The incidence of obesity is skyrocketing worldwide, associated with health problems such as infertility, liver failure and osteoarthritis of the knee, leading to an increase in knee replacement surgeries.1 In 1975, an estimated 6.4% of women and 3.2% of men were considered obese,2 but this has increased tremendously.
In 2017, the prevalence of obesity in the US reached 41.9% with severe obesity reaching 9.2%.3 Heart disease, stroke, type 2 diabetes, and certain cancers are all considered obesity-related conditions.4 while osteoarthritis of the knee, a common cause of pain and disability, is also linked to obesity.
With people developing obesity at a younger age, knee replacement surgery — a questionable medical procedure — is also becoming more popular at a younger age.5
Rising obesity due to knee surgery at a younger age
In Australia, nearly a third of adults are obese.6 In a study comparing data from the Australian Bureau of Statistics’ National Health Survey from 2017 to 2018 with data from the National Joint Replacement Registry, researchers revealed that obesity is associated with an increased risk of undergoing knee replacement surgery.
Of the 56,217 patients in the study who received knee replacements for osteoarthritis, 31.9% were overweight and 57.7% were obese. The risk of knee replacement increased with the body mass index (BMI) category, so obese women aged 55 to 64 were 4.7, 8.4 and 17.3 times more likely to have a knee replacement if they were class 1, class 2 or class 3 were obese, respectively, compared to normal-weight women.
In addition, those in the severely obese category (grade 3) were also more likely to have knee replacement surgery at a younger age — 7.2 years earlier than normal-weight women. While the average age at which normal-weight women receive a knee replacement is 71.3 years, those with Grade 3 obesity underwent the surgery at a median age of 64.1 years.
Grade 3 obesity men were also 5.8 times more likely to have a knee replacement than normal-weight men, and also had the surgery 7.3 years earlier.7 Overall, the researchers noted that nearly 90% of people undergoing primary knee replacement surgery in Australia are overweight or obese. As for why obesity increases the risk of knee osteoarthritis (OA), they explained:8
“The contribution of obesity to the development of knee osteoarthritis is multifactorial. Not only does obesity cause excessive stress on joint surfaces, but dyslipidemia and adipose tissue inflammation increase cytokine production, which also contributes to the etiology of osteoarthritis.”
Knee surgery no better than placebo
Addressing the underlying obesity that increases the rate of osteoarthritis is essential to protecting your knees. Still, surgery is a widely recommended solution in conventional medicine. However, you should know that multiple studies have shown that knee surgery is no better than a placebo.
The meniscus in your knee is a thin crescent-shaped disc of cartilage that serves as a cushion between your thighbone and shinbone and helps stabilize your knees.
Over time, your meniscus can develop tears, especially if you have arthritis. The standard orthopedic surgeon intervention for meniscal tears is to perform an arthroscopic partial meniscectomy. In fact, meniscus arthroscopic surgery is the most common orthopedic procedure in the US.9 but a study conducted in Finland found that arthroscopic knee surgery for degenerative meniscus tears was no more beneficial than “sham” surgery.10
A landmark study conducted in 2002 also looked at arthroscopic surgery for osteoarthritis of the knee, and found that the real operation had no advantages over the sham procedure.11 Although the surgery did not work any better than placebo, arthroscopic knee surgery with meniscectomy has been shown to increase the risk of future knee replacement surgery by a factor of three.12
On the other hand, exercise, along with rehabilitation in middle-aged patients with knee damage, has been shown to be as effective as meniscus surgery.13 It’s also unfortunate that obesity is the cause of knee replacements at a younger age, as your weight is also an important factor in determining the potential success of a surgical repair.
For example, research has found significant changes in the curvature of your knee joint within the first three months after an injury with increased body mass. The results showed that those who underwent surgery experienced greater flattening of the knee joint than those who used rehabilitation without surgery when their body mass index was higher.14
Obesity Affects Male Infertility
Male fertility has been declining for at least 40 years, with an overall 50% reduction in sperm quality from 1938 to 2011.15 The book “Count Down,” written by Shanna Swan, a reproductive epidemiologist at Mount Sinai’s Icahn School of Medicine, is based on a 2017 study they co-authored, which also found that sperm counts decreased between 1973 and 2011. 59.3% fell.16
The most significant decreases were found in samples from men in North America, Europe, Australia and New Zealand, where many had sperm concentrations below 40 million/ml, which is considered the cut-off point at which a man will struggle to to fertilize an egg. Overall, men in these countries had a 52.4% decrease in sperm concentration and a 59.3% decrease in total sperm count (sperm concentration multiplied by the total volume of an ejaculate).
