How weight loss affects joint pain

Anyone can experience joint pain. And while the likelihood of osteoarthritis and chronic pain increases with age, regardless of weight, it is more likely to have joint aches when you are overweight or obese. Obesity is an independent risk factor for joint pain, especially in so-called weight-bearing joints like the knee and low back. This may be due to the amount of pressure excess weight places on the load-bearing joint. But research has shown that people with obesity may also experience pain in other joints like their arms, hand, fingers, and neck. 

One study suggests that one in five people with obesity have knee osteoarthritis, compared with less than 4% of people with a “normal” body weight (defined as a body mass index, or BMI, of less than 25). The same study also found that people with obesity or overweight might be two to five times more likely to experience osteoarthritis. That being said, not everyone with overweight or obesity has joint problems, and many people with  “normal” weight experience osteoarthritis. 

The good news is that losing weight can reduce pressure on the joints, relieving pain, inflammation, and even the progression of osteoarthritis. Let’s take a look at how weight loss can relieve joint pain.

Body weight has a significant impact on joint pain, with people with higher body weights having more severe joint degeneration in their knees. There is also a correlation between higher BMIs and requiring a hip or knee replacement. 

Body weight both compresses load-bearing joints, like the knees, and creates inflammation in the surrounding tissues and joints, worsening the pain you experience. With each step you take, your weight compresses the cushion between the joints and wears away at the bone and cartilage. People with obesity may also be more likely to develop misaligned joints, compounding matters further. Finally, while more weight goes hand in hand with more fat as well as more muscles, the amount of muscle mass is proportionally low in people with obesity, so it’s less able to withstand the extra pounds of pressure.

There is good news. Losing 10% of your body weight can significantly improve pain, physical functioning, and quality of life, as well as other symptoms related to osteoarthritis.

And, every bit of weight loss makes a difference, according to a widely cited study that found that every pound of weight loss reduced the load exerted on the knees, per step, by a factor of four. However, while losing 5% of weight can offer meaningful pain relief, losing 10% or more is what really makes a difference, according to research.

Obesity is thought to cause low-grade systemic inflammation and is associated with higher levels of leptin, a hormone produced by your adipose fat tissue that some researchers think is linked to inflammation and cartilage deterioration. 

You can relieve inflammation and joint pain by losing weight and body fat. Indeed, studies have found that when people are overweight or obese, losing body fat through a reduced-calorie diet or surgery can significantly reduce the inflammatory chemicals that contribute to chronic inflammation.

Both joint pain and obesity make it harder to move around, leading to a vicious cycle where you move less, gain more weight, and lose muscle strength, all of which worsens your joint pain. Knee pain in particular disrupts quality of life, since we rely on them to walk around. Research shows that knee pain can isolate people and prevent them from participating in work and social activities.

On the other hand, losing weight can allow you to move around more, improving your physical health and quality of life. After losing weight, people with obesity and joint pain not only report improved quality of life, but report feeling better about how their body looks and functions.

It can be tough to lose weight when you’re dealing with joint pain. It’s important to talk to your doctor before starting to exercise and figure out what type of exercise is right for you. For people with high body weights and joint pain, a plan that involves both exercise and diet tends to be more effective than exercise or diet alone, and lead to more improvements in joint pain, gait, and physical functioning. 

Step one is deciding to lose weight. You’re already there! Now, on to how to do it.

Diet

To achieve the recommended 10% weight loss over six months, the National Institutes of Health recommends the following calorie restrictions:

• People with BMIs of 27 to 34.9 should reduce their caloric intake by 300 to 500 calories per day.

• People with BMIs of 35 or higher should reduce their caloric intake by 500 to 1,000 calories per day.

Ensure the diet you do follow contains all the essential nutrients you need. In particular, to avoid osteoporosis, make sure you meet the daily calcium intake recommended for your age group:

• Ages 18 to 50 years old: 1,300mg per day

• Ages 51 to 70 years old: 1,000 mg per day for men, and 1,200 mg per day for women

• Over age 70 years old: 1,200 mg per day

Good sources of calcium include yogurt, cheese, and milk (soy and dairy), as well as leafy greens, salmon, and tofu. Vitamin K — which can be found in green veggies like spinach, brussels sprouts, kale, and broccoli — can help your body better utilize calcium as well. Additional dietary recommendations for people living with joint pain include:

• Increasing your intake of omega-3 fatty acids by eating 1-2 portions of fish per week

• Reducing your cholesterol through fiber (e.g. oats), soy proteins (e.g. soy milk, edamame, or tofu), and nuts

• Eating foods rich in vitamin A (700 to 900 mcg daily), vitamin C (75 to 90 mg daily), and vitamin E (15 mg daily)

• Getting enough vitamin D, by spending 10 to 20 minutes outside (don’t forget the sunscreen!) and eating foods like eggs, fish, and fortified milks and cereals

Exercise

When you’re living with joint pain, it’s hard to move around, let alone exercise. But, regular exercise helps your mobility, which plays a large role in your functioning and pain. Plus, exercise helps you rebuild the muscle strength you need to stay mobile after the muscle loss that can occur with significant weight loss. 

