Arthritis and Obesity

I’m fighting a losing battle: That’s how Ranay C. felt when her doctor suggested she lose weight. Her joints hurt too much to exercise. And she says the medications her doctor prescribed to help relieve her rheumatoid arthritis pain and other symptoms made her gain weight. It’s a cycle, says this CreakyJoints Facebook member; a vicious cycle.

You get it. Perhaps your own doctor told you the same thing. Maybe they were nice about it; maybe they weren’t. And maybe you feel just as frustrated about needing to lose weight to help manage your arthritis. Losing weight is hard — there’s no denying that. And when your joints are stiff and sore, when it hurts to exercise, when you’re exhausted from arthritis pain, the task can feel impossible.

“Everyone blames themselves if they can’t lose weight,” says Angela Fitch, MD, associate director of the Massachusetts General Hospital Weight Center in Boston — people think it’s their fault they can’t stop drinking soda or keep craving unhealthy foods. “But there are biological reasons that can drive you to make those choices,” she says. Plus, some forms of arthritis itself, and its treatment, can lead to an increase in body fat and loss of lean muscle mass, explains John Davis, III, MD, rheumatologist at the Mayo Clinic in Rochester, Minnesota.

Obesity isn’t just needing to eat less and lose a few pounds. It’s a chronic, treatable disease. It’s not going to go away overnight, and it’s something you continually need to work at, says Dr. Fitch, who serves as a board member of the Obesity Medicine Association. But it is a battle worth fighting. And it’s one you can win — if you take it one tiny step at a time.

Obesity can raise the risk of getting certain types of arthritis and it makes every type of arthritis harder to manage. But losing even a little weight can have a huge impact on physical and mental health.

Why Obesity Raises Your Risk of Arthritis

Obesity and Osteoarthritis

For osteoarthritis (OA) and obesity, the connection is clear: the more you weigh, the greater your risk of developing osteoarthritis in certain joints. OA occurs when the cartilage that cushions and protects the ends of bones in your joints wears down over time. Added weight puts more pressure and stress on weight-bearing joints, such as the knees and hips, explains Dana DiRenzo, MD, MHS, instructor of medicine in the department of rheumatology at the Johns Hopkins University School of Medicine. Studies have shown that obese women had nearly four times the risk of knee OA as compared with non-obese women; for obese men, the risk was nearly five times greater.

Another factor may be fat itself. “Adipose [fat] tissue is an inflammatory tissue,” says Dr. DiRenzo. It produces proteins called cytokines that cause inflammation in and around the joints, which can add to joint damage.

Obesity and Rheumatoid Arthritis

Exactly how obesity affects rheumatoid arthritis (RA) and other forms of inflammatory arthritis is unclear, but experts believe that inflammatory compounds from fat may play a role here too. RA is an autoimmune disorder — which means that your immune system is attacking your own body; in this case your joints — that causes inflammation of the joints and also affects other organs in the body.

“It may well be that cytokines and adipocytokines [produced by fat cells called adipocytes] contribute to this inflammatory state, and these cytokines can activate immune effectors and other cell types in the joint to initiate and sustain joint inflammation,” explains Dr. Davis. In a study published in the journal Arthritis Care & Research that he co-authored, researchers analyzed medical records on 813 adults with RA and 813 without RA to examine the association between obesity and risk of developing RA. They found that RA cases rose by 9.2 per 100,000 women from 1985 to 2007 and that obesity accounted for 52 percent of that increase.

Obesity and Psoriatic Arthritis

Research also suggests a link between obesity and psoriatic arthritis (PsA) — a form of inflammatory arthritis that affects some people with psoriasis, an autoimmune disease that causes scaly, red patches of skin. A population-based study found the risk of developing PsA among psoriasis patients increases with BMI, or body mass index; the higher your BMI, the more your risk of PsA increases.

Obesity and Gout

The same is true with gout, which is a kind of arthritis characterized by intense episodes of painful swelling and tenderness in joints, most often in the feet and especially in the big toe. Gout occurs when high levels of uric acid (a normal waste product) in the body causes uric acid crystals to form and accumulate in the joints, triggering painful attacks. Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. If you’re overweight, your body produces more uric acid and your kidneys have a tougher time eliminating it.

