Managing obesity, osteoarthritis, and inflammation
Ross Hauser, MD, Marion Hauser, MS, RD
Research in medicine does not stand still. Frequently we update our articles because a wave of new studies appear on a specific subject, such is the case in the relationship between obesity and inflammation.
Before we get into the science of inflammation, let’s have a quick review of food choices and inflammation.
Our daily food choices fall into either “pro-inflammatory” or “anti-inflammatory” categories. Researchers have found links between eating a pro-inflammatory (bad inflammation) diet and increased fractures in women, as well as an increase in osteoarthritis in both men and women. As we age, pain and fractures are very real concerns, and smarter dietary decisions can help us stay strong and pain-free!
Salmon, for example, is a well-known source of omega-3 fatty acids. These essential fats are often labeled as “anti-inflammatory,” since they decrease systemic inflammation. The fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can improve functional ability and reduce pain in a myriad of conditions, including osteoarthritis.
Onions and garlic both possess anti-inflammatory agents that help with chronic pain. Onions also have the antioxidant quercetin that aids in inflammation. Since both onions and garlic are the basis of so many recipes, the fact that they are so good for us is a great bonus.
Berries are excellent sources of antioxidants. The popular blueberry contains a strong antioxidant called anthocyanin. Strawberries contain high concentrations of anthocyanins as well. A major anthocyanin in strawberries, pelargonidin-3-O-glucoside (P3G), can help in inflammatory conditions. According to a 2018 edition of Food Chemistry, oxidative stress and its components were halted and reduced by P3G.The benefit of strawberries doesn’t stop there. Resveratrol is found in high concentrations in strawberry seeds. Resveratrol has shown cardiovascular-protective properties as well as anti-cancer properties.
What are pro-inflammatory foods? Sugar is one of the top inflammatory foods to eliminate much as possible. Others include trans and saturated fats, fried foods, processed meat, refined carbohydrates, and artificial sweeteners/additives. Choosing fresh, whole foods instead of pro-inflammatory foods as often as possible has far-reaching effects on our health, including our joints.
Research: Doctors do not want to talk weight loss because people understand that they need to lose weight. Where is the disconnect
Let’s look at a September 2021 paper focused on helping doctors understand their overweight patients. This paper was published in the journal Postgraduate medicine. (x)
“Obesity is a major risk factor for development and worsening of osteoarthritis. Managing obesity with effective weight loss strategies can improve patients’ osteoarthritis symptoms, functionality, and quality of life. However, little is known about the clinical journey of patients with both osteoarthritis and obesity. This study aimed to map the medical journey of patients with osteoarthritis and obesity by characterizing the roles of health care providers, influential factors, and how treatment decisions are made.”
What did the researchers find? (90%) patients have/are currently trying to lose weight.
- Patients with osteoarthritis and obesity self-manage their osteoarthritis for an average of five years before seeking care from a healthcare provider, typically a primary care provider.
- Upon diagnosis, osteoarthritis treatments were discussed;
- many (61%) patients reported also discussing weight/weight management.
- Despite most (74%) patients being at least somewhat interested in anti-obesity medication, few (13%) discussed this with their doctor.
- Few (12%) physicians think their patients are motivated to lose weight, but almost all (90%) patients have/are currently trying to lose weight.
- Another barrier to effective obesity management in patients with osteoarthritis is the low utilization of clinical guidelines for osteoarthritis and obesity management by primary care provider.
Let’s state the obvious – people desiring weight loss are not being help. What can be done?
For many people, weight loss comes from within. These people find the right motivational factors and are able to make their way towards their weight goals. There is no magic formula for weight loss. You need to find something that works for you. Some simple tips are:
1. Set realistic goals to lose weight slowly (1 or 2 lbs per week). Losing too much too quickly may result in health problems, as well as cause you to regain quickly after resume eating the way you used to eat. Try to make lifestyle changes in your diet for life – not just to lose weight.
2. Consistency. This applies not only to eating, but to exercising as well. The older we get, the more we realize that we must be consistent with our eating patterns and with our exercise. When we feel like we are gaining weight, it is often because we lost our consistency. Your weight and general health will reflect what you do and eat most of the time.
3. Exercise burns fat quickly and gives you energy. There seem to be many different opinions about whether you need to exercise to lose weight or just change your diet.
4. Work on Muscle building.. Just doing small amounts of weight training and/or CORE training can make a big difference (especially for women). Muscle burns more than fat.
5. Metabolic rate. Raising your metabolic rate will use energy which either burns fat or stops fat being stored. Exercise will raise you metabolic rate. We have also found that spicy/hot foods can also contribute.
Mismanagement of diet. Weight loss can make problems worse in the aging person.
In some people, weight loss would be a recommended strategy to help alleviate joint point related to osteoarthritis. As is pointed out in this article, obesity plays a greater role than just weight load and stress on your joints, the fat you accumulate is creating its own inflammation. Where you have fat, you have inflammatory factors.
Let’s quickly look at a September 2021 paper in the medical journal Experimental gerontology (1). It comes from doctors at the Baylor College of Medicine.
