Caring Medical - Where the world comes for ProlotherapyWeight loss may be your best anti-inflammatory

Marion Hauser, MS, RD

Losing weight is difficult. Especially for someone in chronic pain. Over the years we have found that when someone achieves their weight loss goals, it is usually not a diet plan that made the difference for them, it is usually some type of motivation or inspiration that helped these people achieve their weight goals.

In this article I hope to perhaps provide some small motivation that can show how you can attack two problems, at the same time, that may be causing you concern. Your challenges in losing weight and your challenging dependence on  anti-inflammatory medications to get you through your day.

If obesity causes chronic pain through inflammation, is losing weight an anti-inflammatory?


Excessive weight causing inflammation and joint pain

In our clinics, we see a wide variety of patients with a wide variety of problems, included are many patients who have issues of weight and obesity. We understand how difficult it can be for people to lose this excess weight, especially when they are in pain and have limited mobility and function.

When someone comes in for a visit who have clear weight concerns, we do not lecture these peoples on the value of losing weight. These people we see have been to numerous doctors and had numerous treatments and every step of the way they were likely told that they NEED to lose weight. The patient was also likely given numerous nutritional guidelines and dietary recommendations that have not been successful.

In our clinics, we try to jump start weight loss by making the painful joints less painful and by education. The purpose of this article is to provide information and that hopefully, you will be able to get some help from that information in your weight loss journey.

A 2017 study from Ohio State University in the medical journal Pain, (1) tries to explain how and why obesity causes chronic pain through inflammation. In this research, the goal was to evaluate if and how a diet of foods with anti-inflammatory properties affected pain and other problems of inflammation in joints.

Here is what they found:

  • Results provide support for (good) dietary intake providing benefit in patients with excessive weight or obesity and their levels of pain.
  • Overall, higher body fat was associated with self-reports of greater pain, and dietary practices consistent with better health and anti-inflammatory effects were associated with lower self-reported pain.
  • Poorer food choices among individuals with higher body fat may contribute to symptoms of pain.
  • Overall, dietary intake of foods with greater anti-inflammatory effects appears to be relevant in the relationship of body fat to pain.
    • The researchers found it especially interesting that the primary component of dietary intake driving the beneficial effects were consumption of seafood and plant protein.
    • Given the higher content of omega-3 fatty acids in seafood and the documented anti-inflammatory effects of omega-3 fatty acids, this provides further support for the hypothesis that intake of foods with demonstrated anti-inflammatory effects.
    • Plant proteins with demonstrated anti-inflammatory effects (eg, nuts and seeds, soy products) accounted for beneficial effects in respondents following a strictly vegetarian diet

The conclusion of the study presented simple data indicating that dietary intake of foods with anti-inflammatory effects helps control body pain in obese individuals.

This research was not the first to confirm such a connection.

Obesity is more than weight load – it causes inflammation without wear and tear

Doctors at the University of Calgary writing in the journal Osteoarthritis and Cartilage (2) examined obese laboratory animals and found that not only does obesity cause osteoarthritis because of weight load, but it also causes osteoarthritis in a “non-mechanical” way – in other words by inflammation without wear and tear.

  • What is striking about this research is that the laboratory animal had osteoarthritis in one joint caused by wear and tear, yet in the joint on the other side, the knee for example, where wear and tear were not present, the inflammation was just as great. The inflammation attacking the joints of the animals was caused by a high fat/high sugar diet. This is covered further in our article Abdominal obesity, hypertension, and diabetes is destroying your knee.

This type of research is helping doctors get away from the excessive weight load model of thinking, although weight load does cause obvious problems, and helps them look at the inflammation problems.

This was confirmed by French researchers in Current Opinion in Rheumatology,(3) who suggest that the rising prevalence of hand osteoarthritis is from obesity and since the hand does not bear weight, this suggests that the role of systemic inflammatory mediators in fat cells cause inflammation signaling to be sent out and attack joints.

Doctors at the University of Padova in Italy writing in the Journal of Cellular Physiology, (4) in citing the above research that suggests obese people have an increased risk to develop not only knee but also hand osteoarthritis, the concept that adipose (fat) tissue might be related to osteoarthritis not only through overloading suggests that obesity induces a low grade systemic inflammatory state characterized by the production and secretion of several adipocytokines (inflammatory mediators) that may have a role in osteoarthritis development.

