Tag Archives: knees

New Study Suggests Obesity Doesn’t Make Joint Surgery Less Safe

BadKnees

Another media appearance for the bad knees.

I recently came across a recently published study that was published in The Journal of Arthroplasty regarding overweight and obese patients and joint surgery.  In particular, the study evaluates data from 900 hip surgeries and over 1,500 knee surgeries.  The data was evaluated in terms of weight, BMI, how often blood transfusions were necessary, complications from infections, and time spent under the knife (how long the surgeries took).

The study results were “counterintuitive” to many–meaning it failed to confirm some of their deeply held biases about hip and knee surgery and people who are fat.  The concern was that surgery on fat people would take longer than surgery conducted on thin people, and thus would increase the probability that a blood transfusion would be required.  This is of deep concern to doctors because blood transfusions can cause serious complications–with as many as 1 in 5 causing some sort of negative effect.

However, this assumption was not borne out by the research.  In fact, overweight and obese patients were less likely to require a transfusion than their thinner counterparts.  During hip surgery, on average 35 percent of the “normal weight’ patients required a transfusion compared to 28 percent of the “overweight”  patients and 22 percent of the “obese” patients.  During knee surgery, 17 percent of the “normal weight” patients needed transfusions compared to 11 percent of the “overweight” patients and 8 percent of the “obese” patients.

Furthermore, the study indicates that their research turned up no evidence that overweight or obese patients spend any more time under the knife than their thinner counterparts.  However, a slight uptick in complications from infection was noted for those in the overweight and obese categories.

A recent article in HealthDay turns to a surgeon from Los Angeles for a quote.  Dr. Alex Miric, an orthopaedic surgeon with Kaiser Permanente in Los Angeles stated:

“I agree that the results are counterintuitive,” Miric said. But he also agreed that conclusions “would need to be replicated with more surgeons and a larger and more current patient population before such a finding would gain traction in the orthopaedic community.”

Hmmm.  While surgeries for fat people might not take longer or be more dangerous than those for thin people, it seems pretty clear that surgeon bias against fat people is alive and well.  I have read many anecdotal accounts from people denied surgery–especially hip or knee replacement surgery because they were too fat.  People with diminished mobility and often severe pain are sent home to “lose enough weight” to be a candidate.  Those fat people determined to receive surgical relief often find themselves wandering a desert of medical red tape looking for a surgeon willing to take on their case.  And they suffer needlessly while they do.

The question of whether the mobility and pain outcomes are as successful for fat people as thin people is a topic for another post.  But in the meantime, I wonder how many studies will have to be done and how many cases will need to be reviewed before the “counterinituitive” nature (read physician weight-based bias) will be reversed.  And how many fat people will have to suffer for how long while we wait for that to happen.

Fired up?  Want to fight stigma and bias?  I’d love to recommend that you join Ragen Chastain, a huge group of additional talented speakers and I for the Fat Activism Conference THIS WEEKEND.  We start on Friday night, so if you don’t want to miss it, I suggest you register now!

Love,

Jeanette DePatie

AKA The Fat Chick

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See Fatty Run, Can Fat People Run Safely?

halfinish2I am frequently asked both on Facebook and in the Fit Fatties Forum, “I am fat.  Is it still safe for me to run?”  So I thought I’d take up this question in today’s blog post.

The short answer is that most people, given proper form, equipment, time and training can learn to jog or run safely, but not all.  There is little evidence that it is inherently unsafe for people of size to jog or run.  Plenty of fluffy folks finish 5K, 10K, half-marathon and marathon races every day.  There is little to no evidence that running causes pain or loss of cartilage in the knees–no matter what your size.  However, if you already have problems in knees, hips, ankles, back or feet, you should proceed with extreme caution as running can make these problems a lot worse.

BadKnees

If you have “bad knees” you should get cleared by a doctor before you start running.

Frankly, fat folk should approach running in the same way that thin people do.  You should probably start by being checked out by your doctor.  If you are coping with joint pain or back pain of any sort, you should probably also see a joint or sports medicine specialist and get cleared for exercise before you begin.  Once you get the all clear from your doctor(s), then it’s time to gear up.  Start by getting yourself a great pair of shoes.  The best way to find those great shoes is to go to a running store, and get fitted by a professional.  This is not the time to choose shoes because they are your favorite color or because they are on sale.  Good shoes that fit properly and meet the special needs of your particular tootsies are critical for safe walking and running.

