthritis in weight-bearing joints such as the knees and hips. Additionally, increased weight and BMI have been linked to changes in spinal biomechanics, resulting in higher incidences of low back pain. Obesity not only limits mobility, potentially leading to orthopedic disabilities and deconditioning, but also increases the risk for complications in orthopedic surgery. These complications can include infections, sepsis, thromboembolism, trauma, musculoskeletal damage, organ impairment or failure, reduced long-term implant viability, and even mortality.
Addressing weight management, physical activity and strength training can significantly mitigate the adverse effects of obesity on musculoskeletal health, improve mobility and enhance overall quality of life.
Patients with weight-related musculoskeletal conditions benefit from a multidisciplinary approach involving various health care professionals. This team should include providers trained in obesity medicine, nutritionists, exercise physiologists, behavioral therapists and specialists such as orthopedic surgeons, sports medicine providers and bariatric surgeons when necessary. Effective interprofessional communication among these team members is crucial for enhancing patient care. Using the Obesity Medicine Association’s (OMA) four pillars of obesity treatment — nutrition therapy, physical activity, behavioral modification and medical interventions — can improve success rates and reduce disease burden.
For instance, dietitians can offer valuable nutritional guidance, physical therapists can recommend appropriate exercises for recovery from weight-related injuries and medical providers can monitor metabolic risk factors and suggest medical interventions. When necessary, patients can be referred to orthopedic or sports medicine physicians for further management, including injections or surgical treatments.
To reduce the growing burden of obesity-related musculoskeletal conditions, the focus should be on prevention and early intervention. Policymakers should prioritize creating environments that make healthier food choices and physical activity more accessible to everyone. Community efforts should start with children and extend to all age groups, emphasizing the importance of healthy eating and active lifestyles. This includes educating about the negative effects of processed meats, refined grains, fast foods and sugary drinks. Communities should also promote activities that increase physical activity, limit screen time, improve sleep and reduce stress. Increasing funding for obesity prevention programs and adopting community-based participatory approaches can enhance engagement and tailor interventions to local needs. Addressing socioeconomic factors such as food insecurity, poverty and discrimination is critical to creating a supportive environment for maintaining a healthy weight.
In health care settings, screening for obesity and related comorbidities should be a priority. Using frameworks such as the five As — ask, assess, advise, assist and arrange — can help identify at-risk individuals and offer guidance and support. It is important to use more than just BMI in clinical settings; incorporating tools like waist circumference can provide a more comprehensive assessment and help screen for fat mass-related disorders such as arthritis, low back pain and sleep apnea.
By focusing on these strategies, we can effectively reduce the burden of obesity-related musculoskeletal conditions and improve the overall quality of life for affected individuals.
For providers looking to learn more about addressing obesity and musculoskeletal conditions, the OMA’s Obesity Algorithm is a valuable resource that covers the basics of obesity treatment. Additionally, the OMA offers webinars such as “Fat-Muscle-Bone Axis” and “Sarcopenic Obesity,” which delve into both obesity and musculoskeletal conditions.