Obesity may prevent tissue remodeling, healing and damage repair

In a recent paper, Duke University researchers noted (5) and speculated that obesity may prevent tissue remodeling. Remodeling is the repair process of healing. In recent years much has been made of stem cell therapy as a non-surgical regenerative medicine staple treatment for cell remodeling. We utilize stem cell therapy in our clinics. In this research the investigative team looked at the impact of obesity on adult stem cells as stem cells are closely associated with the remodeling and potential repair of of bone and cartilage. These doctors hypothesized that obesity would alter the frequency, proliferation, multipotency and immunophenotype [healing protein expression] of stem cells from a variety of tissues.

Does this mean stem cell injection therapy will not work for obese patients?

No, the Duke researchers concluded: “These findings contribute to our understanding of mesenchymal tissue remodeling with obesity, as well as the development of autologous stem cell therapies for obese patients.” In other words, while the impact of obesity is not fully understood, obesity certainly makes healing more challenging but not impossible.

When an obese patient comes into our office seeking non-surgical alternatives to joint replacement we MAY suggest:

  • Stronger treatment protocols beyond simple dextrose prolotherapy. This may include growth factors, platelet rich plasma, stem cells, or a combination of treatments.
  • If so we inform the patient they will likely need more treatments than an ‘average weight’ person.
  • Nutritional, exercise and weight loss guidelines will be suggested.

Weight management, not joint replacement. Knee replacement is not an easy way to weight loss.
Research: Knee replacement does not help people lose weight.

Many patients are under the assumption that the quickest way to attack their obesity problem is to get a joint replacement. The thinking is that is they eliminate their knee pain they will be able to exercise and lose weight. Surgeons are being told to tell patients that is not true for many obese patients.

Doctors at the University of Texas MD Anderson Cancer Center (6) showed that increasing BMI (Body Mass Index – Obesity) and anxiety levels and decreasing levels of positive social interactions were associated with increased patient costs (the need for continued care) following total knee replacement. The greater the obesity the greater the patient need for care (cost) following the knee replacement.

Research: It is unclear whether total knee replacement facilitates weight reduction.


One thing for sure, surgery in obese patients is more technically challenging.

Doctors in the United Kingdom reported these findings in the journal Maturitis (7)

  • There is a proven association between obesity and knee osteoarthritis, and obesity is suggested to be the main modifiable risk factor.
  • Obese patients are more likely to require total knee replacement
  • It is unclear whether total knee replacement facilitates weight reduction
  • Surgery in obese patients is more technically challenging.
    • This is reflected in the evidence, which suggests
      • higher rates of short- to medium-term complications following total knee replacement, including wound infection and medical complications, resulting in longer hospital stay, and potentially higher rates of malalignment, dislocation, and early revision.

Research: High patient weight is a risk factor for mechanical implant failure and some knee replacement manufacturers list obesity as a contraindication for implant use.

In another study from the United Kingdom, doctors were much more critical of putting implants into obese patients as they noted in the Annals of the Royal College of Surgeons of England.(8)

High patient weight is a risk factor for mechanical implant failure and some manufacturers list obesity as a contraindication for implant use. Doctors in the United Kingdom were amazed to find out that:

  • A total of 10,745 patients in a two year period 2012-2013 received knee or hip implants against manufacturer recommendations.
  • 16% of all obese patients) received implants against manufacturer recommendations.

Research: overweight patients are at a more than 40% greater risk and obese patients are at more than a 100% increased risk of knee replacement surgery compared to patients with normal weight

The simple summary to all the research listed above is this:

Doctors at Oxford University publishing in the journal Arthritis and Rheumatology (9) found that overweight patients are at a more than 40% greater risk and obese patients are at more than a  100% increased risk of knee replacement surgery compared to patients with normal weight. Weight reduction strategies could potentially reduce the need for knee replacement surgery by 31% among patients with knee osteoarthritis.

Excess weight is a potentially modifiable factor but not the only risk factor that is associated with chronic pain and severe pain.

