Imagine being one of the millions of Americans in need of a hip or knee replacement due to osteoarthritis. Severe pain, reduced physical activity, an inability to perform many routine tasks — the symptoms can be truly debilitating.
But if you're obese or overweight, there's a good chance that your orthopedic surgeon will refuse to provide care. As one patient told the New York Times of her doctor, "He told me to come back when I had lost 30 pounds."
She isn't alone. According to one survey, fewer than half of orthopedic surgeons will operate on patients with a body mass index above 40. Patients with type 2 diabetes, cardiovascular disease, and high blood pressure face similar barriers to the surgeries they need.
All of these conditions share a common underlying cause: chronic systemic inflammation. Ironically, the very inflammation-driven "metabolic" condition that can get someone to the point of needing a joint replacement in the first place can be what compels their doctor to refuse to perform one.
Thankfully, some doctors are trying to change the status quo by using an approach called "lifestyle medicine." Lifestyle medicine is a medical specialty that uses evidence-based interventions in patient's behavioral choices to prevent, treat, and even reverse diseases driven by chronic systemic inflammation.
While recent pharmaceutical interventions, such as GLP-1 medications like Ozempic, Wegovy and Zepbound, can be an important tool in managing metabolic conditions, they don't provide a comprehensive solution. These drugs can jumpstart a patient's weight loss journey, but without permanent behavioral changes, patients will need to stay on the medication indefinitely to maintain weight loss. Further, these medications do not affect other drivers of chronic inflammation, such as poor sleep and physical inactivity. Lifestyle medicine, on the other hand, can help patients make sustained and consistent behavioral changes needed to tackle inflammation.
The discipline applies six pillars of health that have been found to reduce systemic chronic inflammation: nutrition that balances the good and bad bacteria in the gut, physical activity, sleep, stress management, improving social connections, and avoiding and reducing the use of risky substances.
Improving one pillar of health can have a positive impact on others. When nutrition improves, for example, sleep can improve. Mitigating inflammation caused by poor sleep may be the trigger for some patients to start to experience weight loss.
Contrary to what television ads might claim, there is no single "magic" pill or injection for good health. And addressing weight loss or diabetes in isolation will not solve a patient's entire problem. Taking on systemic inflammation is the most effective, science-backed approach we know of to improve health holistically.
Lifestyle medicine provides the evidence and framework for this care. The hospital I work at has built, a standardized program specifically geared to addressing metabolic conditions in relation to painful musculoskeletal conditions.
New data show that this model of care can work for patients trying to optimize their health prior to surgery. One recent study at New York's Hospital for Special Surgery, which I co-authored, looked at 54 patients with metabolic conditions, including obesity, who were seeking elective orthopedic surgery. Of those, 13 were initially unable to schedule surgery as a result of their metabolic conditions, including obesity. By the end of the program, 85% were able to improve their health and qualify for surgery.
Achieving results like these takes more than medication management. To be successful, programs need to be personalized to reflect goals patients set for themselves. For example, a patient may want to lose weight, sleep better, and reduce pain. Clinicians can then devise plans for achieving those specific goals.
One powerful motivating factor is encouraging patients to look past their current pain and envision the lives they will live after they succeed. One patient of mine had a dream of traveling to Italy with her grandchildren. Another wanted to see Paul McCartney perform live. Those aspirations made sticking to our lifestyle medicine plan much more attainable.
Today, more than two hundred lifestyle medicine programs operate across the country. But only two of them help prepare patients for orthopedic surgery by treating metabolic and musculoskeletal conditions. That needs to change. The entire medical community must embrace lifestyle medicine as a core element of treating osteoarthritis. Patients deserve no less.
