BMI - what to do when your BMI is said to be too high

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Jamie

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From Josephine:

I use broken link removed: https://www.weightconcern.org.uk/node/24
 
ai47.tinypic.com_2e2jm68.jpg


It can happen.

You meet with your surgeon and he tells you that you're just too heavy for a successful outcome with joint replacement surgery. "Lose some weight first, " he says. "Then come back and we'll discuss it."

You leave feeling sad, hopeless and wondering what to do next. You'd love to lose weight, but it's almost impossible to stay with a consistent exercise program because your joints hurt too much.

So what now???

The best course of action is to get busy and find a new surgeon who is more understanding of the problem. There are many who will perform knee or hip replacements on obese patients. If you're in the USA, use the BoneSmart SURGEON LOCATOR (tab in the dark blue bar at the top of the page) to find potential surgeons within whatever distance you are willing to travel. If you're in the UK, post your location with a tag to our forum nurse, Josephine, and she can help you locate a surgeon. If you're in another country, find all the orthopedic surgeons in your area and contact them.

aimg.photobucket.com_albums_0903_althetrainer_cell_phone_cartoon_guy_talking.jpg

Their websites won't mention whether or not they work with overweight patients, so call as many on your list as possible and ask if the surgeon is comfortable working with someone of your size.

Before you begin your search, it helps to be armed with information. The posts in this thread will provide data to assist in your search. Most surgeons will want to know your Body Mass Index (BMI), so calculate that before you start calling clinics. Be prepared to tell them if you have gained a significant amount of weight BECAUSE of your bad joint(s). Let them know how much weight you've gained and in what period of time. Also, talk about your willingness to begin a healthy life program once you are pain free.

In this thread, you will also find an article supporting the argument that weight is not a factor in how well someone will do after joint replacement surgery. While there may be some additional days spent in a hospital unit where you can be carefully monitored for possible breathing or heart issues, the performance of your new joint will be much the same as any other patient.

Hopefully we will be able to provide more research results for you in the future.

What you must do is NEVER give up hope! Many folks before you have had successful hip or knee replacements and have gone on to happy lives with their new joints. There is a surgeon out there who can help you. You just have to find him! We're here to help as much as we can in your search.
 
From Roy Gardiner:

There are any number of BMI calculators on the net. The ones I have seen require you to convert your height and weight to metric. But that is what computers are for! So I have created one that allows you to enter either metric or Imperial measurements to your choice

Here's what the screen looks like: broken link removed: https://www.roygardiner.com/images/bmiscreen.jpg (link rather than image because it's quite big).

To use it it's here amongst other cycling related calculators, scroll down until you find it: broken link removed: https://www.roygardiner.com/gears.htm
 
And.....from Bumpa:

Patients with high BMI show similar improvements in patient-reported outcomes after TKA
September 4, 2012

Researchers from the United Kingdom have reported similar improvements in patient-reported outcomes after elective total knee arthroplasty regardless of patient body mass index, according to a recent study published in the Journal of Bone & Joint Surgery.

Paul N. Baker, MBBS, MSc, FRCS(Tr&Orth), and colleagues analyzed patient-reported outcome measures of 13,673 primary total knee arthroplasty (TKA) procedures from the National Joint Registry preoperatively and 6 months postoperatively. Patients were divided into three groups based on body mass index (BMI). Obese patients in the group with a BMI between 40 and 60 kg/m² had similar Oxford Knee Score, EuroQol 5D index and EuroQol 5D VAS scores postoperatively compared to patients with a BMI between 15 and 24.9 kg/m², according to the abstract.

“Patients achieve equivalent improvements in knee function and general health irrespective of their preoperative BMI,” Baker told ORTHOPEDICS TODAY. “Obese patients gain as much benefit from knee replacement as patients with a ‘normal’ BMI, even if they do not end up at a similar postoperative level. Accordingly, we feel that the obese should not be excluded from the benefit experienced by their fellow patients with lower BMI from undergoing total knee replacement.”

Although patient-reported outcomes in the group with the highest BMI were similar, the group had significantly higher wound complications than the patients with “normal” BMI, Baker and colleagues noted. The study comes as a response to recent legislation in the United Kingdom that would limit access to total knee arthroplasty (TKA) procedures for patients with a BMI > 35 kg/m², according to Baker.

