Will Weight Loss Help My Joint Pain?

How long have you been putting up with that joint pain because you assumed it was due to your weight? That’s what we’ve been told, after all. Something about excess load acting on the weightbearing joints causing excess wear and tear, right?

Wrong. Let’s take a moment to debunk this myth. The good news is that I’ve done this a few times with the trolls on Instagram, so I’ve become a bit of an expert in anticipating their thoughts. The conversation goes something like this…

How long have you been putting up with that joint pain because you assumed it was due to your weight? That’s what we’ve been told, after all. Something about excess load acting on the weightbearing joints causing excess wear and tear, right?

Wrong. Let’s take a moment to debunk this myth. The good news is that I’ve done this a few times with the trolls on Instagram, so I’ve become a bit of an expert in anticipating their thoughts. The conversation goes something like this…

Too much load on your joints = pain

If that’s the case, then why don’t all fat people get joint problems?

Guess they must be lucky. Too much load on your joints = wear and tear

If that’s the case, why do thin people get osteoarthritis (wear and tear of the joint, which leads to pain)?

Are you trying to suggest that excess weight doesn’t damage the joints?

I’m trying to suggest that osteoarthritis is a complex condition, and we don’t know why some people get it and others don’t. We DO KNOW that there’s a genetic component, and that a history of injury or damage to the joint is a significant risk factor. It has been linked to inflammatory changes, and alterations to the immune system.

But the heavier you are, the more likely you are to get joint pain😏

Er, yeah. That’s hardly surprising since higher weight people have less access to healthcare, are often denied treatment, and have a history of weight cycling which damages muscles and bones in the long term. Plus, we experience weight stigma and social exclusion which is linked to chronic inflammation. And that’s bad for the joints too.

So you think people with joint pain shouldn’t lose weight?

Absolutely. I think the last thing people with joint pain should do is reduce their muscle mass and bone density, reduce their serotonin/dopamine/oxytocin levels, increase their stress levels, and cause long term damage to their bodies. Which is exactly what happens when people attempt weight loss.

So what should they do then?

I’m glad you asked. Let’s spend the rest of this post exploring this in more detail.

Weight Loss doesn’t improve joint pain in the long-term

We can all agree that while higher weight individuals are more likely to have OA of the knee compared to their leaner counterparts, we’re not sure why. But the question is, does weight loss help?

Some studies have shown a boost in quality of life with weight loss prior to knee replacement surgery, but here’s the twist – very few studies stick around long enough to see if that boost stays for the long haul. Those that do find that any initial differences don’t last.

In fact, long term studies show that while surgery definitely improves quality of life, joint function, and mobility scores, weight loss doesn’t have any bearing on this.

Weight loss can WORSEN joint pain

Weight loss causes a lot of damage to your body. Side effects include muscle wasting and weakness, anaemia, dizziness, malaise, and fatigue. Energy restriction impacts your hormones (including insulin, thyroid and reproductive hormones), slows your metabolic rate, increases your cortisol levels, and leads to chronic inflammation.

For starters, chronic inflammation has been implicated in the underlying mechanism of osteoarthritis. Excess cortisol release can prevent healing, and muscle strengthening/stabilisation exercises have been shown to improve joins pain. But there’s more.

Energy restriction also reduces levels of serotonin (the ‘feel good’ hormone), dopamine (responsible for motivation and pleasure), and noradrenaline (responsible for energy levels and attention). It also reduces oxytocin levels, your body’s natural stress reliever.

The psychological side effects of weight loss include irritability, depression, apathy, decreased concentration, and food-related obsessions. Poor mental health affects cognition, energy, and pain levels.

What about exercise?

People with chronic conditions like osteoarthritis, autoimmune conditions, and fibromyalgia, are often advised to exercise for their health. And there’s nothing wrong with this advice per se. We know that physical activity has been shown to improve symptoms and increase life expectancy, although it needn’t be structured exercise for it to be beneficial.

Many people also find movement helps them manage their symptoms, which is a good thing. But it is also not the be-all and end-all. You don’t have to move in order to be “healthy”. And sometimes movement exacerbates symptoms and makes things worse.

There’s also a big difference between moving for joy/pleasure, and moving to lose weight. But most of us have been conditioned to believe that physical activity is a “lifestyle choice”. And “healthy lifestyle choices” are often first-line recommendations in treatment guidelines. 

Which is why weight often creeps into conversations about exercise and they end up being very stigmatising.

What if I can’t get treatment for my joint pain unless I lose weight first?

Many doctors will deny you surgery/injections/epidurals if you’re over a certain BMI limit. Some doctors will refuse to treat you at all unless you lose weight first. Not only is this completely unethical, but it is a breech in a doctor’s duty of care. In fact, I would argue that it is negligence.

Nevertheless, it happens all the time. And when you’re in pain, the thought of being denied care or having your treatment withdrawn is enough of an incentive to pursue weight loss. I suspect most of us would if we were in that situation.

The problem is that weight loss isn’t sustainable, and even changes in diet and exercise patters aren’t feasible in people with a history of joint pain. For example, a person with hypermobile EDS is at a higher risk of sustaining an exercise-induced injury, which causes more long term damage. A person with fibromyalgia and chronic fatigues may lack the spoons to exercise and cook meals from scratch.

And don’t forget that with every weight cycle, it gets harder and harder to achieve the same percentage of weight loss. Which means more extreme measures become necessary. 

Weight neutral care for joint pain

We shouldn’t have to fight to get the care we deserve. We should be able to access it without any difficulty. And were it not for this white supremacist, capitalist, patriarchal society we live in, that would be our reality.

I don’t know about you, but fighting white supremacy, capitalism, and the patriarchy isn’t on the cards for me every time I visit the doctor.  That’s if I do visit the doctor. I try and avoid them at all costs, even to my own detriment.

That’s mainly because I can’t remember the last time I visited a doctor and they didn’t mention my weight. It’s not just the stigma, but the lack of treatment options too. What’s the point? Even when I tell them not to talk about weight, doctors find a way to circumvent my wishes;

“Fine, we won’t talk about your weight but have you considered making some changes to your diet and doing more exercise?”

Surely there’s a way to manage symptoms like joint pain without bringing up weight, diet OR exercise?

Why yes, yes there is.

By the end of this masterclass, you’ll be able to refuse weight loss advice, ensure you get the treatment you deserve, and challenge any BMI based treatment denials. 

You’ll no longer feel like putting up with symptoms or putting off your doctor’s appointment. And if you’re thinking, “I’ve put up with it for this long and I know the doctors won’t care, so why bother?”. Consider this. We both know you CAN manage these symptoms. But the questions is SHOULD YOU HAVE TO?

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