“The number of adults 65 years and older is increasing worldwide and will represent the 20% of the population by 2030. Half of them will suffer from obesity. The decline in muscle mass and strength, known as sarcopenia, is very common among older adults with obesity (sarcopenic obesity). Sarcopenic obesity is strongly associated with frailty, cardiometabolic dysfunction, physical disability, and mortality.
Importantly, diet-induced weight loss is associated with fat, muscle, and bone mass losses, and may further exacerbate age-related sarcopenia and frailty outcomes in older adults.
Successful approaches to induce fat mass loss while preserving lean and bone mass are critical to reduce the aging- and obesity-related physical and metabolic complications and at the same time ameliorate frailty.”
What is “inflammaging”?
“Inflammaging,” is a combination word consisting of “inflammation” and “aging.” Doctors now regularly use this term to describe the harmful aspects of chronic low grade inflammation in aging people. A December 2017 paper in the medical journal Frontiers in immunology, published by doctors at the University of Miami and University of Chieti-Pescara, helps explain this problem.(2)
Here is what the researchers said:
- “Obesity superimposed on aging drastically increases chronic low-grade inflammation (inflammaging), which is an important link between obesity, insulin resistance, and age-associated diseases.” To make matters worse is the emerging problem that aging obese patients do not have good clinical response to the medications they are taking. If you are overweight and you are trying to convince people that your medications are not helping, you may have an argument that your obesity is a hindrance.
While this paper focuses on many disorders of aging including type-2 diabetes, rheumatoid arthritis, cognitive impairment, and dementia, where obesity plays a significant role, we will focus on the aspects of obesity and osteoarthritis.
A quick point though, as stated in this research and another study from university research teams in Italy published in Clinical and molecular allergy, (3) the increase of obesity inspired pro-inflammatory cytokines (small proteins that send pro-inflammatory and anti-inflammatory messages through out the body) is associated with dementia, Parkinson’s disease, atherosclerosis, diabetes type 2, sarcopenia (bone loss) and a high risk of morbidity (disease) and mortality (death). Coming up with a treatment for inflammaging is obvious paramount to the patient’s health.
Obesity accelerates progression of osteoarthritis – Exercise and loss of at least 10% of body weight can effectively lead to improvement in symptoms, pain relief, and physical function.
Study highlights from the University of Miami and University of Chieti-Pescara team:
- Despite the fact that osteoarthritis directly correlates with age, the real cause of this association is not clear, and osteoarthritis development can be separated into aging-dependent (breakdown associated with aging) and aging-independent (breakdown associated with injury, wear and tear demands of sports and heavy labor) processes.
- Both aging-dependent and aging-independent osteoarthritis developments increase production of matrix metalloproteinases (enzymes that breakdown and destroy tissue) and cytokines.
- Both aging-dependent and aging-independent osteoarthritis increase production of Reactive oxygen species (ROS) induced age-related changes in chondrocytes (cartilage cells). Simply Reactive oxygen species (ROS) is a chemical reaction that leads to oxidant damage.
- Weigh loss
- Obesity accelerates progression of osteoarthritis
- Exercise and loss of at least 10% of body weight can effectively lead to improvement in symptoms, pain relief, and physical function.
- Physical activity may reactivate a regenerative process by mobilizing stem cells and increase proteoglycan (proteins) production that restore cartilage structure.
The last statement warrants a few articles on its own, and we have them. These articles will help you understand how physical activity and weight loss help heal damaged joints even advanced joint degeneration. Please see How stem cells heal degenerative joint disease after years of cortisone and painkillers, and Excessive weight and joint pain – the inflammation connection.
Doctors working with nutrition and metabolism are among those researchers who are bringing attention to osteoarthritis as a whole joint disease and in fact a whole body disease.
This is a title of an 2017 study: “Obesity-associated metabolic syndrome spontaneously induces infiltration of pro-inflammatory macrophage in synovium and promotes osteoarthritis.” Before we go onto to discuss this research these are the keywords that should stick out: spontaneously, pro-inflammatory, promotes osteoarthritis.
This study lead by researchers at the Queensland University of Technology, the University of Southern Queensland, and The Prince Charles Hospital in Australia begins with acknowledging that obesity is an important risk factor for osteoarthritis however how obesity causes osteoarthritis remains largely unknown.
Before you read on you may think that the answer is obvious, excessive weight is causing pressure and load on joints. Studies as we have shown in companion articles on this website, are actually looking at how obesity causes inflammation without weight load being a factor. We are going to pull in that research here later in this article.
Back to the Australian researchers: obesity is creating a toxic inflammatory environment spontaneously
The researchers fed Wistar rats a high-carbohydrate, high-fat diet for period of 8 and 16 weeks. The study showed that, obesity induced by this diet is associated with spontaneous and local inflammation of the synovial membranes in the rats even before the cartilage degradation.
- Comment: The obesity is creating a toxic inflammatory environment spontaneously, meaning it is not waiting for degenerative joint disease to occur to produce the classic symptoms of swelling and painful inflammation. This is an amazing reversal of roles – inflammation before degeneration.
