March is National Nutrition Month, and an opportunity to think about our approach to eating, physical activity, and general wellness. As a physician who specializes in weight management, this month is especially relevant to the patients who come in to see me for help with losing weight.
Many different types of patients are referred to see me for weight loss. Some have been struggling with weight since a very young age, having seen nutritionists when they were children, or trying “diet pills” in their college years. Some women have found it difficult to lose weight since having children, or noticed weight gain associated with menopause. Many patients have experienced weight gain since having an injury, or after osteoarthritis started to limit their ability to exercise. They are all eager to have orthopedic surgery after weight loss.
My approach begins with an explanation of why even modest weight loss before a knee replacement will be beneficial. Here are some facts about weight loss and reasons to consider it before having surgery.
- Even weight loss of just 5 to 10% of your total body weight can significantly improve health outcomes and decrease perioperative risk. Weight loss of 5% can decrease your chance of developing type 2 diabetes, and can reduce cholesterol levels. Anecdotally, patients have told me their mood is improved with minimal weight loss, even 5 pounds.
- Having a higher weight before orthopedic surgery increases the risk of complications, including wound infection, joint infection, dislocation of the joint and the need for revision surgery. There is also a higher risk of having an issue with anesthesia if you are at an elevated weight. Weight loss before surgery can set you up for your best chance of success for during and after the procedure.
- Exercise is important for numerous health reasons and can help with weight loss, but if you are unable to exercise because of arthritis or an injury, you can still lose weight. Making other lifestyle changes, or a medically supervised program, such as what we offer at HSS, can be your tools. You don’t need to wait until after a joint replacement to start to try and lose weight.
- It is not just a matter of willpower. When anyone tries to lose weight, the body fights it – hormone levels change that can make you feel hungrier and actually slow down your metabolism. These are some of the reasons most diets don’t work. We can now mitigate the body’s resistance to weight loss with certain strategies, i.e., specific eating plans, intermittent fasting, and FDA approved medications for weight loss (see the next point).
- Many people don’t know that there are now FDA approved medications for weight loss that have been extensively studied and have been proven to be safe and effective. Some of them even offer benefits in addition to weight loss, such as cardiovascular risk reduction.
When a patient agrees to start a weight loss program, we typically begin with focusing on improving diet and eating behaviors. If someone feels that stress eating is an issue for them, we can discuss strategies to tackle that kind of behavior. Or for some people, evenings are the most challenging time of day, so we discuss how to cut down on nighttime snacking. I will also discuss medication options with patients. For example, I may start a medication to help with menopause related weight gain, or a treatment that can help with sugar cravings. The idea is to get patients started on a weight loss plan so that they can be optimized for surgery.
My goal as a weight management physician, during Nutrition Month and every other month of the year, is to provide a non-judgmental space where patients can share their stories. We then work together to create a plan that is tailored to that story. Having surgery can be the opportunity to make positive changes that have a long-term impact. The goal of HSS Weight Management is to provide patients with tools to improve their overall health and wellness for life.
Dr. Caroline Andrew is a medical weight management specialist at HSS. She is a board certified internal medicine physician and fellowship trained in obesity medicine. Using both dietary and behavioral interventions, along with medications for weight loss, she helps patients lose weight and maintain weight loss.