We know many of our patients have been to other health care providers and they have been browbeaten with the continuing cadence that they “need to lose weight.” These patients understand this, it is still difficult for them to do so. Patients frequently tell us that it is not the lack of knowledge that they need to lose weight but rather the lack of will power or motivation to keep focused on better and healthier eating and obtaining a more active lifestyle.

This asking for motivational help is a key to achieving their treatment goal. But you still have to find that motivation. For men, that goal may be easy, erectile dysfunction. It is said that nothing will get a man to the doctor faster than erectile dysfunction. This is borne out in the research. In a study from Brown University, (10) doctors writing on erectile dysfunction are cardiac events noted: “As a result of an improved understanding about the pathophysiology of erectile dysfunction and improved treatment options, an increasing number of men are presenting for evaluation than several decades ago. In fact, many of these men are visiting their health care professional for the first time with erectile dysfunction as their primary complaint. ”

The obesity, anxiety, stress connection to inflammation and joint pain


Excess weight is a potentially modifiable factor but not the only risk factor that is associated with chronic pain and severe pain.

Swedish doctors have published a new study in the journal of BioMed Central Geriatrics (11). The title of their article is the question they ask: Is excess weight a burden for older adults who suffer chronic pain?

It is common for older patients to have obesity and chronic pain. The researchers in this study wanted to understand how pain and obesity reacted to each other and influenced the severity of the patient’s pain symptoms. To do so, they took:

  • A group of patients over the age of 65 who were obese. Then the patients in this group who were obese were separated into people with chronic pain and people without chronic pain.
    • More obese older adults experienced chronic pain (58%) than those who were low-normal weight (39%) or overweight (41%).
    • Obese elderly more frequently had pain in extremities and lower back than their peers.
    • Being obese was more greatly associated with chronic pain than being overweight
    • Obesity was also significantly related to severe pain.
    • However, the researchers also found traumatic history (the loss of a spouse or loved one or other similar events), rheumatic diseases, and depression or anxiety diagnosis showed stronger associations with pain aspects than weight status.

The researchers had to conclude that in older adults, excess weight is a potentially modifiable factor but not the only risk factor that is associated with chronic pain and severe pain.

How Obesity, mental distress and poor sleep equally whole body pain in 51 year old women

When someone does have obesity and chronic pain, it is easy for other factors to start to have a great negative impact on health.

Norwegian researchers writing in the European Pain Journal paint a grim but accurate picture of the effects of obesity on aging patients.(12) In a group of patients who were mostly females average age 51, obesity was linked to mental distress, poor sleep quality, and poor physical fitness. This lead to a condition of WSP – WideSpread musculoskeletal Pain.

  • Simply: obesity + mental distress + poor sleep = Pain.  To effectively heal, ALL these issues need to be addressed.

The vicious cycle, lack of sleep causes more pain causes obesity

Doctors at the Norwegian University of Science and Technology wrote in the Journal of sleep research (13) that chronic musculoskeletal pain increases the risk of insomnia, particularly among those who report several pain sites. The researchers suggest that a healthy active lifestyle (weight loss and exercise) could reduce the risk of insomnia in people with chronic musculoskeletal pain.

Doctors can help patients with chronic joint pain alleviate their symptoms by losing weight by focusing on exercise and more importantly the ability to exercise

Doctors at the University of Florida recently published research in which they attempt to outline ways doctors can help patients with chronic joint pain alleviate their symptoms by losing weight. They focused on exercise and the ability to exercise.

Writing in the Journal of pain research, (14) the Florida doctors suggest that in obese patients, general and specific musculoskeletal pain is common. Emerging evidence suggests that obesity worsens pain by mechanical loading (weight stress on joints), inflammation (creating a destructive inflammatory environment in the joints, see below), and psychological status.

The researchers continue:

“Pain in obesity contributes to the deterioration of physical ability, health-related quality of life, and functional dependence . . . While acute exercise may transiently exacerbate pain symptoms, regular participation in exercise can lower pain severity or prevalence. Aerobic exercise, resistance exercise, or multimodal exercise programs (combination of the two types) can reduce joint pain in young and older obese adults in the range of 14%–71.4% depending on the study design and intervention used.”

