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and exercise.


Healthcare workers are aware of the need for culturally competent care, yet

current assessment tools cannot identify measures that are effective and those that are not.


More effective training needs to be developed for healthcare providers to consider the potential

roles of conscious and unconscious bias. And, equally if not more importantly, patients must

be educated on the importance of becoming active partners in their own care.


Among the 50 million U.S. adults with arthritis, obesity is associated with progression of

arthritis, activity limitation, disability, reduced quality-of-life, and poor clinical outcomes after

joint replacement.


In middle-aged women, higher weights (BMI) results in an increased

likelihood of hip and knee replacement, although the magnitude of risk is much greater for a

knee replacement.


In particular, obesity is associated with onset of knee OA (the most common

type of arthritis), disease progression, disability, total knee joint replacement, and poor clinical

outcomes after knee joint replacement, and likely has a critical role in the increasing impact

of arthritis on disability, health-related quality of life, and healthcare costs.


Lifetime risk

for symptomatic knee OA alone is 60.5% among persons who are obese, double the risk for

those of normal/underweight.


For hip OA, U.S. and international studies have demonstrated

mixed results, with obesity generally associated with symptomatic OA and joint replacement.


An ongoing study of 238,00 female nurses that started in 1976 found that women who were

obese, especially at age 18, had an increased risk of undergoing a hip replacement in later life.


Women in the Framingham OA study who lost 11 lbs. reduced their risk of symptomatic knee

OA by half.


During 2003–2009, obesity prevalence among U.S. adults with arthritis was 54%

higher than among adults without arthritis, and obesity prevalence among adults with arthritis

increased significantly in 14 states and Puerto Rico during that time period.


U.S. Burden

Some form of arthritis affects 50 million adults

in the United States and the CDC has predicted

that the number will increase to 67 million, or

25% of the adult population, by 2030.



and arthritis are critical public health problems

with high prevalences and medical costs. In the

United States, an estimated 72.5 million adults

aged ≥20 years are obese, and 50 million adults

have arthritis. Medical costs are estimated at

$147 billion for obesity and $128 billion for

arthritis each year.


Osteoarthritis (OA), the most

common type of arthritis,


accounts for much of

this burden.

As a nation, we pay an inordinate price for the pain and disability from OA. In 2004, OA

resulted in over 11 million physician and outpatient visits, 662,000 hospitalizations, and more

than 632,000 total joint replacements, with accompanying hospital costs of $22.6 billion.


In addition, employment rates are lower among adults with arthritis because of arthritis-

attributable work limitations; hence, they either are working less or not working due to their