obesityObesity in America is in epidemic proportions! We as a country are getting fatter. It is estimated that two thirds of Americans are now considered overweight. This is up from 45 percent in 1960. Obesity threatens to bypass smoking as the number one health hazard in America. One third of us are considered obese which is defined as a body mass index (BMI) of greater than 30. Even more alarming is the fact that 17% of children are considered obese. What Causes Obesity? Obesity occurs when a person consumes more calories than he or she burns. For many people this boils down to eating too much and exercising too little. But there are other factors that also play a role in obesity. Genetics! Obesity and thinness tends to run in families. In a study of adults who were adopted as children, researchers found that participating adult weights were closer to their biological parents' weight than their adoptive parents'. Obesity is a risk factor for a number of health problems including diabetes, heart disease, stroke and osteoarthritis. As a result obesity may adversely affect the feet, ankle and legs including the knee and hip joints. The effect of obesity on the lower extremity should come as no surprise as it is estimated that every pound of body weight puts three pounds of force through the foot while walking and as much as seven pounds when running. For example if two people, one of normal weight and the other overweight suffer the exact same injury through the same mechanism of injury, the overweight person will suffer a greater degree of injury meaning it will end up more severe. For example this could be the difference between straining a ligament versus breaking a bone. To make matters worse, overweight people may suffer from metabolic syndrome which can slow the healing process. Going back to the example above, this means not only will the overweight person require more time to heal because of a more severe injury than the normal weight person, but the overweight person’s metabolism will further delay the healing process. Scientists have found a direct correlation between obesity and pathology of the lower extremity. Carrying added in weight in an individual who tends to pronate, may lead to chronic heel pain. So why am I writing about obesity? It should be clear that there is a direct connection between some foot and ankle pathology and excessive weight. This occurs on two fronts. One is the biomechanical abnormalities that I have already discussed such as being more prone to worse injuries and being more susceptible to chronic type of foot and ankle pains. Additionally, overweight people have a greater tendency to become type II diabetics. Most disconcerting is the fact that there has been a substantial rise in diabetes among our youth; those ages between 10 and 19 years. (1) As obesity relates in everyday practice, I see many people with a variety of foot and ankle problems who happen to be overweight. In spite of all the treatment protocols available to me for various conditions, one central fact remains. Unless these people lose weight, their lower extremity problems are not going to totally resolve themselves and even if we are lucky in eradicating a problem, those that are overweight have a much greater chance of redeveloping the same problem. In many circumstances where I feel the major catalyst to the particular problem a patient presents with is their weight, I am point blank about that fact. I tell these patients that I am not a magician and unless something is done about their excess weight this particular problem (and others) will continue to plague them. I have seen this hundreds of times over my career where excess weight and foot and ankle problems lead to a viscious cycle of pain, leading to diminished activity, leading to further weight gain, leading to even less activity.
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