Choose function over fashion for your fitness footwear.

Choose function over fashion for your fitness footwear.

Once you’ve got the all-clear and are geared up, you need to start SLOWLY.  I cannot emphasize this enough.  If you are not already walking regularly, you should start with a walking program.  There are lots of different schools of thought about how to move from walking to running.  I am personally very partial to Jeff Galloway’s Run Walk Run approach.  I started by walking 10 minutes and running for 30 seconds.  I ran from telephone pole to telephone pole.  I eventually trained to the point I could do a marathon.  I know lots of people who have safely used this approach.  Going all out each workout as hard and as fast as you can is not noble.  It is not bad-assed.  It is a recipe for disaster.  There’s nothing particularly noteworthy about having to quit your running program after 4 days because you hurt yourself.

Once you’ve been running for a while, it is also important to PROCEED SLOWLY.  Most sports programs recommend that you ramp no more than 10 percent per week.  That means if you are running one mile per session this week, you can run 1.1 miles per session next week.  Note that this progression is much, MUCH slower than many of the published and printed running programs out there.  While many of the programs that train you for your first 5K or marathon are great, I find that many bodies are simply not designed to ramp up that quickly.  That’s why I took my first marathon program, cut it in half, and trained for a half marathon instead.  That’s why, when I do 5K or 10 K training programs now, I tend to spend two or even three weeks at each level before I move on.  If you’re doing a total of 3 miles of training this week, it’s probably not cool to do 6 miles of training next week.  It might work for you.  It might leave you a total wreak.  Learn to learn from and listen to YOUR body.

There are lots of other things you can do to help keep yourself safe.  Make sure you stretch.  Do a proper warm up.  Add cross training to give some of your running muscles a break.  Add strength training to build up the muscles and ligaments around your joints and help to stabilize them.  Make sure to work on your form.  Proper running form–including how and where you place your feet, stride, and even arm placement, are very important.  Running is a repetitive motion.  Very small problems in your form can lead to very big pain down the road.

Be sure to address back and other joint pains early and often.

When it comes to running, pain is a very important teacher.  Some people can run without experiencing any significant pain.  For some people, pain happens a whole lot.  In any case, pain is not to be ignored.  It can tell you when you need to adjust your form.  It can tell you when you need to add more cross training or strength training.  It can tell you that the purple tennis shoes you bought because they were on sale were a bad idea.  It can tell you that you need to stop running for a while so you can address a problem in your back or your joints.  It can tell you that running just isn’t for you right now.  DO NOT IGNORE PAIN.  Listen to it.  Learn from it.

Happy trails to you!

Happy trails to you!

So can fatties run?  Can running be safe and enjoyable for people of size?  Of course!  People of all sizes simply need to approach running with caution, gear up, start slowly, ramp slowly, and listen carefully to their bodies.  Here’s wishing you happy trails!

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want to learn more about exercise at every size and GET FREE STUFF?  Don’t forget to join my list right here.

Fat and Bad Knees

naughtyknees

This ad for moisturizer suggests you use their body creme ” for sexy knees”.

One of the things I am constantly told as a fat person is that for fat people, knee pain is inevitable.  And in fact, I am told, I can expect a lifetime of “bad knees”.  Now, given my somewhat skewed view of the universe, rather than scaring me silly, the threat of “bad knees” usually make me think of an image like the one in the body cream ad above, or this silly image below:

BadKneesBut putting the silly pictures aside for a moment, I am an athlete who has had some problems with knee and leg pain my entire life.  I have been lucky enough to have some doctors who are great, but have also run into the all-too-common problem of fat-phobic doctors diagnosing me with having knees while fat.

My feet and leg problems started at birth.  When I was very young, and quite skinny, I was severely pigeon-toed.  As a result, I wore a brace with bars connecting my feet to bed every night.  It looked sort of like this:

footbraceNow I wore this brace to bed back when I was too young to untie and tie my own shoes.  I’m fairly sure that the need to get in and out of bed to go potty while wearing these things has shaped my sardonic view of the world, but I digress.

