Obesity punches above its weight in osteoarthritis

Arthritis Research UK published a report in 2009 entitled “Osteoarthritis and obesity” in which they highlight the severe consequences of obesity for musculoskeletal health. Throughout the

report, however, the mechanical effect of excess body weight is assumed to be the direct cause of osteoarthritis (OA). Although this assumption is common, is it supported by the evidence? A

survey of the studies associating OA with obesity is inconclusive on whether body weight is the causative factor. The increase in direct-loading on joints due to weight-gain is not as great

as is often believed, and compensatory gait patterns ameliorate much of the kinematic effects. One manifestation of obesity, however, is increased adipose tissue—a rich source of

proinflammatory endocrine factors. I propose that body weight might not be the main problem in OA pathogenesis, but that increased adipose tissue itself might be both an indicator and a

driver of widespread disease.

I am very grateful to colleagues in my research team and to the peer-reviewers for critical comments on earlier drafts of this manuscript.

Division of Applied Medicine, Bone and Musculoskeletal Research Program, University of Aberdeen, Institute of Medical Sciences, Foresterhill, AB25 2ZD, Aberdeen, UK

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