Barbara Bergin, MD, is a founding member of Texas Orthopedics, Sports and Rehabilitation Associates in Austin. Here she discusses the growing concern of obesity and how to tackle the issue from an orthopedic surgeon's point of view. 1. Understand the severity of the problem. Obesity is a growing medical concern that has no safe or effective medical treatment. Physicians can only treat the effects of the condition, such as hypertension or diabetes, but not the condition itself. "We have only the 'eat less and exercise more' modality, but obesity is not just a behavioral problem. Genetics and a number of other factors play a role. Patients need more than a simple push away from the table response," says Dr. Bergin.
In an orthopedic practice most obese patients are seeking help for damage done to their weight bearing joints. Exercise is closely tied to weight loss, but because of their weight and pain many obese patients are unable to exercise. "I encourage those doing research on obesity to develop some kind of treatment or I can only see this problem getting worse," says Dr. Bergin.
2. Address the issue with sensitivity. Many orthopedic surgeons have difficulty finding the time or are reluctant to speak with patients about losing weight. A lack of sensitivity and the tendency to immediately attribute the issues to the patient's weight will result in the loss of the patient and any chance to help. "Don't make weight the primary issue right away," says Dr. Bergin. "When you raise the issue, acknowledge the orthopedic problem (knee arthritis, degenerative meniscus tear, chondromalacia) first. Then approach the effects of their weight on the problem with sensitivity."
3. Be prepared to offer help. As obesity continues to grow as a major orthopedic issue, orthopedic surgeons need to have options for their patients. Simply telling patients to eat healthier without any guidance will accomplish nothing. Consider adding a nutritionist to the practice or have a referral list. Have samples of portion and calorie-controlled menus available at the office. "When appropriate, I will also not hesitate to tell a patient that I'm unwilling to operate on them until they lose 50 pounds, or some appropriate amount of weight," says Dr. Bergin.
4. Surgery is not a complete solution. Orthopedic surgeons can offer surgical procedures to obese patients but surgery is only a temporary solution. This does not mean obesity is not an orthopedic problem. At least 25 percent of Dr. Bergin's patients are morbidly obese and this number is growing. "Patients often delude themselves into thinking that once they have their surgery, they will lose the weight because they’ll be able to exercise, but I’ve never seen it happen," says Dr. Bergin.
Orthopedic surgeons are reluctant to perform total joint replacements on patients under 60, but obesity affects all age groups. Total joint replacements are meant to eliminate patients' pain and in theory this will allow obese people to begin regular exercise. The exercise needed to result in long-term, sustainable weight loss is unrealistic. The total joint replacements will wear out and the body's metabolism will only slow when a patient exercises too much.
"The physical and economic burden of obesity is growing," says Dr. Bergin. Orthopedic surgeons will continue to see this trend in their patient practice and with no treatment or long term strategy all that can be done is address the issue patient by patient.
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