by Judi Rhys, Chief Executive of Arthritis Care
I recently attended a plenary session at the European Federation of National Associations of Orthopaedics and Traumatology Congress. The presentations were concerned with the ‘global musculoskeletal challenge’ and the ‘imminent avalanche of demand’ ahead. Many of the speakers referred to the rise in worldwide obesity and the link between obesity and osteoarthritis. A review of research in this area suggests an obese person is 14 times more likely to develop knee osteoarthritis, compared with a person of normal weight. And while we know that obesity is a risk factor for a number of conditions, it confers an increased chance of developing osteoarthritis of the knee four times greater than the risk associated with high blood pressure or type-2 diabetes.
But we also know that many people with osteoarthritis struggle to lose weight and maintain that weight loss. Initiating and supporting behaviour change is a real challenge, as I well know from my earlier career in public health. Simple exhortations from health professionals to lose weight are largely ineffective and blaming individuals for not achieving weight loss is inappropriate. Many factors combine together to affect health behaviours and we know that the context of people’s lives determines both behaviours and attitudes towards health.
For example, where people live, their income and social status, education, employment, social support networks, genetics, access to health services and gender are all factors that impact on health and many of these are clearly outside of an individual’s direct control. The Kings Fund suggests that some people living in a deprived area will have multiple health problems ten to fifteen years earlier than people in affluent areas – a stark reminder of the inextricable link between health and wealth.
So, what does this mean for those of us concerned with preventing the avalanche, when more than sixty per cent of the population have a negative or fatalistic attitude towards their own health? A review of the evidence carried out by The Health Foundation suggests that in order to change behaviour, people need to want to change. When people are involved in decision making about their health behaviours successful outcomes are more likely. Approaches that empower and activate people so that they feel more confident about change are more likely to result in altered health behaviour, and there is strong evidence that improved self-efficacy is associated with better clinical outcomes.
Approaches that include motivational interviewing by telephone or in person, group or individual education programmes with an active component, coaching with proactive goal-setting and follow-up sessions to review progress, and programmes based on psychological and emotional support that acknowledge people’s stages of change have all been shown to be effective.
My mother in law, many years ago, while awaiting her third hip replacement, was told by her orthopaedic surgeon that she was ‘a bit short for her weight’. Needless to say, as an intervention, this was not particularly successful in achieving behaviour change. Indeed, I recall her feelings of shame and self-blame at her predicament.
If we are serious about tackling this issue, then we need to do much more to ensure that the attitudes and skills of healthcare providers are those that encourage people to feel engaged and supported, while also continuing to invest in research to help us understand the factors that improve self-efficacy and motivation to adopt healthy behaviours.
The Bone and Joint Decade World Summit, to be held this October, in partnership with ARMA, will provide further opportunity to discuss and debate this topic.