Advice for Dealing With Obese Patients

Doctors concerned about how best to treat and deal with their obese patients received assistance from a statement developed by a Communications Cabinet workgroup of the American Academy of Orthopaedic Surgeons (AAOS) and published in the daily edition of AAOS Now—the publication of the AAOS, Las Vegas convention.

More than one-third (34.9% or 78.6 million) of U.S. adults are obese. Obesity-related conditions include heart disease, stroke, type-2 diabetes and certain types of cancer, some of the leading causes of preventable death. The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1, 429 higher than those of normal weight.

Obesity affects some groups more than others. Non-Hispanic blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic whites (32.6%), and non-Hispanic Asians (10.8%). Obesity is higher among middle age adults, 40-59 years old (39.5%) than among younger adults, age 20-39 (30.3%) or adults over 60 or above (35.4%) adults. (Source: Centers for Disease Control: http://www.cdc.gov/obesity/data/adult.html)

Diabetes, associated with obesity, translates into an increased risk of surgical site infections. William M. Mihalko, M.D. is quoted in AAOS Now as saying, “Obesity is the boulder on the cliff, poised to fall and cause other comorbidities.” He added that Metabolic Syndrome, a cluster of risk factors associated with obesity, is on the rise.

The statement outlined steps for surgeons to recommend to their patients with morbid obesity (defined as a body mass index of 40 or higher) to take prior to undergoing elective orthopedic surgery. One step was to seriously consider the impact of their weight on possible complications and results after surgery.

The statement advises surgeons to consider a delay in surgery until the patient has lost weight and explain to their patient that this is not a personal judgment statement on the part of the doctors but a “risk reduction tool to avoid potentially serious and life-changing complications.” Finally they should urge their obese patients to participate in a weight-loss program before undergoing total joint arthroplasty or replacement.

The statement urges orthopedic surgeons and patients to maintain an open dialogue about the detrimental effects of obesity on musculoskeletal health and the increased risks of obesity that can cause inferior surgical outcomes.