Studies of people with knee osteoarthritis have found walking and quad-strengthening exercises to be beneficial, but really, the best exercise will depend on the individual. Talk with your healthcare provider to determine a safe exercise routine for you based on your current health situation. 

Different types of exercises that have been studied in people with obesity and joint pain include:

• Resistance training using body weight, dumbbells, or cuff weights

• Aerobic exercises like walking or cycling

• Aquatic exercises like swimming, water aerobics, or walking laps in the pool

Aquatic exercise can relieve pain, and improve joint function and quality of life. Water-based exercise can be particularly helpful for people with joint pain because the water’s buoyancy helps support your body weight, taking some of the pressure on your joints while allowing you to work out. Plus, the warm water can help your mind and your muscles feel more relaxed, making it easier to move. However, while aquatic exercise can help you build muscle and lose fat, it may not reduce your BMI as much compared with other types of exercise.

Walking on a treadmill can also be a safe and effective way for overweight people with osteoarthritis to lose extra weight. In one study, people participated in a 12-week ​​lower body positive pressure (LBPP)-supported low-load treadmill walking program, where the treadmill is placed in an air chamber that uses air pressure to relieve pressure on the joints. At the close of the twelve weeks, participants reported significant improvement in their knee pain. They also developed a decent amount of thigh muscle strength. Best of all, as the study went on, they required less and less support from the air pressure in order to walk pain-free.

Remember: exercise is good on its own, but exercise and diet together are better. Within six months, people lose an average of 3.7% of their body weight using exercise alone, but 5.7% with diet and exercise combined.

Medication

GLP-1 medications like Ozempic and Wegovy have been shown to help people lose 15% of their body weight within a year and a half. These medications are safe and effective, with mild to moderate gastrointestinal side effects (like nausea and diarrhea) that tend to improve with time as your body gets used to the drug. 

Generally, weight loss medications are more effective when combined with lifestyle changes like diet and exercise.

Surgery

For some people, surgical intervention like bariatric surgery may be an option. People who undergo bariatric surgery experience more significant improvements in joint pain than a mix of medications and diet and exercise recommendations. Not only did the people who underwent surgery lose significantly more weight (29% vs. 4.1%) but they were also the only ones who reported any improvement in knee and wrist pain.

A separate study found that the space in the knee joint seems to widen with weight loss after bariatric surgery, suggesting that weight loss itself may relieve knee pain — regardless of a person’s physical activity level or muscle strength.

More tips for losing weight

The above tips offer big ways you can lose weight, but even small habit changes can help with weight loss.

In addition to changing what you eat, adjust how you eat. Eat smaller meals, and eat more slowly. Opt for healthier options when you eat out. Pay attention to nutrition labels when you’re at the grocery store. Go for a short walk instead of sitting or lying down after a meal. If you’re an emotional eater (like many of us are), practice managing your stress through meditation or yoga as opposed to snacking.

Speaking of stress, it can make it tougher to lose weight. When people are stressed, they tend to overeat, consume fewer fruits and vegetables, and indulge in fatty, salty, or sugary food. They also move less. Stress is linked with a lot of health issues, including obesity. Finding ways to manage your stress can help with weight loss. In one study, participants attended an 8-week stress management program. By the end of the study, their BMI had significantly decreased and they felt less depression and anxiety. 

Exercise can also combat stress and improve mood, making it easier to stick to your diet and weight loss program. Take advantage of opportunities for small movement throughout the day. Stand up and stretch during your workday, use the stairs instead of an elevator, or park just a few spaces further away. One study found you can reduce your risk of death by 33% just by getting up and moving for two minutes (or more, if you can swing it) for every hour of sitting.

Start with however much exercise you can manage. The Centers for Disease Control and Prevention (CDC) recommends five days of moderate- to vigorous-intensity exercise, five days per week, for a total of 150 minutes per week. However, even small amounts of moderate physical activity can offer health benefits, like a reduced chance of death from any cause. And the sooner you get moving, the easier it becomes.

These are all just ideas. If they feel overwhelming, pick one or two and commit to that. Every bit helps.

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Current version

May 16, 2023

Written by

Amelia Willson

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.