Should High BMI Prevent Orthopedic Surgery? Surgeon Explains Why Not

Obesity is quickly becoming a global health crisis, with high rates found in Many western countries and doubling worldwide since 1990. Among its Many risks include complications with surgery. But valdemar loiba, a surgeon at nordorthopaedics clinic, says being overweight or obese shouldn’t necessarily preclude patients from seeking important orthopedic procedures.

October 7, 2024 by Nordorthopaedics Leave a Comment

September 4, 2024. According to the World Health Organization, 2.5 billion adults were considered overweight in 2022, or 43% of the global adult population. That included over 890 million adults who were living with obesity, defined as a chronic complex disease of excessive fat deposits that can impair health. Adult obesity has more than doubled since 1990, to one in eight worldwide. The population of overweight adults has gone from 25% to 43% in that same time span. This includes national obesity rates of 27% in the UK, 28% in Canada, and 43% in the United States, according to the Global Obesity Observatory.

Obesity is defined as having a Body Mass Index (BMI) of 30 or greater and can often cause doctors to postpone or rule out essential surgeries for their patients. However, a large sample study conducted in the United Kingdom recently showed that those with elevated BMI did not do significantly worse following surgery, concluding that restricting surgery based on BMI alone is not based on clinical evidence.

Valdemar Loiba, a surgeon at Nordorthopaedics Clinic, a leading international orthopaedic center in Kaunas, Lithuania, explains why he regularly performs surgery on patients with a high BMI.

First Dr. Loiba says there are a few reasons why such patients might not be operated on. They may have an increased risk for wound healing complications and infection. They may also require a prolonged hospital stay, longer rehabilitation, additional medications, and can develop further problems because of existing comorbidities like diabetes or cardiovascular disease.

Still, Dr. Loiba has operated on patients with high BMI, and he says the average range of his patients is 25 to 35, including some with BMI exceeding 40. For instance, “If we have a patient with a locked knee and we know that the cause is torn meniscus, we will do surgery without looking at the patient’s BMI.”

However, Loiba says, “if we have a patient with valgus deformation of the knee and a chronic meniscus tear, normally we will do a high tibial osteotomy surgery. But if the patient has a BMI of over 35, their weight would be considered as a strong contraindication for this kind of operation and we could not perform it,” he explains.

Of course, the problem with lowering BMI for orthopedic surgery is that a patient’s debilitating pain makes weight loss via exercise highly challenging. Having a high BMI can further damage the joint, often resulting in less mobility, more weight gain, and a vicious circle for the patient.

Meanwhile, medications for weight loss work best when combined with regular exercise. They also can have various side effects, aren’t always covered by health insurance, and simply don’t work on everyone. If weight loss is necessary, Dr. Loiba recommends patients consult with a dietologist or even bariatric surgeon.

As Dr. Loiba stresses, every patient’s situation is different. Doctors and patients should gather and discuss all information when making a decision to operate. While rates of obesity continue to rise and present a myriad of health hazards, obesity alone shouldn’t necessarily prevent patients from receiving the crucial surgeries they need.

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