The researchers noted increased synovitis and increased macrophage infiltration (immune cells are now invading the areas causing swelling and edema) into the synovium (the protective joint membrane) and a predominant elevation of pro-inflammatory M1 macrophages (A specific type of immune cell) is occurring.
- Comment: The toxic elements created by obesity, and nowhere is wear and tear or load discussed, is the inflammation it creates. Obesity is pro-inflammatory, promotes osteoarthritis.
This study concludes that future therapeutic strategies targeted at the synovial macrophage phenotype (an obesity causing classification of inflammation) may be the key to break the link between obesity and osteoarthritis.(4)
- In other words the joint environment has becoming a diseased joint environment via obesity induced joint inflammation. It can be managed by managing obesity.
When we write our articles, we like to “connect the dots,” this means looking at multiple studies and finding the common thread. This line of thinking takes us over to the Netherlands who one week earlier published their article “Metabolic dysregulation accelerates injury-induced joint degeneration, driven by local inflammation; an in vivo rat study.” The keywords we will be looking at here are accelerates injury-induced joint degeneration.
The growing evidence for the existence of an obesity causing type of osteoarthritis
In this study from researchers at the University Medical Center Utrecht, the doctors wrote of the growing evidence for the existence of an obesity-related phenotype of osteoarthritis in which low-grade inflammation and a disturbed metabolic profile play a role. (A phenotype is a classification, what these doctors are trying to show is that osteoarthritis caused by obesity is a special type of osteoarthritis, caused by inflammation, not wear and tear or rheumatoid factors.)
In a Rat model study, the scientists were able to link together a devastating progression of quick and rapid joint degeneration.
- Forty Wistar rats were divided intow two groups
- Group A a standard/balanced diet
- Group B a high-fat diet.
- After 12 weeks, in 14 out of 20 rats in each group, cartilage was mechanically damaged in the right knee joint. The remaining six animals in each group served as controls.
- Comment: The researchers damaged the cartilage to see how the immune system would respond to injury in an over fed high fat diet test rat.
- After a subsequent 12 weeks, serum was collected for metabolic state (disease or healing environment), subchondral bone changes (bone spurs or bone degeneration), osteoarthritis severity determined by histology (microscopic evaluation), and macrophage presence (Our friends from the immune system the macrophage which cleans up injury debris to make way for healing.)
- The high-fat diet rats showed increased statistically relevant metabolic parameters, resulting in a dysmetabolic state and subsequent synovial inflammation, whereas cartilage degeneration was hardly influenced.
- The high-fat condition in combination with mechanical cartilage damage resulted in a clear statistically significant progression of the osteoarthritic features, with increased synovitis and multiple large osteophytes (bone spur development).
- It is concluded that a metabolic dysbalance due to a high-fat diet increases joint inflammation without cartilage degeneration.
- The dysmetabolic state (obesity causing toxic environment) clearly accelerates progression of osteoarthritis upon cartilage damage.(5)
If you have cartilage damage from wear and tear – obesity accelerates that damage to osteoarthritis
What else can you say? If you have cartilage damage from wear and tear – obesity accelerates that damage to osteoarthritis and more so and the need for knee replacement. If you have somehow been spared wear and tear damage in your joints, the obesity induced inflammation will damage it on its own. Researchers cannot make a more powerful statement.
Other articles on this obesity, inflammation and joint disease
Here is more research from our other articles:
- Metabolic syndrome and osteoarthritis joint pain
- In this article a highlighted study is on the connection between insulin, inflammation, and joint pain here are the bullet points of their findings.
- Excessive weight and joint pain – the inflammation connection
- In this article a highlighted study is from Ohio State University published in the medical journal Pain. The study goal was to evaluate if and how a diet of foods with anti-inflammatory properties affected pain and other problems of inflammation in joints.
- How diet, Type II diabetes and obesity compromise tendon healing
- Obesity and Back Pain
Do you have questions about obesity and osteoarthritis? You can get help and information from our Caring Medical staff.
1 Colleluori, Georgia, and Dennis T. Villareal. “Aging, obesity, sarcopenia and the effect of diet and exercise intervention.” Experimental Gerontology (2021): 111561. [Google Scholar]
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3 Ventura MT, Casciaro M, Gangemi S, Buquicchio R. Immunosenescence in aging: between immune cells depletion and cytokines up-regulation. Clinical and Molecular Allergy. 2017 Dec;15(1):21. [Google Scholar]
4 Sun AR, Panchal SK, Friis T, Sekar S, Crawford R, Brown L, Xiao Y, Prasadam I. Obesity-associated metabolic syndrome spontaneously induces infiltration of pro-inflammatory macrophage in synovium and promotes osteoarthritis. PLoS One. 2017 Aug 31;12(8):e0183693. [Google Scholar]
5 de Visser HM, Mastbergen SC, Kozijn AE, Coeleveld K, Pouran B, van Rijen MH, Lafeber FP, Weinans H. Metabolic dysregulation accelerates injury‐induced joint degeneration, driven by local inflammation; an in vivo rat study. Journal of Orthopaedic Research. 2017 Aug 25. [Google Scholar]
This article was updated September 27, 2021