The concept of obesity is a touchy one in today's social atmosphere, and being sensitive so as to not insinuate "fat-shaming" can be very tricky. As society constantly tries to ride the thin line between "fat-shaming" and educating, it is vitally important that everyone, no matter of age or sex, be aware of the risk they implement on their health. 

It is absolutely necessary for men and women, both, to be comfortable in their own skin, and be confident in who they are as a person and what their body looks like.  Finding a self-confidence-boosting activity to add to the daily regimen has not only proven to lead to an increase in dopamine (happy hormone) production, but also a decrease in cortisone (stress hormone) production. Emotional health is a vital portion of overall health status. 

Being comfortable in your own skin was meant to help people understand that their body will not always look like models or even other average individuals. We all respond differently to caloric intake, exercise, and lifestyles. For example, some people were born with incredible metabolisms - and good for them! Many of us are not, however, and we must make adjustments to our mindsets to understand that although we may never be as thin as some, we can be comfortable in our own skin. Medically speaking, however, being comfortable in your own skin is not validating obesity. 

Obesity traditionally has been defined as a weight at least 20% above the weight corresponding to the lowest death rate for individuals of a specific height, gender, and age (ideal weight). 

Twenty to forty percent over ideal weight is considered mildly obese; 40- 100% over ideal weightis considered moderately obese; and 100% over ideal weight is considered severely, or morbidly, obese. More recent guidelines for obesity use a measurement called BMI (body mass index) which is the individual's weight multiplied by 703 and then divided by twice the height in inches. BMI of 25.9- 29 is considered overweight; BMI over 30 is considered obese. Measurements and comparisons of waist and hip circumference can also provide some information regarding risk  factors associated with weight. The higher the ratio, the greater the chance forweight-associated complications. Calipers can be used to measure skin- fold thickness to determine whether tissue is muscle (lean) or adipose tissue (fat).

Much concern has been generated about the increasing incidence of obesity among Americans. Some studies have noted an increase from 12% to 18% occurring between 1991 and 1998. Other studies have actually estimated that a full 50% of all Americans are overweight. The World HealthOrganization terms obesity a worldwide epidemic, and the diseases which can occur due to obesity are becoming increasingly prevalent.

Obesity affects quality of individual patient care, the strain the healthcare system must endure to adjust, possible health insurance coverage, and nearly every organ in the body. People with obesity often have other health problems, including diabetes, heart disease, certain tumors and cancers, and psychiatric disorders. However, the role of obesity in orthopedic conditions and their treatment is less well-publicized.

According to orthopedic surgeon William M. Mihalko, MD, PhD, of Campbell Clinic Orthopaedics in Memphis, Tenn., “obesity can accompany a multitude of comorbidities that can have a significant impact on a patient’s outcome from elective orthopaedic surgery.” He and his co-authors of “Obesity, Orthopaedics, and Outcomes,” a study published in the November issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), suggest that even though patients with obesity face higher surgical complication rates, orthopaedic procedures can help minimize pain and improve bone and joint function.
The Pains of Excess Weight
Obesity is a strong independent risk factor for pain. Adolescents with obesity were more likely to report musculoskeletal pain, including chronic regional pain, than their normal-weight peers. The disease nearly doubles the risk of chronic pain among the elderly—causing pain in soft-tissue structures such as tendons and ligaments, and worsening conditions such as fibromyalgia in individuals already living with constant pain in their muscles and joints.
Obesity and osteoarthritis
Osteoarthritis (OA)—a progressive “wear and tear” disease of the joints—is frequently associated with obesity. Every pound of body weight places four to six pounds of pressure on each knee joint. Research suggests that excess weight increases pressure, or the biomechanical load, on the knees and increases the likelihood of wearing away the cushioning surface of the knee joint, resulting in the development of OA and the need for total knee arthroplasty (TKA). The need for a TKA is estimated to be at least 8.5 times higher among patients with a body mass index (BMI) greater than or equal to 30, compared with patients who have a BMI within the normal range of 18.5 to 24.9.
Obesity and Injury
In addition to the increased likelihood of wear and tear on joints, excess weight also affects injury status. The odds of sustaining musculoskeletal injuries is 15 percent higher for persons who are overweight and 48 percent higher for people who are obese, compared to persons of normal weight.
Statistically, overweight and obese children also have significantly greater odds of lower extremity injuries and pain than do children of normal weight. Back and lower extremity pain, especially of the knee and foot, are more common among children with obesity.
Pre-surgical Considerations
“Although no upper weight limits have been established that would contra-indicate elective orthopaedic surgery, every surgeon must understand the unique risks an obese patient faces and understand how to optimize and treat each of these patients on an individual basis,” says Dr. Mihalko. The study authors recommend that patients with morbid obesity (BMI of 40 or higher) be:

  • advised to lose weight before total joint arthroplasty (TJA);
  • offered resources for weight loss before surgery; and,
  • counseled about the possible complications and inferior results that may occur if they do not lose weight.

While patients with obesity may experience slower recovery and higher risks of surgical complications that can compromise outcomes, outweighing the functional benefits of TJA in some cases, orthopedic interventions still can provide improvements in quality of life for even for extremely obese patients.