Elsevier

The Journal of Arthroplasty

Volume 37, Issue 12, December 2022, Pages 2317-2322
The Journal of Arthroplasty

Health Policy and Economics
Self-Reported Health of Severely Obese US Adults With Osteoarthritis

https://doi.org/10.1016/j.arth.2022.06.018Get rights and content

Abstract

Background

Severe obesity is associated with complications following arthroplasty, leading surgeons to increasingly counsel patients regarding weight loss. For patients seeking arthroplasty, learning that severe obesity may be a relative contraindication to surgery can create a challenging clinical interaction. We sought to describe the self-reported health of United States (US) adults who had severe obesity and osteoarthritis (OA) to better understand patient perspectives.

Methods

The National Health and Nutrition Examination Survey, a nationally representative sample of the US population, was used to identify adult participants who had a body mass index (BMI) over 35 and an OA diagnosis. In total, 889 participants representing a US population of 9,604,722 were included. Self-reported health was dichotomized as poor to fair versus good to excellent. Analyses were weighted to produce national estimates. Associations between obesity severity and patient characteristics with self-reported health were assessed.

Results

Of US adults with a BMI over 35 and OA diagnosis, 64% rated their health as good or better. For adults who had a BMI over 45, 55% still reported their health as good or better. The strongest predictors of self-reported health were measures of physical functioning. Only 37% of participants who had much difficulty walking a quarter mile rated their health as good or better compared to 86% without difficulty (P < .001).

Conclusion

Approximately two-thirds of patients who have severe obesity and OA do not perceive their health as compromised and consider decreased physical function as the primary driver of decreased health. This suggests that counseling about the association between obesity and overall health may improve shared decision making and that patient satisfaction metrics may be difficult to interpret in these clinical situations.

Section snippets

Materials and Methods

The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional sample of the noninstitutionalized, civilian US population. Participants are selected through a complex, multistage, probability sampling design. In the first stage, counties are randomly selected. In the second stage, specific areas of the counties, such as city blocks, are randomly selected. Households within these areas are then randomly selected. Individuals within these households

Results

Of US adults over years of age with a BMI over 35 and OA diagnosis, most (64%) rated their health as good or better (Fig. 1). As the level of obesity increased, self-reported health decreased, although 55% of participants who had a BMI of 45 or greater still reported their health as good to excellent (Table 3).

Although age, gender, and race did not have strong univariable associations with self-reported health, higher education was associated with an increased self-reported health (Table 4).

Discussion

Given US trends regarding the obesity epidemic, life expectancy, and functional expectations, it is likely that patients who have OA and severe obesity will continue to present to orthopaedic surgeons with an interest in TJA. Understanding how to optimize this challenging clinical interaction is important. This study described the self-reported health of a representative sample of US adults who had OA and severe obesity, finding that two-thirds describe their health favorably and that

Conclusions

Approximately two-thirds of patients who have severe obesity and OA do not perceive their health to be compromised and view their functional limitations from OA as the primary driver of their health. This can create a disconnect between patients and orthopaedic surgeons when it comes to consideration of weight as a risk factor and relative contraindication for a TJA. Although future studies are needed to better understand how to best manage these patients, it is necessary to counsel patients on

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    • There was no source of external funding for this work.

    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2022.06.018.

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