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crucial to prevent further deterioration of health. · Development and utilization of evidence-based surgical risk and readiness assessment measures may help reduce the use of BMI as an independent measure of surgical risk. 18 Bone and Joint Health Strategic Clinical Network Additionally, the use of obesity-related health assessment tools may provide a better indication of the adiposity-related health risk in the patient. · Awareness and education around weight bias should be provided, as it can create inequities in healthcare. · Engagement with patients who have both osteoarthritis and obesity is important to gain their perspective and involve them in advocating for changes in osteoarthritis care. · Promoting healthcare provider and patient collaboration pre and post care is needed to ensure care that recognizes shared responsibility for improving treatment outcomes. · Greater understanding of the inter-connection between mental health, osteoarthritis and obesity is needed, including strategies to optimize treatment in patients where long term joint pain may be influencing symptoms of depression or anxiety. Post Workshop: Outputs and Next Steps The following is a summary of the discussions, keynote talks, and short talks that took place at the AHS BJH SCN OA & Obesity Workshop on June 13 & 14, 2017 in Leduc, Alberta. On their own, osteoarthritis and obesity are recognized as complex and chronic health care conditions for which we do not have a cure, and both require long term management to enable a good quality of life. When combined – both existing in one individual – the complexity is further enhanced and many patients struggle to navigate the health care system in an effective manner. Given our tendency to function in medical silos, an integrated approach to the patient is often not available or implemented. Our fundamental knowledge base regarding these conditions are also incomplete, and there is recognition that we are lacking an understanding of the various ways that the underlying pathophysiology of the two conditions influence each other and impact the life of an individual. Further the interplay with mental health was recognized and requires more attention in such discussions. The workshop talks were presented on a range of topics that highlight this complexity, as well as areas of clinical and basic investigative work being done to inform our understanding of the conditions and ultimately, improve patient care in the health care system. These talks included topics such as: the underlying mechanisms of inflammatory processes; adaptations to the digestive process (metabolic syndrome, nutrition); muscle depletion and fatty infiltration of muscle tissue (sarcopenic obesity); limitations of using Body Mass Index (BMI) as a meaningful clinical determinant; weight loss and weight management; determinations regarding readiness for and appropriateness of arthroplasty for patients with obesity; considerations regarding higher rates/incidence of potential anesthesia complications; economic considerations related to providing arthroplasty to patients with obesity; and why poor outcomes and adverse events occur in such patient populations. The stark reality communicated by the speakers was that pathophysiological changes that occur via obesity are difficult to influence long term or reverse; that there are number of factors 19 Bone and Joint Health Strategic Clinical Network impacting both obesity and OA and the subsequent interface of these two conditions; and that sustained weight loss is incredibly challenging and very uncommon in individuals classified as morbidly obese (less than ~10% are successful). Thus a need for effective obesity prevention strategies became very clear and a shift from the perception that joint replacement surgery as a primary goal for the patient is needed long term. It was also apparent from the discussions that even when arthroplasty is a treatment option, there is a lack of clear guidance on how to determine appropriateness of patients who present with both advanced OA and obesity. And yet glimmers of hope and potential also emerged from the discussions. These include the opportunity to more effectively partner with primary care in preparing patients for surgery and managing patients up-stream when they have mild to moderate OA; more effective strategies and approaches in working with individuals with obesity (considerations of weight bias, using indicators other than BMI to make treatment recommendations) to develop patient-specific programs with shared responsibilities; the effective implementation of existing prevention interventions, continuing the work to determine criteria for arthroplasty. Further, the patients who were present at the workshop, although perhaps not representative of the “average” patient, certainly showcased the potential for success, the influence of effective motivation, and the importance of patients being engaged in their own care. Lastly, given that we continue to struggle with how to treat and manage patients with OA and obesity, we may need to explore different ways of looking at or understanding these health issues. Bringing together the expertise of the short talk presenters and the knowledge and personal experience of the workshop participants, a number of themes emerged through round table discussions. Those identified by the group
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