It may seem hard to believe but approximately 34.45% of the entire US population is obese which leads to rapid cartilage loss. This also suggests that one of every three Americans have a body-mass index of more than 30 kg/m2, which is very high. Each year more than $150 billion are spent by the government and non-government agencies to cover the costs and expenses related to obesity. But here are a few questions:
- What are the statistics of obesity in other parts of the world? Is this a western issue or a global problem?
- What are the factors that may influence weight gain or weight loss?
- And most importantly, is there an association between obesity and musculo-skeletal issues?
The answer to these questions will be discussed in this article.
Unfortunately, despite the popular notion, obesity is a global health issue that affects Asian and African communities as well. For example, according to the latest data reported in the annual report of World Health Organization, it was suggested that the prevalence of obesity in some south east asian countries is up to 14 – 22% that makes it a more global and serious issue.
What are some of the factors that may contribute to the obesity and its related complications?
Obesity is a condition, where your body has excessive fat deposition in all the tissues due to metabolic de-rangements or inappropriate lifestyle and habits. In order to understand the complications of excessive body weight, it is very important to know the factors that may contribute to obesity.
After which, we can then determine the strategies or tips which are effective in preventing rapid cartilage loss. Based on an extensive research, scientists have concluded that obesity has a multi-factorial origin – caused by environmental factors, genetical factors, hormonal irregularities and dietary or nutritional factors (3).
In addition, due to excessive mechanization and automation, the overall level of physical activity has been greatly reduced. We use cars, trains, or other means of transportation in order to move from one place to another. Likewise, instead of engaging in regular sports activities, most of us tend to watch television, play video games or perform other sedentary tasks.
Over the years, many studies have linked obesity to several metabolic issues like diabetes, hypercholesterolemia, cardiovascular dysfunction, stroke and musculo-skeletal ailments (such as back pain, muscle pain and joint problems).
Association of Obesity With Rapid Cartilage Loss
Regardless of the cause and pathogenesis, research suggests that high body mass index is strongly associated with musculoskeletal issues. For example, statistics reported in the Journal of Arthroplasty suggested that 52.1% patients who underwent knee replacement surgery in the year 2005 had body mass index of greater than 28 kg/m2. Most frequently reported manifestations of cartilage loss are:
- Frequent episodes of unprovoked bone and muscle pain
- High propensity to develop joint dislocation or fracture
- Arthritis (rheumatoid arthritis or osteoarthritis)
- Limited range of motion due to joint stiffness
- Grating sensation while joint mobilization
- Redness or easy soreness of joints
In the light of extensive clinical investigation, here are some patho-physiological factors that may explain the pathogenesis of joint and bone disorders in the setting of obesity.
- Accelerated wear and tear in tissues
With physiological aging, our joints and connective tissue elements wears off despite high quality nutrition and optimal physical activity even in individuals with normal body weight. In addition, individuals who are obese or over-weight are at additional risk of experiencing joint and soft tissue damage.
This is because clinical studies suggest that your muscles, joints and cartilage are required to work harder than their capacity to perform any physical activity in individuals who are obese. Obviously this leads to accelerated wear and tear in the musculo-skeletal components and leads to rapid cartilage loss and degeneration of muscles.
- Inflammatory mediators
Obesity is a metabolic issue and it is imperative to mention that your body try to fight it off by increasing the release of certain hormones and chemicals mediators. Needless to say that these inflammatory mediators often causes more harm than any good.
Study conducted by Simon Frostick suggested that ongoing inflammation in obese individuals can accelerate the process of osteoarthritis or age-related joint degeneration by increasing the secretion of inflammatory chemical. Needless to say that ongoing inflammation also weaken the strength and stability of other connective tissue elements as well.
- Changes in the composition of muscles
With deposition of fat, your muscles are slowly infiltrated or invaded with fat fibers. This greatly compromises the strength and power of muscles, which is why your bones, joints and cartilage works more intensively to perform even a casual physical function. Likewise, the push and pull of muscles also poses more pressure on the cartilage. This acts as a two-edged sword, not only the cartilage undergoes wear and tear damage but also the pressure on muscles exposes cartilage to injuries.
- Compromised physical activity
Weight gain greatly compromises the capacity or capability of an individual to perform exercise or physical tasks because of a generalized feeling of lethargy, fatigue, weakness, shortness of breath and poor strength. This further promotes weight gain and in turn the musculo-skeletal degeneration process discussed above.
