Obesity is a multifactorial disease of complex interlinked factors like metabolism, genetics, hormones, environmental factors, etc.
General population including some clinicians always think that obesity treatment is very easy, just diet and exercise. But science and data state otherwise. An almost negligible percentage of people lose significant weight at the end of three years. This is because of the compensatory physiological changes in the body which try to regain the lost weight. For example, as one starts losing weight, the level of hunger hormone starts increasing and the metabolic rate slows down. Even muscles start smart adaptation so as to perform the same task in much lesser calories. Hence, exercise is never advised as a treatment of obesity in any medical literature. However, exercise is important for better health and has a role in the maintenance of weight loss.
Can patients with morbid obesity join Gym?
Patients who wish to join a gym or start a vigorous exercise programme should check their BMI before starting. Those with BMI more than 32.5 are morbidly or severely overweight / obese and such people are unlikely to lose weight and maintain it. However, they may induce harm to their body and joints. Excess weight, in fact, may stress or strain their joints and ligaments and can further induce orthopaedic problems or worsen them. A bariatric physiotherapist is an integral part of an obesity surgery centre and should advise exercise to such a person after proper evaluation.
Correlation Between Obesity and joints and bones:
Most of the patients with obesity have a deficiency of Vit D and may have some degree of osteoarthritis. Excess weight induces strain on the joints and ligaments, changes the centre of gravity, pain on movements or stiffness. Sometimes, torque during exercise may induce a fall or even a fracture.
Every kg of excess weight adds four to six kg of weight over the knee joints, states AAOS (American Association of Orthopaedic Surgeons) knee joints, hip joints, spine and ankles are most frequently affected in Indians. Obesity also induces diseases like diabetes, GOUT, heart disease, sleep apnoea, respiratory disorders, neuropathy and these diseases along with musculoskeletal disorders of obesity with or without pain, making it difficult for a person to do routine exercises.
Patients with morbid obesity with OA knees are recommended bariatric surgery prior to joint surgeries. These may prevent joint interventions and improve outcomes of orthopaedic surgeries if needed
Metabolic and Bariatric Surgery and the role of a physiotherapist:
Metabolic and bariatric surgeries are keyhole, laparoscopic surgeries on the stomach or intestines which improve the metabolism, reduce food intake, reduce excess hunger and thereby induce long term and sustained weight loss.
Patients need physiotherapy before and after surgery over the long term. Pre-operative focus is on diet-induced weight loss and improving respiratory reserve as well as ambulatory status. The main focus is on less weight-bearing exercises or short walks more frequently to minimise chances of deep venous thrombosis.
Post-operatively, as the patients start losing weight, all other aspects of physiotherapy are introduced and accelerated slowly in phases and according to the weight loss, as well as tolerance of the patient.
Physiotherapists who work in the bariatric unit have their relatives with obesity undergo bariatric surgery as soon as they see the involvement of joints. The same holds true with orthopaedic surgeons.
Picture perfect example:
A lady with severe osteoarthritis of the knee, who has advised spine surgery as well as knee replacement, is being seen free from all the joint pains after bariatric surgery and physiotherapy.