“The current situation in the UK is that the responsibility for health budgeting has devolved to the primary care physicians and their associated primary health care trusts. From the money allocated to them, they are responsible for purchasing services from hospitals for their patients,” Baker said. “Certain health care trusts have refused to pay for knee arthroplasty procedures in patients above specific BMI thresholds due to a perceived reduction in risk/benefit in this group. Our argument is that these thresholds are completely arbitrary and lack any evidence to support their use.”

Reference:
Baker P, Petheram T, Jameson S, et al. The association between body mass index and the outcomes of total knee arthroplasty. J Bone Joint Surg Am. 2012; Aug 15
 
I am having difficulty finding a surgeon that will replace my bone on bone hip. I'm becoming less and less mobile each day with excruiciating pain any help would be appreciated. I am obese.
New study into the challenges of obesity:

Being overweight may be physically changing the environment within people’s joints, as new research suggests that obesity is promoting pro-inflammatory conditions which worsen arthritis.

In a new study published in Clinical and Translational Medicine recently, researchers from the University of Birmingham have found that specific cells in the joint lining tissue (synovium) of patients with osteoarthritis are being changed due to factors associated with obesity.

Previous research has shown that fat tissue that has been metabolically altered by obesity releases proteins called cytokines and adipokines, which are known to promote inflammation around the body. The newly published study funded by Versus Arthritis observed that in cells taken from biopsies of arthritic joints, obesity also changes the environment within the joint itself, leaving cells in the joint vulnerable to being ‘turned’ into those that promote inflammation.

Dr Susanne Wijesinghe from the Institute of Inflammation and Ageing at the University of Birmingham said: “We have seen that obesity can promote the kind of destructive inflammation in joints that goes far beyond what we might expect to see from wear and tear alone, even in non weight-bearing joints such as the hands.

“Obesity is creating an environment in the body, which is negatively affecting cells called synovial fibroblasts, which are stem cells involved in regulating the lubricating fluid of the joints. The effect is that these cells get recoded into those that promote inflammation within the fluid around the joints. Then, like bad apples in a barrel, they begin to affect the whole joint, increasing secretion of chemicals such as CHI3L1 which degrade the joint and increase the progression of osteoarthritis.”

Hips don’t lie – weight isn’t driving factor in load-bearing joints

Weight wasn’t determined to be the driving factor for impacting the joint cells leading to greater inflammation, the research found.

The team of researchers used biopsy information from a range of joints including both weight-bearing joints such as hips and knees as well as the hands to determine whether the additional physical strain on joints associated with obesity was driving pro-inflammatory cytokines. The results found that there were independent impacts of obesity on load bearing and non-load bearing joints, and that among the 16 patients with BMI of over 30, weight alone didn’t account for the molecular changes in those joints.

Simon Jones, Professor in Musculoskeletal Ageing in the Institute of Inflammation and Ageing at the University of Birmingham said: “This research helps us to both design better studies that more accurately understand the different conditions that affect patients with osteoarthritis, and it also better guides the way we develop drugs for the condition in the future.

“Potential targets and ways of delivering drugs can now be specifically considered for patients who do and don’t have metabolic changes driven by obesity. In addition, if we treat osteoarthritis patients with obesity as a clinical sub-group we can also see whether specific therapies that address the metabolic element driving the disease can halt that underlying risk.”

Zoe Chivers, Director of Services and Influencing at the charity Versus Arthritis said: “This study provides further evidence that osteoarthritis (OA) is not just inevitable ‘wear and tear,’ but the result of complex and diverse biochemical changes in the joint.

“The research reveals that obesity can lead to a change in the cells in the joint lining to make them more inflammatory, and that these changes occur not only in load bearing joints such as the knee and hips, but also in non-load bearing joints such as the hand.

“These findings greatly enhance our understanding of what can cause osteoarthritis, bringing us closer to discovering more effective treatments in the future.”

Source: University of Birmingham

Reference: Jones et al (2023). ‘Obesity defined molecular endotypes in the synovium of patients with osteoarthritis provides a rationale for therapeutic targeting of fibroblast subsets.’ Clinical and Translational Medicine.
 
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