Osteoarthritis Without Weight Loss

An Evidence-Based Guide

Osteoarthritis (OA) is a condition where joints become painful and stiff over time. Think of your joints like hinges – normally they move smoothly. But with osteoarthritis, the surfaces become rough and movement becomes more difficult and painful.

Main Symptoms Include:

  • Joint pain that worsens with activity
  • Morning stiffness that improves with movement
  • Reduced range of motion
  • Swelling around affected joints
  • Clicking or cracking sounds during movement

Important Facts About Osteoarthritis

What Actually Causes Osteoarthritis?

Osteoarthritis has many contributing factors:

  • Age (biggest risk factor)
  • Genetics (50-65% heritable)
  • Sex (more common in females)
  • Previous joint injuries
  • Biomechanical factors (joint alignment, leg length differences)
  • Connective tissue disorders
  • Immune system responses
  • Insulin resistance

The Truth About Weight and Osteoarthritis

Despite what you might have been told:

  • Osteoarthritis affects people of all sizes
  • The old theory about “load on joints” has been disproven
  • Athletes doing high-impact sports that increase the load on their joints don’t show higher rates of OA unless injured
  • Changes that are blamed on weight could just as easily be caused by weight stigma, weight cycling, and chronic stress

What About Weight Loss as Treatment?

The evidence for weight loss as a treatment is quite clear:

  • Most studies show no clear link between weight loss and improved symptoms
  • One large study showed minimal pain reduction (0.5 points out of 20)
  • Weight loss attempts can cause additional stress and potentially worsen symptoms
  • Medications and proper treatment work regardless of weight changes

How Weight Stigma Affects Your Care

Weight stigma in healthcare can seriously impact osteoarthritis treatment:

  • Effective treatments may be delayed while focusing on weight loss
  • You might be pressured into dangerous diets
  • The stress of forced weight loss attempts could make your symptoms worse
  • Important symptoms might be dismissed or blamed on weight
  • Joint damage might progress while waiting for weight loss to “work”

How To Treat Osteoarthritis Without Weight Loss

Physical Therapy

  • Muscle strengthening exercises (symptom permitting)
  • Range of motion exercises (symptom permitting)
  • Proper pain management during movement 
  • Individualized approach based on your needs

Medications

  • Pain relief medications
  • Anti-inflammatory drugs
  • Joint injections when appropriate
  • Treatment of any underlying conditions

Surgery

Research shows joint replacement surgery:

  • Works equally well for people of all sizes
  • Provides similar improvements in quality of life regardless of weight
  • Should not be denied based on weight
  • Has similar long-term outcomes across weight categories

Your Rights as a Patient

You deserve healthcare that:

  • Treats your symptoms effectively
  • Doesn’t delay proper treatment by focusing on weight loss
  • Considers all available treatment options
  • Respects you and takes your concerns seriously
  • Provides appropriate medication when needed
  • Does not cause harm through weight stigma

Getting Good Care

If your healthcare provider focuses primarily on weight loss:

  • Use this script: “I am aware of the association between osteoarthritis and higher weight. I have done my research regarding the benefits and risks of intentional weight loss for osteoarthritis. I have decided that I do not wish to pursue this avenue. I therefore do not consent to discussing my weight or weight loss during this or any future consultation.”
  • Ask about evidence-based treatments:
    • Physical therapy options
    • Appropriate pain management
    • Medication choices
    • Surgical options when needed
  • Ask “How would your recommendations change if weight wasn’t a factor?”
  • Seek a second opinion if needed
  • Remember that you deserve care that addresses your actual health needs

Being Denied Surgery Due to Weight?

What the Research Says

Recent studies on higher weight patients who lost weight prior to knee replacement demonstrate:

  • No difference in surgical outcomes between those who lost weight and those who didn’t
  • Similar improvements in quality of life and knee function regardless of weight
  • No significant difference in:
    • Operation time
    • Length of hospital stay
    • Discharge destination
    • 30-day complications
    • Readmission rates
    • Long-term outcomes

Common Surgical Denial Excuses and the Truth

  1. “The anesthetic risk is too high”
    • The largest study on anesthetic complications found that almost all complications related to healthcare delivery problems, not patient size
    • Proper planning and equipment are the key factors
  1. “You won’t recover as well”
    • Research shows similar improvement in quality of life and function across weight categories
    • Long-term studies show equivalent outcomes
    • Physical therapy works equally well for people of all sizes
  1. “The new joint won’t last as long”
    • No evidence supports this claim
    • Replacement joints are made of durable materials designed to withstand significant forces
    • Studies show similar longevity of replacements across weight categories
  1. “The infection risk is too high”
    • While infection risk is slightly higher, studies show weight loss before surgery doesn’t reduce this risk
    • The solution is proper pre- and post-operative care, not weight loss
    • Many factors affecting infection risk are related to healthcare delivery, not patient size

Weight Loss Won't Treat Your Osteoarthritis But Surgery Will

Your Legal Rights

  • You have the right to proper pre-surgical evaluation
  • You’re entitled to discussion of all available options
  • Blanket policies based on weight may be discriminatory
  • You can refuse to pursue weight loss
  • You deserve access to appropriate equipment and facilities
  • You have the right to care from properly trained staff

Important Reminders

  • Osteoarthritis is not your fault
  • You couldn’t have prevented it
  • Effective treatments exist that don’t require weight loss
  • You deserve evidence-based care that treats your actual symptoms
  • Weight loss requirements for surgery are not evidence-based
  • You have the right to refuse weight-focused interventions

This information, produced by Dr. Asher Larmie, is provided for educational purposes and should not replace professional medical advice. Always consult with healthcare providers for personal medical decisions. For more detailed information and resources, check out his masterclass.