But most importantly, it will also affect the bone remodeling processes. Human bones are in constant state of remodeling and regeneration which is facilitated by physical activity and motion. However, since obese individuals are less mobile, the remodeling process is generally slow that makes the bones and joint cartilage more vulnerable to degradation and damage.
Clinicians explain that both weight bearing joint and non-weight bearing joints of the body are affected. Weight bearing joints are damaged because of overuse or abuse whereas non-weight bearing joints are damaged due to poor activity or remodeling.
- Onset of metabolic issues
Obese individuals often suffers from hormonal and metabolic complications (such as diabetes, depression, anxiety, hypothyroidism or mood disorders) that further deteriorates their capacity to cope with the normal daily social and physical functions. But that’s not all.
Diseases like diabetes, hyper-cholesterolemia and endocrine abnormalities directly influences the bone and joint health by:
- Accelerating wear and tear
- Affecting regeneration
- Increasing the risk of injury
- Impeding the nutritional or blood supply to vital cartilaginous tissue
The effect is additive over time and leads to the early onset of osteoarthritis and other degenerative bone disorders. According to an experimental study published in Arthritis Research and Therapy, Robert A Mooney and associates provided statistical evidence that dietary irregularities that promotes weight gain (such as intake of high fat diet), can accelerate the progression of osteoarthritis.
According to another study reported in Menopause journal, investigators explained the association between metabolic syndrome and cartilage loss.
“Metabolic syndrome has been known to affect a wide range of biological tissues which is described by scientists as a dysregulation of cytokines, adipokines, and hormones (Examples are thyroid hormone and estrogen). Consequently, metabolic imbalance may both directly and indirectly influence joint health and cartilage turnover, altering the progression of diseases such as OA”.
- Higher risk of injuries
Obese individuals are at higher risk of experiencing acute or chronic injuries. More ironically, vast majority of these injuries are silent or asymptomatic (thereby causing more harm in the long term). For example, Andrew J Teichtahl and associates conducted a detailed study on the association of cartilage health and changes in the body weight.
Teichtahl and his team enrolled over 250 obese individuals with no history of an acute injury or bone pain and followed the study participants over a period of 2 years.
During the study period, investigators identified:
- The prevalence of medial meniscal tear in the study group was 18%.
- An increase of 1% in the body weight was linked to a 0.2% greater risk of developing meniscal tear.
- With every 1% rise in total body weight, the chances of developing bone pain increases by 11.2%.
Opposite findings were observed in the individuals who lost body weight.
What can you do to prevent rapid cartilage loss?
Since obesity is the culprit behind rapid cartilage loss, it is highly recommended to initiate a reliable and functional weight loss regimen. According to a latest study reported in the peer reviewed journal Annals of the Rheumatic Disease, investigators analyzed the association between weight loss and cartilage health in 111 obese subjects. 32% of the study participants reported moderate to severe knee osteoarthritis with a mean body-mass index of 36 kg/m2.
Over a period of 12 months, the study participants were subjected to healthy weight loss regimens and periodic assessments were carried out to analyze the effect on cartilage health. The study concluded:
“Moderate weight loss is associated with improvements in the quality (increased proteoglycan content) and quantity (reduced cartilage thickness losses) of medial articular cartilage (in the setting of knee osteoarthritis).”
However, it is highly recommended to opt for interventions that are less stressful on the joints. For example, choosing workout as the sole strategy to shed extra weight is a dangerous approach that may culminate in aggressive cartilage damage and higher risk of injuries.
- Adopt moderate physical activities such as swimming, yoga, aerobic training and conditioning exercises that helps in strengthening the cartilage.
- Choose high quality nutrients and supplements that are effective at promoting the health of cartilage.
- Speak to a healthcare provider to assess the basal health of your cartilage. In addition, if you have pre-existing joint or metabolic issues, make sure to seek proper health in order to delay cartilage degeneration.
- Speak to a dietitian in order to gradually reduce your calorie count. In addition, make sure to incorporate healthy and balanced diet to ensure optimal health.
- Set milestones to gauge your progress.
- If you decide to incorporate exercises for your cartilage health, seek help from a personal trainer to avoid injuries. Most importantly, avoid over-exertion and aggressive exercises.
In simple words, if left poorly managed, obesity can compromise the overall quality of your life by damaging bones and joint cartilage. That is why healthy weight loss regimens are often considered helpful and effective in the long term to prevent rapid cartilage loss instead of medications and surgical interventions.