What regenerative medicine doctors know is that to benefit from exercise, a patient needs to be able to exercise. Tackling the difficult problem of obesity to many doctors and researchers is the start.

If this article has helped you understand the problems of obesity and joint pain and you would like to explore Prolotherapy as a possible remedy for your joint pain, ask for help and information from our specialists

Prolotherapy Specialists lumbar spinal stenosis degeneration

Danielle Steilen-Matias, PA-C | Katherine Worsnick, PA-C | Ross Hauser, MD | David Woznica, MD

Research citations:

Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropractic & Manual Therapies
2. Collins KH, Reimer RA, Seerattan RA, Leonard TR, Herzog W. Using diet-induced obesity to understand a metabolic subtype of osteoarthritis in rats. Osteoarthritis Cartilage. 2015 Feb 3. pii: S1063-4584(15)00028-X. doi: 10.1016/j.joca.2015.01.015. [Google Scholar]
3. Berenbaum F, Eymard F, Houard X. Osteoarthritis, inflammation and obesity. Curr Opin Rheumatol. 2013 Jan;25(1):114-8.  [Google Scholar]
4. Belluzzi E, El Hadi H, Granzotto M, Rossato M, Ramonda R, Macchi V, De Caro R, Vettor R, Favero M. Systemic and local adipose tissue in knee osteoarthritis. Journal of cellular physiology. 2016 Dec 1. [Pubmed]
5 Wu CL, Diekman BO, Jain D, Guilak F. Diet-induced obesity alters the differentiation potential of stem cells isolated from bone marrow, adipose tissue and infrapatellar fad pad: the effects of free fatty acids. International Journal of Obesity advance online publication, 20 November 2012; doi:10.1038/ijo.2012.171. [Google Scholar]
6 Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB, Lopez-Olivo MA, Barbo AG, Landon GC, Siff SJ, Lin H, Suarez-Almazor ME. Effect of Body Mass Index and Psychosocial Traits on Total Knee Replacement Costs in Patients with Osteoarthritis. The Journal of rheumatology. 2016 Aug 1;43(8):1600-6.  [Google Scholar]
Kulkarni K, Karssiens T, Kumar V, Pandit H. Obesity and osteoarthritis. Maturitas. 2016 Jul;89:22-8. doi: 10.1016/j.maturitas.2016.04.006. Epub 2016 Apr 11. Review. [Google Scholar]
8 Craik JD, Bircher MD, Rickman M. Hip and knee arthroplasty implants contraindicated in obesity. Ann R Coll Surg Engl. 2016 May;98(5):295-9.  [Google Scholar]
9. Leyland KM, Judge A, Javaid MK, Diez-Perez A, Carr A, Cooper C, Arden NK, Prieto-Alhambra D. Obesity and the Relative Risk of Knee Replacement Surgery in Patients With Knee Osteoarthritis: A Prospective Cohort Study. Arthritis Rheumatol. 2016 Apr;68(4):817-25. [Google Scholar]
10 Miner M, Kim ED. Cardiovascular disease and male sexual dysfunction. Asian J Androl. 2014 Dec 12. doi: 10.4103/1008-682X.143753. [Google Scholar]
11 Dong HJ, Larsson B, Levin LÅ, Bernfort L, Gerdle B. Is excess weight a burden for older adults who suffer chronic pain?. BMC geriatrics. 2018 Dec;18(1):270.  [Google Scholar]
12 Magnusson K, Hagen KB, Natvig B. Individual and joint effects of risk factors for onset widespread pain and obesity–a population‐based prospective cohort study. European Journal of Pain. 2016 Aug;20(7):1102-10. [Google Scholar]
13 Skarpsno ES, Nilsen TI, Sand T, Hagen K, Mork PJ. Do physical activity and body mass index modify the association between chronic musculoskeletal pain and insomnia? Longitudinal data from the HUNT study, Norway. Journal of Sleep Research. 2017 Jul 26. [Google Scholar]
14 Emery CF, Olson KL, Bodine A, Lee V, Habash DL. Dietary intake mediates the relationship of body fat to pain. Pain. 2017 Feb;158(2):273-277. [Google Scholar]

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