October 2016

Out on a limb: Weight loss vs wellness

1Limb-JordanaBy Jordana Bieze Foster, Editor

Obese individuals often spend their entire lives telling themselves how much better their lives would be if only they were thin. But losing massive amounts of weight following bariatric surgery doesn’t automatically make a person a better candidate for total knee arthroplasty (TKA)—any more than it automatically makes a person happy—if underlying issues have been ignored.

Lower extremity specialists are well aware that TKA is associated with significantly greater risks in obese patients than in their normal-weight counterparts (see “TKA in obese patients: Weighing the risks vs the benefits,” February 2014, page 16). So it makes sense intuitively that, in patients who lose a significant percentage of their body mass following bariatric surgery, the risks associated with TKA would in turn be reduced.

But research suggests that’s often not the case; TKA complication rates months after bariatric surgery can be as high as in obese patients who have not had a surgical weight loss procedure (see “Role of bariatric surgery in patients with knee OA,” page 29). Experts say this may be because postbariatric patients too often don’t receive follow-up care that will help them address their underlying comorbidities and nutritional issues. If postbariatric patients without knee OA aren’t being encouraged to exercise, those with knee pain are probably receiving even less encouragement.

The concept of bariatric surgery as a cosmetic procedure rather than as just one component of a holistic treatment plan has become pervasive, as have its unfortunate consequences. Jen Larsen’s 2013 memoir, Stranger Here: How Weight-loss Surgery Transformed My Body and Messed with My Head, is just one of a growing number of testimonials detailing the many ways an obese person can achieve thinness without necessarily achieving happiness—at least, not without working through any number of underlying behavioral health issues first.

Postbariatric weight loss won’t make a patient with knee OA healthier or happier, if underlying issues have been ignored.

Larsen lost 180 pounds after her weight-loss surgery, but continued to struggle with low self-esteem and dysfunctional relationships with food, alcohol, and other people. “I think it was comfortable and easy to let fat be my whole problem,” she wrote. “And when I was left with no fat but plenty of problems…it’s like I had cleaned out the flooded basement, which is great and all, but now I had to actually address the cause of the flooding, and it was harder than you think.”

The weight loss that follows bariatric surgery won’t cure a patient’s knee OA, but it does often result in significantly decreased pain and improved gait mechanics. Those positive outcomes put the patient in a much better position to focus on exercise, which in turn can help address some of those underlying comorbidities that can complicate TKA. It’s unfortunate that so many aren’t aware of this opportunity.

It won’t be easy, and some patients won’t want to put in the necessary work. But postbariatric patients deserve to know that weight loss is just one leg of their journey to a happier, healthier life. And they also deserve access to the type of postbariatric lower extremity care that can help them complete that journey.

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