Imagine being one of the millions of Americans needing a hip or knee replacement due to osteoarthritis. Severe painreduced physical activity, inability to perform many routine tasks – the symptoms can be truly debilitating.
But if you are obese or overweight, there is a good chance that your orthopedic surgeon will refuse to provide you with care. As one patient told the New York Times of her doctor: “He told me to come back when I lost 30 pounds.” »
She is not alone. Fewer than half of orthopedic surgeons will operate on patients with a body mass index above 40, survey finds. Patients with type 2 diabetes, cardiovascular disease and high blood pressure face similar barriers to surgical procedures what they need.
All of these conditions share a common underlying cause: chronic systemic inflammation. Ironically, the “metabolic” condition caused by inflammation, which can bring someone to the point of needing a joint replacement in the first place, may be what causes their doctor to refuse to perform one.
Fortunately, some doctors are trying to change the status quo using an approach called “lifestyle medicine.” Lifestyle medicine is a medical specialty that uses evidence-based interventions in patients’ behavioral choices to prevent, treat, and even reverse diseases caused by chronic systemic inflammation.
“Contrary to what TV commercials claim, there is no ‘magic’ pill or injection for good health.”
Although recent pharmaceutical interventions, such as GLP-1 drugs like Ozempic, Wegovy, and Zepbound, can be an important tool in the management of metabolic conditions, they do not provide a comprehensive solution. These medications can jump-start a patient’s weight loss journey, but without permanent behavioral changes, patients will need to continue taking the medication indefinitely to maintain their weight loss. Additionally, these medications do not affect other factors of chronic inflammation, such as poor sleep and physical inactivity. Lifestyle medicine, on the other hand, can help patients make the lasting, consistent behavioral changes needed to combat inflammation.
The discipline applies six pillars of health that reduce systemic chronic inflammation: a diet that balances good and bad bacteria in the gut, physical activity, sleep, stress management, improving social connections and avoidance and reduction of risky substance use. .
Improving one pillar of health can have a positive impact on others. When nutrition improves, for example, sleep may improve. Reducing inflammation caused by poor sleep may be the trigger for some patients to lose weight.
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Contrary to what TV commercials might claimthere is no “magic” pill or injection for good health. And tackling weight loss or diabetes in isolation won’t solve a patient’s entire problem. Addressing systemic inflammation is the most effective scientific approach we know 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 designed to treat metabolic conditions related to painful musculoskeletal conditions.
Emerging data shows this model of care can work for patients trying to optimize their health before surgery. A recent study at the Hospital for Special Surgery in New York, which I co-authored, examined 54 patients with metabolic disorders, including obesity, who were seeking elective orthopedic surgery. Of these, 13 were unable to schedule surgery due to their metabolic conditions, including obesity. At the end of the program, 85% were able to improve their health and qualify for surgery.
To achieve such results, it is not enough to manage medications. To be successful, programs must be personalized to reflect the goals patients set. For example, a patient may want to lose weight, sleep better, and reduce pain. Clinicians can then develop plans to achieve these specific goals.
A powerful motivator is encouraging patients to look beyond their current pain and imagine the life they will live after success. One of my patients dreamed of traveling to Italy with her grandchildren. Another wanted to see Paul McCartney perform live. These aspirations have made sticking to our lifestyle medicine plan much more achievable.
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. This must change. The entire medical community must embrace lifestyle medicine as a central component of osteoarthritis treatment. Patients deserve no less.
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