Osteoarthritis

Fat People and Joint Pain Part 2

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Often the assumption is made that fat people develop osteoarthritis due to higher body weight causing damage to the joints. Even if body size did cause osteoarthritis, that would still not justify a recommendation of weight loss and/or a denial of treatment for the reasons we discussed in Part 1 of this series.

In truth is is far more complicated than just larger body = osteoarthritis. That is made clear by the fact that plenty of thin people develop osteoarthritis and plenty of fat people don’t. In fact, osteoarthritis has many risk factors including everything from genetics (which twin studies have shown to account for about 40% of risk) to previous injury, and congenital conditions.

Even if we’re just talking about “wear and tear” there are many many factors involved (everything from access to supportive footwear, to participation in athletics at various ages, knowledge and attitude of coaches and trainers if one does participate, ability to access healthcare for joint health throughout one’s life and more.)

Research shows a correlation between larger bodies and greater risk, but that’s far from showing causation. Before the cause could be attributed to body size alone, there would have to be studies that control for the variables that impact fat people (of which there are many,)

• Fat people’s common difficulty getting competent healthcare for joint pain (especially early joint pain,) Instead, we are typically being prescribed weight loss.

• The effects of weight-cycling (ie: yo-yo dieting) on long-term joint health. Since most diets end in weight regain, and most fat people are put on multiple diets, thus experiencing weight cycling which is linked to increased inflammation which is in turn linked to increased risk of osteoarthritis. For example, an NIH study found that fat patients with osteoarthritis who weight cycled over a four year period experienced “significantly greater progression of cartilage degeneration and bone marrow edema degeneration – as measured by whole-organ magnetic resonance score – than did noncyclers, regardless of their overall weight gain or loss by the end of the study period.”

• The impact of weight stigma. This includes both the increased inflammation that has been linked to weight stigma, and the impact of stigma on fat people seeking out care at the same rate and level of injury/pain that thin people do, on fat people participating in physical activities that might mitigate their risk for arthritis etc.

The truth is that, because of weight stigma, fat people experience the world differently than thin people do, and these differences, including in our healthcare, can impact our health – including our joint health – and all of that must be accounted for before we attribute health issues to fat bodies.

And, again, even if we there was a causal link to being higher weight and osteoarthritis, weight loss would still not qualify as an ethical, evidence-based solution. (Similarly, taller bodies are also at higher risk of various health issues, but trying to make those people shorter isn’t the solution.)

So what is?

In part 3 we’ll discuss weight-neutral options for joint care, and research to help fight treatment denials based on weight bias.

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.