Why do men fail to lose weight on diets aimed to reduce knee and joint pain?

Marion Hauser, MS, RD

In this article, we are going to examine the difficulties older men face with joint pain and the need to lose weight and eat a healthier lifestyle. We will look at four studies that get inside the man’s head to show how difficult this can be for him.

“The last time I really tried to lose weight, I stayed on the diet for just a day or two.”

Changing a man’s mind about weight loss – You ARE NOT dieting, you ARE eating healthy

“The last time I really tried to lose weight, I stayed on the diet for just a day or two.” That statement comes from research we will be covering below and it comes from aging men who had a lot of joint pain and were strongly advised to get on a diet.

If your husband, your father, or an important man in your life who has been strongly advised to lose weight so that they would have less knee pain, less back pain, and better overall health, said that you would be thinking, why are they not listening to doctor’s orders to lose weight?

The recurrent themes that researchers found that go through a man’s mind when he is “forced” to be on a diet

  • I am being deprived or prevented from enjoying life. I kneed to enjoy life because I am in pain.
  • Do I really need to be on a diet? Can’t I get rid of the pain another way?
  • I know I need to lose weight but I can’t.

Men in the UK ask Oxford University researchers: “Do I really want to be going on a bloody diet?”

This was the title of a paper published in the August 2018 issue of Disability and Rehabilitation: (1) “Do I really want to be going on a bloody diet? Gendered narratives in older men with painful knee osteoarthritis.”

In this paper, first published onlinee in May 2017 researchers examined the problems of disability in men who are told they need to be on a healthy diet so they could increase their chances of successful rehabilitation from knee replacement are discussed.

This comes from researchers at Oxford University: Here are the study’s learning points and highlights:

  • Small reductions in body weight can decrease osteoarthritic knee pain.
  • Intuitively this should provide a strong incentive for weight-loss.
  • However many people undergoing knee joint replacement are categorized as obese. Somewhere the incentive was lost.

The men in the study respond: “I am too far gone,” “weight loss doesn’t matter anymore.”

The researchers, as just pointed out, had a goal to make rehabilitation better by putting joint replacement patients on a better diet. This is where they ran into barriers. Many older men with osteoarthritis had resigned themselves to the fact that they were “too far gone,” and “it doesn’t matter anymore.”

In the one year study, the Oxford researchers came up with 6 themes that seem to permeate inside a man’s mind when it comes to being told that are obese and need to lose weight to make their rehabilitation more successful. The themes can all relate to the same individual depending on the mood at the time.

  1. I am big and healthy and don’t need to lose weight; (denial/perceived self worth)
  2. Being this size isn’t good for me; (acceptance)
  3. Men don’t have to worry about that sort of thing; (denial/perceived self worth)
  4. I am not as active as I used to be; (justification)
  5. I have worked hard all my life; (justification /perceived self worth)
  6. What is the point in trying anyway? (anger)

The researchers concluded that based on this line of thinking, unique to men, it will be  challenging for men to lose weight even when told it will help post-surgical rehabilitation. Here is a striking statement from the study.

Men may not associate being overweight with being unhealthy

This is not denial, it is a line of thinking that suggests big men are healthy and successful men.
Diet and knee osteoarthritis
What can you do as a spouse, child, loved one, or caretaker to help an older man lose weight? The researchers suggest:

  • Your man may take pride in being in good shape and may respond better to weight loss strategies that focus on fitness not body size.
  • Men may link weight gain with a decrease in activity levels rather than overeating. Get them active.
  • Health care professionals should challenge the assumption that weight loss will follow surgery. Studies show people gain weight after joint replacement. This is something we see all the time, the idea that joint replacement will allow a patient to become more active and thereby lose weight. Not so for many patients.

More than half the men in one study were on diets, researchers examined why they keep failing to lose weight

It is not easy for anyone, especially aging people with arthritis to lose weight. But many try. Researchers from the University of Florida and the University of West Florida examined the weight loss strategies of Baby Boomer men (born in 1946-1964).

Publishing in the Journal of Human Nutrition and Dietetics, (2) the Florida researchers aimed to identify weight-loss strategies used by the Baby Boomers to see if they worked.

In the study of 211 men, 82% were classified as being overweight or obese.

  • Fifty-six percent were currently trying to lose weight.
  • Self-managed healthy weight-loss strategies included
    • reducing portions,
    • increasing physical activity,
    • cutting back on fried foods,
    • cutting back on sweets,
    • cutting back on alcohol,
    • using meal replacement drinks/bars and joining a weight-loss program.
  • Self-managed unhealthy strategies included
    • skipping meals
    • using over-the-counter ‘diet pills’.

The more obese men employed the least healthier options more often.

Spouses were considered essential to their weight management success

Here is what the researchers determined:

  • Older men struggle more to lose weight. In interviews subjects noted:
    • ‘I’ve been struggling for the last 2-3 years’.
    • ‘The last time I really tried to lose weight I stayed on the diet for just a day or two’.

They also noted, “Wives were considered essential to their weight management success.”

In the two above studies, we clearly see that it is difficult for aging men to lose weight and they may give up very easily by justifying that “it doesn’t matter anymore,” or even acknowledging that they have a weight problem. When men do try to lose weight the bigger the problem, the more reliance on quick-fix solutions like diet pills and fasting.

Men justify their weight through anger and apathy

Let’s go back to the above study and revisit the themes men exhibit in trying to lose weight

  1. I am big and healthy and don’t need to lose weight;
  2. Being this size isn’t good for me;
  3. Men don’t have to worry about that sort of thing;
  4. I am not as active as I used to be;
  5. I have worked hard all my life;
  6. What is the point in trying anyway?

Changing a man’s mind about weight loss – You ARE NOT dieting, you ARE eating healthy

Let’s go back to the United Kingdom and a study from the University of Oxford. Here are the learning points of their July 2018 (3) study:

  • “Reframing” means changing the way that a person thinks or feels about a weight loss attempt or weight loss maintenance to enhance its experience or facilitate its success.
  • The researchers examined the ways in which people use and experience reframing in self-directed weight loss.


Most medical studies reviewed involved people who had tried to lose weight previously.

  • Some people thought of dieting as a form of deprivation.
  • Reframing their thinking, teaching people to think about their new eating habits as an exciting new way of life made weight control seem less burdensome for these participants and they felt able to maintain their efforts.

This is such a complex subject. The information here is to show that older men, facing joint replacement or arthritis pain, have difficulty getting on a healthy lifestyle. The challenges are significant as anger and frustration leads to a way to uncaring. It is therefore up to a man’s support system to help him and you achieve the goals of a healthy lifestyle for him.

Do you have questions about joint pain and diet?
You can get help and information from our Caring Medical Staff.


1 Toye F, Room J, Barker KL. Do I really want to be going on a bloody diet? Gendered narratives in older men with painful knee osteoarthritis. Disability and Rehabilitation. 2017 May 5:1-7. [Google Scholar]
2 James DC, Wirth CK, Harville C, Efunbumi O. Weight‐loss strategies used by baby boomer men: a mixed methods approach. Journal of Human Nutrition and Dietetics. 2016 Apr 1;29(2):217-24. [Google Scholar]
3 Hartmann‐Boyce J, Nourse R, Boylan AM, Jebb SA, Aveyard P. Experiences of Reframing during Self‐Directed Weight Loss and Weight Loss Maintenance: Systematic Review of Qualitative Studies. Applied Psychology: Health and Well‐Being. 2018 Jul;10(2):309-29. [Google Scholar]


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