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The Impact of Obesity on Bone and Joint Health This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions. According to the Centers for Disease Control and Prevention (CDC), “overweight” and “obesity” are labels for weight ranges that exceed what is generally considered healthy for a given height. How to Calculate Waist-to-Height Ratio (WHtR) WHtR = Waist (in.) Height (in.) How to Calculate Body Mass Index (BMI) BMI = Weight (lb.) × 703 Height2 (in.) Weight Status Men Women Underweight Less than 43% Less than 42% Normal 43-52% 43-48% Overweight 53-62% 49-57% Obese 63% or greater 58% or greater BMI Ranges Weight Status 18.4 or less Underweight 18.5 to 24.9 Normal 25.0 to 29.9 Overweight 30.0 to 39.9 Obese 40.0 to 49.9 Morbidly obese 50.0 or more Super obese The American Academy of Orthopaedic Surgeons (AAOS) believes that orthopaedic surgeons and patients should maintain an open dialogue about the detrimental effects of obesity on musculoskeletal health, and the increased risks of obesity on orthopaedic pre- and postsurgical complications and inferior outcomes. Obesity—an increasingly common condition among patients with orthopaedic conditions— affects individual patient care, the healthcare system and nearly every organ in the body. It is one of the most common diseases that adversely affect bone and joint health. More than two-thirds of adults in the United States are overweight1 , and one in three adults2 have obesity. The percentage of adults with obesity has more than doubled over the past 30 years—from 15 percent in 1980 to 35 percent in 2010. 3 Approximately 17 percent4 of children have obesity, triple the rate from just one generation ago. At the current rate of increase, by 2030, an estimated 44 percent5 of American adults will be diagnosed with the disease. The overall direct and indirect costs of obesity-related healthcare in the United States exceed $215 billion per year6 . However, obesity is not only a domestic health challenge. It also is a global health challenge. In 2008, the World Health Organization estimated that, worldwide, approximately 500 million7 adults age 20 and older are obese while 1.5 billion are overweight. A November 2014 study from the McKinsey Global Institute reported that the global cost of obesity-related healthcare is $2 trillion per year. The Impact of Weight on Bone, Joint, and Overall Health Care Obesity frequently contributes to soft tissue damage and osteoarthritis—a progressive wearand-tear disease of the joints. The impact of obesity is especially felt in osteoarthritis of the hip and knee joints. Every pound of body weight places four to six pounds of pressure on each knee joint. Individuals with obesity are 20 times more likely to need a knee replacement than those who are not overweight. From 2002 to 2009, the number of total knee arthroplasty (TKA) procedures performed on patients with obesity doubled. The detrimental effects of obesity on surgical outcome results and complication rates are welldocumented in medical literature. These effects include higher rates of infection and prosthesis failure/loosening of the implant when compared to patients of normal weight. In addition to contributing to arthritis and other musculoskeletal health issues, obesity also is linked to diabetes, heart disease, sleep apnea, liver disease, pancreatitis, certain tumors and cancers, and psychiatric disorders. Obesity, in the absence of these conditions, does not appear to significantly increase the risk of orthopaedic pre- and postoperative complications. However, in combination with any of these conditions, obesity can adversely affect orthopaedic surgical outcomes. Pre- and postoperative complications may include wound healing, infections, blood clots, blood loss, and dislocation of the replacement joint, especially in the hip. FIGURE 1 Operative time and length of hospital stay for surgeries tend to increase among patients as BMI increased. Compared to patients of normal weight, patients with obesity may also experience the following: Shoulder: Lower functional outcomes following rotator cuff injuries and repair. Spine: Higher rates of hardware failure, complications, and infections. Hand: A direct decrease in hand grip strength. Hip and Knee: Significantly higher rates of complication and hardware failure after total joint arthroplasty (TJA). However, postoperative function greatly improves after surgery in individuals with obesity. Foot and Ankle: Excess weight can cause chronic overuse disorders of the foot and ankle like “flat foot,” which can lead to plantar fasciitis, Achilles tendonitis, and foot and ankle pain. . Sports Individuals with obesity participating in fitness activities are at greater risk
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