When I was in high school, and I was going through one of my thin periods, I ran track.  I ran the mile and the 2 mile races (mostly because nobody else wanted to…).  When I first started running, I had severe problems with shin splints.  Because I was thin, nobody thought that the solution was simply to tell me to lose weight.  We tried a variety of things including elaborate taping, different icing regimens and a lot of aspirins before somebody figured out that I just needed tennis shoes with a different sort of arch support.  For an investment of $25 the problem was solved.

Later in life, I suffered a few injuries.  I had a fairly severe meniscus tear in my knee as a result of leaping onto a pile of mats to adjust some audio equipment at the gym.  I also tore a ligament in my foot because I tripped on the front of my sandal and landed wrong.  Each of those injuries netted me a month or two on crutches.

So when I got midway through my most recent jaunt of marathon training, it’s not surprising that I found myself coping with some knee pain.  Luckily I had a great GP at the time who referred me to a sports medicine doctor.  He confirmed that I had a whole lot going on in the lower-extremities department.  He noted the flat feet (that I’ve had since birth) the fact that my feet pronate (also had since birth) and prescribed some custom shoe inserts and a few specific exercises I could do to strengthen my knee joint.  Problem solved.  Marathon finished.  Cheap medal and sweaty finish line photos earned.  And even though I was about the same weight then that I am now, neither my GP or my sports medicine guy gave me any flack about my weight.

444pmI didn’t realize then just how lucky I was.

Since then, I have moved and changed insurance and have had other doctors.  These doctors were not so great actually.  One of them asked about knee pain (I didn’t bring it up).  And I said, that yes, sometimes after a tough workout, my knees will be a little sore.  “Aha!” the doctor cried. “This is proof positive you need to lose weight.  If you lose weight, your knee pain will go away.  If you stay this weight your knees will hurt all the time!”

Okay.

The fact that my knees function at all, given the foot problems I was born with as well as the athletic injuries I’ve suffered is pretty amazing.  And at no point, did this doctor ask about any medical history regarding my feet, shoes, injuries, sports activities or anything else.  He simply predicted that I would be in pain as long as I was fat and that the remedy was simply to lose weight and keep it off.

Never mind that I didn’t come in there asking about knee pain.

Never mind that there is no method, and I mean NONE that is proven to be successful for long-term weight loss in most people and that even if I was one of the 5-10 percent of people who are able to lose weight and keep it off, there is no guarantee that it will do anything at all to relieve knee pain.

Never mind that there are successful methods of coping with knee pain that are widely considered effective for people of all sizes and that these methods have nothing to do with losing weight.

Nope, once this doctor diagnoses you with fat knees, the treatment is a single piece of paper with a diet on it.  According to Doctor Know-It-All, the way to fix your knee problems is, Breakfast: One egg (boiled), one piece of wheat toast (dry), one cup of coffee (black) and 4oz. orange juice, etc…

And my story is so mild compared to the other stories that I hear from folks about this subject.  People who are suffering from knee pain and told that all they have to do is lose weight and their knee pain will go away.  And they are told that their doctor won’t bother to try any other treatment for knee pain until after they lose weight.

It’s lazy and it’s unethical.

If you are coping with knee pain, there are some things you can do.  Very often, knee pain can be improved by correcting underlying muscle imbalances.  You can get help from a physical therapist or sports medicine specialist.  You can supplement this therapy with simple at-home exercises like those offered by my colleague Cinder Ernst.  Also, you may need to see a foot doctor to get custom inserts made for your shoes.  Sometimes simply switching to a good sturdy shoe with good arch support can make all the difference.

You may also find help, as I did from somebody who teaches Alexander Technique and can help you figure out what you are doing in your every day life that exacerbates your knee pain.

Exercise can really help folks coping with knee pain, but it’s important to do it the right way.  Make sure you get the help of an exercise instructor or personal trainer to make sure that you are working out in a way that strengthens and doesn’t threaten your knee joints.  I offer a few simple tips in this video.

Not all fat people have knee pain.  Not all thin people are free from knee pain.  But whatever your size, there are things you can do to protect your knees and help you cope with knee pain should it arise.  Make sure you get the help you need, and don’t let anybody scare, threaten or intimidate you by diagnosing you with having knees while fat.

Love,

The Fat Chick

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Thursday Theater: Knee Stress

Here’s a video about dealing with stress of a whole different kind: knee stress. Here’s some basic information about protecting these amazing and wonderful joints.

Love,
The Fat Chick