54.4 million U.S. adults report arthritis diagnosed by a doctor. Among them, 32.7% also have overweight and 38.1% have obesity — and obesity is more common in people with arthritis than in people without it. Extra weight goes with more pain: in 2014, severe joint pain was reported by 23.5% of adults with arthritis and overweight, and 31.7% of those with obesity.
Losing weight helps. For adults with arthritis and overweight or obesity it can improve pain, function, mobility and quality of life, and reduce disability; the American College of Rheumatology recommends it for adults with hip or knee osteoarthritis and overweight or obesity. And advice matters: adults with overweight or obesity who are counseled by a provider are about four times as likely to try to lose weight as those who aren't.
Visual abstract. CDC
The survey
CDC used the National Health Interview Survey (NHIS) — an in-person survey of U.S. civilians not living in institutions — for 2002, 2003, 2006, 2009 and 2014, the years it asked:
"Has a doctor or other health professional ever suggested losing weight to help your arthritis or joint symptoms?"
Arthritis meant having been told by a doctor or other health professional of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia. Body mass index (BMI) came from self-reported height and weight:
| BMI | Category |
|---|---|
| 25 to under 30 | overweight |
| 30 to under 35 | obesity, class 1 |
| 35 to under 40 | obesity, class 2 |
| 40 and over | obesity, class 3 |
Percentages are age-standardized.
Results
The number of adults with arthritis and overweight or obesity grew from 28.3 million in 2002 to 38.9 million in 2014.
| Told to lose weight | 2002 | 2014 | Change |
|---|---|---|---|
| Everyone | 35.1% | 45.5% | +10.4 points |
| Overweight | 18.1% | 23.8% | +5.7 points |
| Obesity | 50.4% | 62.8% | +12.4 points |
| Class 1 obesity | 40.8% | 52.6% | +11.8 points |
| Class 2 obesity | 60.2% | 63.0% | not significant |
| Class 3 obesity | 69.0% | 84.5% | +15.5 points |
The 2014 figure met the Healthy People 2020 target of 45.3%.
Share told by a health care provider to lose weight, by year and BMI status, National Health Interview Survey, 2002–2014. CDC
Who was more likely to be told, in 2014
| Told to lose weight | |
|---|---|
| Women vs men | 49.2% vs 41.1% |
| Obesity vs overweight | 62.8% vs 23.8% |
| Ever counseled to be physically active for arthritis, vs never | 60.5% vs 17.5% |
| Ever took an arthritis self-management class vs never | 61.5% vs 43.3% |
| Has a primary care provider vs doesn't | 47.6% vs 32.1% |
What it means
Progress, with gaps. About 75% of adults with overweight and 50% of those with class 1 obesity were still not being counseled to lose weight.
Exercise advice is more common. Another report found 61.0% of adults with arthritis were counseled on physical activity in 2014, more than the 45.5% counseled on weight. Providers may find activity easier to raise, or know its arthritis-specific benefits better — and people missing weight advice may be missing activity advice too.
Diet plus exercise works best. In randomized trials, a combined exercise and diet program improved weight, pain, joint forces, inflammation and mobility more than either alone. The U.S. Preventive Services Task Force recommends that providers offer or refer patients to intensive, multicomponent behavioral programs — goal setting, diet and activity changes, tackling barriers, self-monitoring and keeping habits up — and the American College of Rheumatology recommends counseling on both weight loss and activity for hip or knee osteoarthritis.
Self-management classes. People who had taken one were more often told to lose weight; the survey can't say which came first. Either way, such programs substantially raise self-confidence, which helps people act on advice.
Small losses count. A 5.1% weight loss over 20 weeks can significantly reduce functional disability in people with knee osteoarthritis and obesity, while improving pain and mobility.
How to raise counseling rates
- Clinical decision support in electronic medical records — it has increased nutrition and activity counseling and lowered BMI in children with obesity, and might do the same for adults. Standard prompts could help providers refer patients to evidence-based community weight-loss and activity programs, intensive multicomponent interventions or bariatric specialists, and follow up on patients' goals.
- Provider training in self-management support, in class or through publicly available online resources. Useful techniques include motivational interviewing, the 5As — Assess, Advise, Agree, Assist, Arrange — and stressing that small changes can make a big difference.
Limits
- Everything is self-reported, so answers may lean toward what sounds better — which can underestimate BMI — or be misremembered.
- Low response rates could bias results, though the weights adjust for nonresponse.
- BMI can label very muscular people as overweight or obese when they don't need counseling.
- 2014 was the latest year available; rates may have changed since.
Sources
Based on Guglielmo D, Hootman JM, Murphy LB, Boring MA, Theis KA, Belay B, Barbour KE, Cisternas MA, Helmick CG, "Health Care Provider Counseling for Weight Loss Among Adults with Arthritis and Overweight or Obesity — United States, 2002–2014," MMWR volume 67, number 17, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The race and ethnicity rows of the report's table appear mislabeled, and its obesity row repeats the overall row's counts, so neither the counts nor that breakdown is used here.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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