Hormone-disrupting “chemicals everywhere” are a major culprit, Swan says: “Chemicals in our environment and unhealthy lifestyle practices in our modern world disrupt our hormonal balance, causing varying degrees of reproductive harm.”17 Hormone disruptions can also affect weight, and exposure to environmental chemicals has been implicated in exacerbating the obesity epidemic.18
Research presented at the Endocrine Society’s 2022 annual meeting in Atlanta, Georgia further revealed that maintaining a healthy body weight in childhood can help prevent male infertility later in life.19
Children and adolescents who were overweight or obese, or with high insulin or insulin resistance, tended to have smaller testicles compared to their normal-weight peers with normal insulin levels. According to the study’s lead researcher, “more careful monitoring of body weight in childhood and adolescence may help maintain testicular function later in life.”
Fructose, Obesity That Causes Liver Disease
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in developed countries.20 characterized by an accumulation of excess fat in your liver that is not related to heavy alcohol use. Lifestyle factors such as diet, exercise, weight, and smoking all play an important role in worsening (and decreasing) your chances of developing liver disease.
In the US, 24% of adults have NAFLD, and another study presented at the Endocrine Society’s annual meeting in 2022 suggested that high fructose consumption was associated with an increased risk of NAFLD.21 Foods high in fructose, including sodas and sweets, are associated with obesity and diabetes, which are also associated with NAFLD. Lead author Dr. Theodore Friedman of Charles R. Drew University in Los Angeles, California, said in a press release:22
“NAFLD is a serious problem and it is increasing among the population. There is a racial/ethnic difference in the prevalence of NAFLD. People consume high fructose corn syrup in foods, soft drinks and other beverages. Some studies have suggested that high fructose corn syrup consumption is linked to the development of NAFLD.”
While fructose consumption certainly doesn’t benefit liver health, the rise in NAFLD is probably more related to an increased intake of toxic industrially processed seed oils, often referred to as “vegetable oils.”
Examples of seed oils with a high content of omega-6 PUFAs are soybeans, cottonseed, sunflower, canola (canola), corn and safflower.23 Omega-6 is considered pro-inflammatory due to its most abundant variant, linoleic acid, which will radically increase oxidative free radicals and cause mitochondrial dysfunction.24
As researchers noted in the journal Nutrients, “In addition, some studies suggested that omega-6 PUFA is linked to chronic inflammatory diseases such as obesity, non-alcoholic fatty liver disease, and cardiovascular disease.”25 Reducing your intake of fructose and seed oils and increasing your intake of healthy fats is a powerful way to support your liver health and a healthy weight.
It is also important to avoid almost all processed foods and fast foods, as almost all contain these toxic oils and/or fructose. The easiest way to do this is to prepare most of your food at home so you know what you’re eating.
Also keep in mind that because animals are fed grains rich in linoleic acid,26 it’s also hidden in ‘healthy’ foods like chicken and pork, making this meat a major source to avoid. Olive oil is another health food that can be a hidden source of linoleic acid as it is often cut with cheaper seed oils.
Try TRE to lose weight
In addition to avoiding linoleic acid in seed oils, time-restricted eating (TRE) is a simple powerful intervention that mimics the eating habits of our ancestors and restores your body to a more natural state that allows for a whole host of metabolic benefits.27
TRE involves limiting your eating window to six to eight hours a day instead of the more than 12-hour window most people use. For example, research shows that people following TRE had significantly less body weight and fat mass, while maintaining lean body mass, along with improved blood pressure, fasting glucose and cholesterol profiles compared to those following a normal diet.28
Ideally, you want to stop eating a few hours before bed and then start eating mid to late morning after you wake up. TRE, along with a comprehensive lifestyle program to support a healthy weight, including exercise, daily exercise and stress reduction, can help you maintain a normal weight and avoid the pitfalls of obesity, including knee problems, infertility and liver damage.