This was originally a Q&A Wednesday question, but I’ve had no less than six people come to me with this exact same problem all in the same ten day period and, honestly, that deeply concerned me.
Here’s the deal—I’m turning this into a series. I tried to fit this all in one post, but I couldn’t possibly do it justice that way… because no one is reading a book-length essay all about knees. I’m going to break it all up into a bunch of different posts, so be sure to send any questions you have my way so that I can dig all into it.
Here’s the question:
Q: Hi Erika, I’m over 370 lbs and I’m 5′ 6″. I’ve tried everything or so it seems to lose weight. The weight has overwhelmed my frame and I’ve lost the cartilage in both knees. My orthopedist would rather operate on my knees after I lose 150-200lbs. He says it’s too dangerous to operate right now. Right before Christmas I started developing pain in my lower back (I think by being stationary at work and home) and walking hurts. I feel as though if I exercised that would go away. But my knees go out almost every week and I can’t exercise. On Thursday I came out of work went down the steps and I heard the knee go to the right as I went to the left. My doctor and my husband want me to have weight loss surgery. I’ve had 3 cesareans, and the thought of them opening me again frightens me a lot. So with all that, my question is: How can I lose weight without weight loss surgery and have a low impact on my knees in the process? My therapist has said to go slow, so my task this week is to get a lot of water in. But I feel like my husband doesn’t get it and says I should be doing more. I feel pressure to lose weight, I want to lose weight, but no one I’ve talked to has given me any advice on what to actually do. My husband and my kids have good intentions, but I’m not confident they are the support system I need to lose weight, much less have them support me after weight loss surgery. I’m really, really frustrated and I don’t know what to do. Any advice would be appreciated.
The awful thing about this, to my estimation, is that your orthopedic surgeon is right. It is too dangerous to operate right now.
It’s important to understand how this works, not just for yourself, but so that you can explain to your family and friends why you aren’t “doing more.” You’d literally be risking your lower body—actually, your whole body—in a more permanent fashion if you tried to go all out on some Biggest Loser type nonsense.
Make no mistake about it—all of our joints wear and tear. Any part of the body that bends is able to do so thanks to bone-to-bone connective tissue, and it all experiences wear and tear. However, nothing wears quite the way our lower body can.
The amount of time we spend on our feet affects our hips, knees, and ankles, but that is often mitigated by the amount of muscle we have. And, if our diets permit, our bodies will recognize that we need more muscle for the amount of time we spend on our feet, and will respond by working to build that muscle.
The fewer opportunities our bodies get to be challenged to build that muscle, the more sedentary we are more likely to be, and the less likely we are to have that muscle when we really need it.
When we do basic activities like walking, for instance, that muscle acts as a shock absorbent for your joints. When your heels hit the ground, muscle mass responds by contracting and working to reduce the impact felt by the joints. When there’s not enough muscle mass, all that impact attacks the joint directly, worsening that wear and tear.
To make matters worse, what makes this even more troubling is the fact that the ensuing joint pain will undoubtedly change the way you walk, which not only affects how your muscles grow, but that abnormal muscle growth will then affect your hips and ankles. When you see some of our elderly friends and family with bad hips who need walkers? Rest assured, there are knee problems, too. Their hip problems might’ve even began with knee problems.
If you’re wondering whether or not body fat can positively affect and protect joints, it can’t. Body fat isn’t dense enough to absorb shock and isn’t connected to your nervous system the way muscle is, so not only can it not be controlled the way muscle can, but body fat actually only makes the impact on joints even worse. Stand up and jump right now—I mean, if it’s safe for you to do so—and feel the way your muscles clench in response to landing on the ground. Body fat can’t do that. At best, it’s just additional in-the-way-weight when it comes to knee joint health. At worst, it’s an added burden for your joints.
So, when you’re sedentary, (1) chances are high you’ve gained weight that affects how much ‘shock’ your joints feel when you walk; (2) you’re less likely to have the muscle necessary to help protect your joints from eventual wear and tear; (3) you’re far more likely to improperly develop the muscle groups most responsible for supporting those joints because, when your knees or hips hurt, you walk differently… and sometimes, those changes become long-term in ways that become expensive to undo…
…but it’s not impossible. And, in the next post, we’ll discuss ways to do just that: improve and protect joint health, and do it as naturally as possible. (That doesn’t mean that our e-mailer won’t need her surgery any more, but it does mean we can try to reduce the amount of surgical intervention she needs.)
In the meantime, check out some of my favorite references for knee health: