August 25, 2008

Obesity, Diabesity, and Orthopedics

By  Michael D. Shaw

We’ve stated more than once in this column that obesity is the biggest single cause of increased morbidity and mortality in America and elsewhere. Some months ago, we also described the epidemic of Type 2 diabetes, caused in large measure by obesity. According to the CDC, an incredible one in three American children born in 2000 will develop diabetes in their lifetime (the overwhelming majority of whom will develop Type 2 diabetes).

The term “diabesity” is trademarked by Shape Up America!, and refers to the link between obesity and Type 2 diabetes. But diabetes is just part of the list of obesity-related conditions, that also includes hypertension, stroke, gall bladder problems, heart disease, and sleep apnea.

If that weren’t bad enough, there are also orthopedic complications. This medical speciality is now at the front lines of the diabesity epidemic, with doctors increasingly facing younger patients—some in their teens—who need hip and knee replacement operations.

We are reminded by Dr. Bal Rajagopalan, a leading orthopedic surgeon based in Beverly Hills, CA, how excess weight can impact our joints. As it is, the pressure on your knees while climbing stairs is equal to seven times your body weight. Or, stated another way, each additional pound you carry translates into seven extra pounds of pressure on your knees.

Dr. Rajagopalan explains:

“Excess weight results in significantly more pressure on your hips and knees—the primary weight-bearing joints. Lack of physical exercise causes deconditioning of the muscles around the hip and knee joints, exacerbating the situation. The end result is pain and a surgical point of no return, where hip or knee replacement is a necessity.”

For all its benefits, the Internet has ushered in a new era of lethargy. Many people are exercising less, and barely venturing outdoors at all, thus creating a perfect setting for bad eating habits and obesity to flourish.

As Dr. Rajagopalan puts it:

“Twenty years ago, children regularly played sports and grew up in households that valued physical activity. With the arrival of DVDs and laptop computers, too many of these children have matured into adults who lead dangerously sedentary lives.”

While prevention is always better than any cure, the good news is that orthopedic surgery has introduced new procedures that can benefit patients with hip and knee problems. These days, there is a greater emphasis on reproducing and/or replenishing joint fluid, while also using neuromuscular stimulation to increase strength within muscle groups around the joints.

According to Dr. Rajagopalan:

“These are very exciting times because we can help people through any number of conservative steps, or through minimally invasive surgery that allows better range of motion, fast recovery and more preservation of natural anatomy.”

Traditional hip replacement involves a 10 to 12 inch (25-30 cm) incision on the side of the hip, and the hip must be dislocated. Minimally invasive hip replacement surgery allows the surgeon to perform the hip replacement through one or two smaller incisions, with less soft-tissue dissection. The newer cementless implants have a rough, porous surface, which allows bone to adhere to the implant to hold it in place.

Of course, an active lifestyle is no guarantee that you won’t require surgical intervention to fix a joint problem at some time in your life. We are living longer, and are more subject to the consequences of wear and tear.

Let’s not rush it by being overweight!