Breaking Point: Orthopedics and Weight

Intellihealth’s Dr. Louis Aronne and Dr. Katherine Saunders talk with Dr. Michael Parks about the link between orthopedics and weight, as well as the correlation between obesity and arthritis.

The link between orthopedics and weight is clear: for every pound of weight a person gains, the pressure placed on the body’s joints increases two to four pounds. This helps explain why many individuals with obesity also develop arthritis and are more likely to require a total knee replacement. 

Dr. Michael Parks is one of the world’s leading experts on orthopedic problems among patients with obesity, and he’s working to help individuals with high BMIs get the surgeries they need as the associate attending at the Hospital for Special Surgery.

In this episode of Weight Matters, Dr. Louis Aronne and Dr. Katherine Saunders talk with Parks about the connections between obesity, arthritis, and joint replacement surgery outcomes. He also offers advice to people who want to slow or prevent the development of arthritis.

Common Causes of Arthritis

When people first meet with Parks, they often ask about the risk factors for arthritis. Parks stresses that while obesity plays a major role for many individuals, it is not the only cause.

“[Arthritis] is multifactorial,” he explained. “Some people are just going to get it, they’re outliers and get it for no reason. There are other people who may get it because it’s been inherited through their parents, their siblings, they have it, and there’s some genetic component. There’s also a mechanical component, whether people were runners or athletic in the past.”

In patients with higher BMIs, however, the risk of arthritis increases substantially.
“If you’re just mildly obese — that would be a BMI over 30 — you’re about 8-10 times more at risk. But as your obesity increases, you go up to about 32 times more likely to develop arthritis and the need for a total knee replacement,” Parks explained, citing data from the Canadian Registry. “That shows to me that there is a pretty clear relationship between the magnitude of obesity, the development of arthritis, and then the progression to a need for total knee replacement.”

Obesity and Orthopedic Surgery

Even though people with obesity are more likely to require total knee replacements, they often struggle to find doctors who will operate. 

“30% of obese patients undergoing total knee replacements have at least three medical probelms like diabetes, coronary artery disease, hyperlipodemia, hypertension, sleep apnea, compared with only 7% of non-obese patients. So they have these medical problems that we have to contend with, and they could have postoperative complications related to their medical issues that they have,” Parks explained.

Additionally, performing surgery on people with obesity will often take longer, and may require larger instruments, extra people to help, and a different level of technical skill. 

“With these potential downsides to surgery on high BMI patients, it would be easier to just operate on thinner patients, have them quickly in the hospital to go home the same day… and not have the potential for the adverse outcome,” Parks explained.

But at the Hospital for Special Surgery, Parks and his team perform total joint replacements on hundreds of patients with obesity. The hospital has also collaborated with doctors like Drs. Aronne and Saunders to create a Medical Optimization Program, where patients can get help losing weight before a surgery to help improve their outcomes. 

“I stress to the patients that they don’t have to come in and be thin, this is about them 1) being engaged, and 2) about the change, about them losing weight,” Parks explained. “Generally patients will lose 5, even 10% of their body weight, and it allows us then to meet the requirements of many insurance companies, of our own hospital, and to proceed with surgical treatment.” 

Preventing or Slowing Arthritis

If someone is looking to decrease their risk for arthritis, or slow down its progress in the early stages, Parks argues that weight loss is the most important tool at their disposal.

He also encourages people to reframe their idea of what weight loss requires, especially if they have joint pain that makes physical activity difficult.

“Patients often come to me and they say, ‘I can’t lose weight because I have a bad knee or hip and I can’t exercise.’ And I like to tell them right then, that that’s not, in many cases, how you’re going to lose weight. I’ve found with the patients that I see and in my own experience, that it’s going to be dietary,” he explained. 

When you do add physical activity to the mix, it’s also important to find activities that don’t place unnecessary stress on your joints, like walking, bicycling, or swimming instead of running and jumping. 

“I also tell them, probably most importantly, to listen to their body. If they’re doing something that’s bad for their joints, it’s probably painful,” Parks shared. “If they’re uncomfortable, they’re probably doing something they shouldn’t be doing.”

Follow Weight Matters wherever you get your podcasts to never miss an episode. To learn more about Dr. Saunders and Dr. Aronne’s work to transform specialized treatments for chronic conditions through the best in medical science and advanced digital technologies, visit

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