20 / 58
20
Looking at data for 2008 and 2009, AHRQ reported that:
54
• Among adults age 40 and over with diagnosed diabetes, only 23% received all
four recommended services (at least two HbA1c tests, a foot examination, an
eye examination, and a flu shot) in 2009.
• In 2009, Blacks and Hispanics/Latinos were less likely than Whites to receive
recommended care for diabetes.
• In both years, poor, low-income, and middle-income adults were less likely to
receive recommended care for diabetes than high-income adults.
• In both years, adults ages 40-59 were less likely to receive recommended care
for diabetes than adults age 60 and over.
Arthritis: Symptoms and Impact on Obese Patients
Obesity is an independent risk factor for severe pain, reduced physical function, and disability
among adults with OA, which might be related to both the increased mechanical stress caused
by extra weight on the joints as well as inflammatory effects of elevated cytokines and adipokines
that affect cartilage degradation.
55
For patients with OA, the friction produced when bones grind
against one another causes chronic pain and stiffness. The course of functional decline is
generally one of stable to slowly deteriorating function. As a result, many patients limit their
physical activity, which often leads to weight gain. Chronic pain, inactivity, and weight gain can
escalate into obesity, which in turn worsens the burden of osteoarthritis. Once OA is present,
physical inactivity and increasingly sedentary lifestyles may play a major role in aggravating
the associated pain, function, and disability of OA.
56
Obesity can also initiate the cycle. Excess body mass due to obesity and overweight are
clearly implicated in the development of OA of the knee and probably OA of the hip as well.
The increased load that obesity places on joints can exacerbate the pain and functional
limitations of OA. Because of the physics of knee movement, activity magnifies the load
across the knee from upper-body weight by three to seven times. Therefore, weight loss in
obese patients, especially if accompanied by increased physical activity, can improve physical
function and quality of life.
5
Arthritis often affects people who have other chronic diseases, which can make it difficult for
them to exercise to improve any of their comorbid conditions. For example, 52% of people
with diabetes, 57% of people with heart disease, and 53% of people with hypertension have
doctor-diagnosed arthritis.
57
Physical activity is a key element for managing these prevalent
chronic diseases and OA pain stops participation.
58
Obese people with arthritis are 44% more
likely to be physically inactive than are those without it.
59
Because OA shares risk factors
with other chronic conditions, such as diabetes and heart disease, the self-management
and lifestyle changes to prevent or manage OA will likely improve the outcomes for these
conditions as well.
58;60
Physical activity appears to have a substantial protective impact on future OA-related
disability.
61
Even small amounts of weight loss (eg, 10–12 pounds) can have important
benefits for persons with arthritis.
55
One study indicated that women who lost just two
points in BMI in 10 years had a 35% reduction in risk of developing symptomatic knee