How Obesity Makes Arthritis Management Worse

Consider this: Every one pound of excess weight exerts three to six pounds of extra force on joints, says Dr. DiRenzo. If you’re 10 pounds overweight, it increases the force on your knees by 30 to 60 pounds with each step; being 100 pounds overweight means 300 to 600 pounds of extra pressure. All that extra weight on already damaged joints worsens the pain and stiffness and can accelerate disease progression.

Extra fat also means more inflammation. Cytokine levels are already high when you have inflammatory arthritis; obesity compounds it. Research published in the journal Autoimmunity Reviews found obesity can lead to more active and severe RA and PsA. You’re less likely to achieve sustained remission, as well, compared to those with a healthy BMI, according to other studies. And research suggests obese people with ankylosing spondylitis — a type of inflammatory arthritis that can causes some vertebrae in the spine to fuse — are likely to have worse symptoms, less physical function, and lower quality of life.

Plus, obesity may impact how well some of your arthritis meds work, adds Caroline A. Andrew, MD, medical weight management specialist at the Hospital for Special Surgery in New York City. “Studies have shown that some DMARDs (disease-modifying antirheumatic drugs), which are used to treat inflammatory arthritis, may not be as effective in people who are overweight or obese,” she says.

The good news is that the opposite seems to be true: Losing weight can help disease-modifying drugs work more effectively. In a study of patients being treated with tumor necrosis factor (TNF) alpha blockers for psoriatic arthritis, those who lost at least 5 percent of their total body weight showed more of a response to treatment than those who did not lose weight.

How Weight Loss Improves Arthritis

The first thing Dr. DiRenzo asks her patients when they begin to lose weight is: How are you feeling? “And the answer is almost always better,” she says. “Even if you lose just a few pounds, think about how you feel today versus a month ago,” she adds — if you can walk a little farther or move with a little less aching. Improved quality of life is probably the most impactful and tangible effect.

Patty D., a CreakyJoints Facebook member, has lost 75 pounds to date — in part by cutting processed foods, including soda and sugar. “How I feel is what keeps me motivated to continue.”

More benefits of weight loss:

Reduced joint pain and inflammation: Less body weight means less pressure and often less pain. According to a study published in the Journal of the American Medical Association, adults with osteoarthritis who lost weight through a combination of diet and exercise over a period of 18 months reported less knee pain. That’s something CreakyJoints Facebook member Dave M. can attest to: He lost 20 pounds and it made “a huge difference on his knees, hips, and feet.” The study also showed inflammatory compounds associated with arthritis decreased over the course of 18 months of exercise and weight loss.

Better joint function: Research has shown weight loss seems to improve joint function in obese people with knee OA — in part because compressive forces inside the knee joint improved, according to scientists.

Lower risk of comorbid conditions: Cardiovascular disease is a complication of both arthritis and obesity. The same is true for diabetes, as well as depression. Losing weight can help mitigate the risk, says Dr. Davis.

More energy: Angela B. gets home from work exhausted; by the end of the week, it becomes extreme fatigue. On the weekends, she rests to do it all again the next week. “I am too fatigued to exercise at any time,” says the CreakyJoints Facebook member. But as counterintuitive as it sounds, exercise is the best thing you can do to improve fatigue, says Dr. DiRenzo. It releases endorphins, which not only increase energy but also improve mood. Creaky Joints member Anne M. agrees: “Staying within recommended BMI is best pain medication and energy giver of all.”

Sounder sleep: Musculoskeletal pain interferes with sleep and may lead to insomnia, reported researchers in the UK. Weight loss and exercise, however, can help improve sleep.

Expert Advice to Lose Weight and Improve Arthritis

You know the basics: eat more fruits and veggies; choose whole grains, low-fat dairy, and lean proteins; exercise more. But you also know that cooking healthy meals and prepping fresh produce really hurts your hands. And sometimes you can barely walk 10 feet, let alone take 10,000 steps a day.

