The Relationship Status Between Your Weight and Bones? It’s Complicated.

May 31, 2018

blog_bonedensityThere is no doubt that achieving and maintaining a healthy weight benefits your overall health and vitality. Volumes of research confirm its positive impact on reducing the risk of developing over fifty chronic conditions, such as high blood pressure, high cholesterol, type 2 diabetes and several forms of cancer. Losing weight can limit these risks through improvements to multiple biological systems, such as the endocrine, metabolic and circulatory systems. Your body was designed to work in a specific way, and losing excess weight helps you reach its optimal state.

However, there is one system that doesn’t quite fully align with the natural or automatic benefits of weight loss. The skeletal system – consisting of 206 bones and a network of tendons, ligaments, and cartilage – has an interesting relationship with body weight. Weight loss ultimately benefits the skeletal system’s health, but it takes a little work and thoughtful decision-making to make that happen.

Like we said it’s complicated.

Complication #1: How weight loss both improves and weakens bone health

Many people fail to recognize the enormous pressure extra weight can put on bones and joints, felt especially in your knees, back, and hips. According to the Arthritis Foundation, every pound of excess weight exerts about 4 pounds of extra pressure on the knees, which means that someone who is overweight by 100 pounds is adding an extra 400 pounds of pressure on their knees. Carrying extra weight, especially for long stretches of time, can lead to gout, a disease that limits mobility and can cause extreme pain in the joints, and osteoarthritis. Osteoarthritis is the most common form of arthritis in the world and is caused by the wearing down of cartilage. The symptoms, which include pain, tenderness, stiffness, and loss of flexibility develop slowly and worsen over time.

Read how Cynthia improved her joint pain by losing weight.

As you might imagine, weight loss can significantly ease the physical stress on the skeletal system in addition to lowering your risk of osteoarthritis and gout. But ironically, losing weight negatively impacts bone density. The ultimate risk of decreased bone density is fracture.

While the exact cause of this decrease in bone density is unknown, researchers are considering a multitude of factors. These include: extreme diet and nutritional changes, decreased pressure on the skeletal system, hormone production relating to changes in diet and exercise, and changes in body composition and bone marrow fat. This effect is particularly troublesome for older adults, when weight loss becomes more difficult and bone density deteriorates. Post-menopausal women feel the compounded effects of these events more so than men.

Complication #2: Which weight loss approach you choose matters for bone health

As if dealing with the duality of weight loss effects on bone health weren’t complicated enough, it turns out how you lose weight adds an extra layer of complexity. From the cabbage soup diet and over-the-counter supplements to commercial and medical programs, there are seemingly a million different ways to shed the pounds. Each offers its own claims of weight loss effectiveness, but what is not well known is that the impact they have on bone health.

The difference primarily comes down to surgical versus non-surgical approach. If you guessed that weight loss surgery is tougher on bone health, you would be correct. Since the 1950s, doctors have been performing bariatric, or weight loss, procedures that either shrink the stomach or bypass certain parts of the digestive tract. There are four common types of weight loss surgeries: Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, sleeve gastrectomy, and duodenal switch with biliopancreatic diversion. According to the American Society for Metabolic and Bariatric Surgery, to be eligible for any type of bariatric surgery in most areas, candidates must meet one of the following qualifications: Have a body mass index (BMI) above 40 or be more than 100 pounds overweight, have a BMI about 35 and at least one serious weight-related health problem, or have an inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.

In the last decade, the use of bariatric surgeries has increased sevenfold. Though these surgeries have proven to be effective in reducing the weight of the patients, they have also had harmful side-effects. A March 2018 review by the American Society for Bone and Mineral Research indicates that bariatric surgery adversely affects bone health. Gastric bypass induces dramatic increases in skeletal fragility, as patients face short-term and long-term decreases in bone mineral density post-surgery. Patients continue to lose bone even five years after weight loss surgery. This study confirms the findings of a 2014 study by the American Society for Metabolic and Bariatric Surgery, which indicated the need for micronutrient supplementation after surgery.

When considering weight loss surgery, it should be noted that patients are often required to follow a non-surgical medical weight loss program first in order to access insurance coverage for the surgery. Because of this requirement, patients face an additional risk of bone density deterioration, losing bone strength to varying degrees with both weight loss approaches.

Minimizing Bone Health Complications While Losing Weight

Despite these complications, weight loss and bone strength are not mutually exclusive. There are steps you can take to achieve the massive health benefits of weight loss without increasing your risk of bone fracture.

  • Exercise, especially with weights. Both external and body weight exercises can help strengthen bones and joints and improve weight loss. This weight loss relieves the pressure on the skeletal system, making exercise even more effective and enjoyable.
  • Increase calcium and Vitamin D intake. Whether through food or supplements, increasing your intake of micronutrients can counter the effects on bone health. Calcium also has also been proven to support weight loss efforts.

If you are eligible for weight loss surgery, try the non-medical approach first. You may find you don’t need the surgery after all…

Nothing in life comes without complications, but you can minimize and even overcome them by learning all you can, creating a strategy, and making the decisions that are right for you.

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