Obesity is a serious health issue affecting 1 in 8 adults worldwide, with rates continuing to climb. Although having a high body mass index (BMI) can present many health complications, a recent study shows that this should not prevent patients from undergoing certain orthopaedic surgeries that could improve their lives.
A surgeon at Nordorthopaedics Clinic in Lithuania has explained to Digital Journal how he has routinely operated safely on patients with high BMI and obesity, while explaining why certain overweight patients might not be eligible for surgery.
Valdemar Loiba says being overweight or obese should not necessarily preclude patients from seeking important orthopaedic procedures.
According to the World Health Organization, 2.5 billion adults were considered overweight in 2022, or 43 percent of the global adult population. That included over 890 million adults who were living with obesity, defined as a chronic complex disease of excessive fat deposits that can impair health. Adult obesity has more than doubled since 1990, to one in eight worldwide. The population of overweight adults has gone from 25 percent to 43 percent in that same time span, according to the Global Obesity Observatory.
Obesity is defined as having a Body Mass Index (BMI) of 30 or greater and can often cause doctors to postpone or rule out essential surgeries for their patients. However, a large sample study conducted in the United Kingdom recently showed that those with elevated BMI did not do significantly worse following surgery, concluding that restricting surgery based on BMI alone is not based on clinical evidence.
Loiba says there are a few reasons why such patients might not be operated on. They may have an increased risk for wound healing complications and infection. They may also require a prolonged hospital stay, longer rehabilitation, additional medications, and can develop further problems because of existing comorbidities like diabetes or cardiovascular disease.
Loiba has operated on patients with high BMI, and he says the average range of his patients is 25 to 35, including some with BMI exceeding 40. For instance: “If we have a patient with a locked knee and we know that the cause is torn meniscus, we will do surgery without looking at the patient’s BMI.”
However, Loiba says: “if we have a patient with valgus deformation of the knee and a chronic meniscus tear, normally we will do a high tibial osteotomy surgery. But if the patient has a BMI of over 35, their weight would be considered as a strong contraindication for this kind of operation and we could not perform it”.
Of course, the problem with lowering BMI for orthopaedic surgery is that a patient’s debilitating pain makes weight loss via exercise highly challenging. Having a high BMI can further damage the joint, often resulting in less mobility, more weight gain, and a vicious circle for the patient.
Meanwhile, medications for weight loss work best when combined with regular exercise. If weight loss is necessary, Loiba recommends patients consult with a dietologist or even bariatric surgeon.