“Here’s the thing: You only lose weight when you decide it’s critical to you,” says CreakyJoints Facebook member Joanna R., who has maintained a 60-pound weight loss for more than three decades. “It’s a lifelong journey, not a one-time event,” she says. “And only you can do it; no one can do it for you.”

The benefits of shedding extra pounds far outnumber the challenges. Here are 8 tips to help get past the hurdles and lose weight so your joints feel better:

Set small goals. Think about what you’d like to do if your joints didn’t hurt and use that to give you something to work toward, suggests Dr. DiRenzo. If you enjoyed walking around the neighborhood after dinner, start with baby steps: Take a five-minute walk, one day a week, she says; then bump it up to 10 minutes the next week. Then walk two days a week, gradually increasing time or distance. “Give yourself milestones you can meet to keep you successful through the process,” she says.

Try a fitness tracker. Think of it as a way to help you do things more continually throughout the day, says Dr. Fitch. First track your normal — don’t do anything special, and see many steps you take in a day, suggests Dr. Fitch. If it’s 500 steps, for example, aim for 600 steps the following week, and 700 after that.

Fill up on foods that fight inflammation. That’s veggies and fruits, whole grains, nuts and seeds, legumes, and herbs and spices. Not only does an anti-inflammatory diet help with weight loss by boosting energy levels and satiety and improving digestion — these foods also help your body better manage normal inflammation, as well as help it put out the excess inflammation that comes with inflammatory arthritis.

Think quality over quantity in your diet. “You don’t need to eat less, just eat differently,” says Fitch. “Focusing on whole foods and cutting out processed foods, which promote inflammation, gets you healthier nutrition combined with weight loss, which helps your arthritis improve fairly quickly.”

Her motto: “Planned portions of plants and protein throughout the day.”

Stay accountable. When her doctor told her losing weight would help her psoriatic arthritis symptoms, CreakyJoints Facebook member Anne M. used the My Fitness Pal app to keep her on track. She lost about 65 pounds over 12 months. Though she still has stiff, painful joints, her back pain improved immensely. If you’re tech-savvy, a weight loss app works great, says Dr. DiRenzo. You can also keep a journal to help you stay accountable, or find a patient group or weight-loss buddy.

Skip sugary drinks. Slurp down a 30-ounce fountain soda and you’ll drink 400 calories and 25 teaspoons of sugar. Sip a frozen mocha swirl from a popular coffee chain and that’s 730 calories and 35 teaspoons of sugar. As tough as it may be to say no to soda or fancy brews, you really should: Sugar promotes inflammation in your body. And research shows regularly consuming sugar-sweetened drinks is linked to greater weight gain and obesity, which can make inflammatory arthritis symptoms even worse. CreakyJoints Facebook member Vicki B. did just that: She significantly cut sugar in all processed forms and not only lost weight, but reduced inflammation. “I’m living proof this works,” she says. “I have never felt better.”

Review your meds with your doctor. Some medications used to treat RA or other inflammatory arthritis condition can impact weight, says Dr. Andrew. Long-term use of glucocorticoids is associated with weight gain, she says, and several medications used for arthritic pain can also cause weight gain.

“When I was first diagnosed, my weight was ideal,” says one Creaky Joints Facebook member. “After starting biologics, I gained 15 pounds almost immediately and have never been able to shed it.” If possible, try to see an obesity medicine specialist, a physician who has been trained in weight management, suggests Dr. Andrew. “This type of provider can do a thorough assessment, including a review of a patient’s medication list, and potentially [modify your treatment plan] to help mitigate some of the weight effects of the arthritis medications.”

Consider medical interventions. “People tend to think I failed dieting, so now I need meds; I failed meds, so now I need surgery — but it shouldn’t be that way,” says Dr. Fitch. “It’s not a failure if you need medical help. Instead, think of these weight loss treatments as effective tools that can help you accomplish your goal.” Talk to your doctor or an obesity medicine specialist to talk about options and determine if weight loss medication or surgery is right for you.

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