Managing Weight for Arthritis 

 

Weight Management Podcast Episode Transcript

For release 7/2/24 

PODCAST OPEN:           

You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. This podcast and other life-changing resources are made possible by gifts from donors like you. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control of arthritis with tips and ideas from our hosts and guest experts.

 

MUSIC BRIDGE

 

Stacy Courtnay:

Welcome to the Live Yes! With Arthritis podcast. I am your host today, Stacy Courtnay. So, welcome everyone, and thank you for joining us. I have had rheumatoid arthritis for about 20 years now. I was diagnosed when I was 23, right out of college, had just gotten my first job and gotten married. It has been a long road the past 20 years. But today, I'm thriving with medication and some lifestyle changes that I made. Now, I spend most of my time volunteering for the Arthritis Foundation.

 

Today, we're going to talk about weight management for arthritis. And according to a study in 2018 from the National Health and Nutrition Examination survey, nearly one in three adults in the U.S. are overweight; that's approximately 31% of people are overweight. More than one in three men, and more than one in four women, are overweight.

 

Losing excess weight is probably the best therapy for people with osteoarthritis, especially those that are overweight. After all, one pound lost is equivalent to four pounds less pressure on your knees, your ankles and other weight-bearing joints. So, just think about the difference about losing just 10 pounds and how that could impact your arthritis.

 

Weight management is also so important for inflammatory forms of arthritis, such as rheumatoid, like I have. Losing weight and keeping this off is a challenge, and it's not always easy. But today we have two guests who are going to join us to help us to talk about weight management and things that we can do to keep a healthy weight and to lessen the effects of arthritis.

 

Our guest expert today is Michelle McLeod, and Michelle is the director of the Arthritis Foundation's osteoarthritis clinical research programs. Michelle, tell us a little bit about yourself.

 

Michelle McLeod:

Thanks for having me. My background has been with really physically active individuals primarily. I have a background in athletic training, so I was an LA health professional working primarily with collegiate athletes. The person on the sideline who's there behind the scenes before practice, during practice, after practice, tending to injuries and illnesses.

 

I also have a PhD in exercise science. I have taught coursework in exercise prescription, athletic training and have shifted over into the nonprofit side, and focusing on research. Kind of being a behind-the-scenes person and supporting the efforts of others to help come up with treatments and interventions to help keep people active and maintain function and healthy joints. I also teach yoga.

 

Stacy Courtnay:

Thank you. So next we have Raquel Masco. She is a longtime patient advocate and friend of mine who I've known for many years. She is currently a co-facilitator for our African American Connect Group and a former member of our Patient Leadership Council. Raquel, you want to tell us a little bit about your arthritis and weight challenges over the years?

 

Raquel Masco:

Absolutely. Thank you, Stacy. And thank you to the Arthritis Foundation for the opportunity as always to share. I was diagnosed with osteoarthritis in 2015 after years of a variety of symptoms: hair loss, change in skin pigmentation. For a while there, I suspected just lupus.

 

Weight, I didn't have an issue with until after the birth of my son in ’96, always small. And so my metabolism changed. And in 2015, I was rear-ended by an 18-wheeler sitting at a stop light, so all those symptoms that I had finally were recognized when I had to have an MRI for insurance purposes.

 

So apparently things lit up like a Christmas tree. But my diagnosis was just arthritis. When I was diagnosed, I'm a can-do-it, active person, I'm a doer. I raise my hand to volunteer and do things probably more than I should.

 

And with the diagnosis, I didn't stop. It was denial. And I was still trying to do 5Ks, active yoga every day, intense. Until my body said, “I don't know what you're doing, but we're not doing this anymore,” and shut down. And I was sick. And when you're sick and in pain, you cannot get up and exercise. I mean, maybe some people can, but if you have arthritis, and you have the pain that's indescribable to people who don't live with it, just moving an inch can be impossible, can be debilitating and excruciating pain. And so, I stopped exercising, I wasn't doing anything. I put on a lot of weight.

 

It's just a cycle that can seem never-ending. I want to exercise, but I'm in too much pain. Until finally, I came to a point where I felt, “I'm not sure I can keep living like this.” And I didn't want to go down that trail. I got up and decided to do something about it and take back control of my health and my life.

 

Stacy Courtnay:

Thank you for sharing that. You're so right about the vicious cycle. The best thing for you is to get up and to move. But when you're in so much pain, it's just really hard to do that. And the emotional toll that it takes, not moving and gaining weight, it's just very depressing. It's not just the physical pain, it's the emotional and social pain that goes along with the chronic illness.

 

Raquel Masco:

Absolutely.

 

Stacy Courtnay:

Michelle, what is a healthy weight? Is it you look at the BMI? What are some guidelines for a healthy weight?

 

Michelle McLeod:

I think the BMI standards are still what are used. Your ratio of your weight to your height. And based off of that, we get some really kind of superficial information. If you have a BMI between 18-and-a-half and 25-and-a-half, that's considered a healthy, normal weight.

 

Beyond that, up until you get to a BMI of 30, is considered overweight. And anything over 30 is considered obesity. And there's some challenges with the BMI scale, you know: You can have someone who has a lot of muscle, but maybe shorter-statured, who might fall into an overweight or an obese category.

 

It's not the best tool. It does get a lot of criticism, especially in the research space, but it is still being used to give a face-value definition of what's healthy.

 

Stacy Courtnay:

Raquel, you could probably speak to this. So why is it so important to have a healthy weight when you are dealing with any type of arthritis?

 

Raquel Masco:

It's important to keep yourself healthy. It seems counterintuitive to keep exercising, to keep moving, to keep having a healthy weight. But it is important. Being a healthy weight for me means not being too overweight, not being too underweight. And a healthy weight, according to my height, 5'2", for my age, 52, and a healthy weight so that I'm walking up steps; I'm not winded, I'm not hurt. And a healthy weight that when I look at the mirror, really being honest and seeing someone that I appreciate. "You know, I like this person when I look at her in the mirror."

 

And it's important, emotional, mind, body, soul. We're a whole person, and we need all of it to come together.

 

Stacy Courtnay:

Absolutely. Michelle, I'm interested to hear what your feedback is, but what does excess fat have to do with inflammatory arthritis?

 

Michelle McLeod:

The name inflammatory arthritis itself is those inflammatory processes that occur as a result of having excess fat tissue contributing to that. Even thinking about diet and inflammatory foods, foods that may cause inflammation in the body. People ask the question, "If we think of osteoarthritis as being a kind of wear and tear around the joints, like the knee and the ankle and the hip that bear weight, why do people get inflammatory arthritis in the hands?" Obviously, we don't walk on our hands. I think there's some sort of metabolic contributions as it relates to inflammation.

 

Stacy Courtnay:

Yes. Diet and certain foods can definitely affect the inflammation for sure. But, you know, maintaining a healthy weight is important for your arthritis as well as your quality of life, but also the social and emotional side of things. When you're not a healthy weight, it affects all of you. It's a journey. It's not something that's one-and-done.

 

We ebb and flow with our diet, with our exercise, with our healthy habits.And some days are better than others. And I'm sure, Raquel, you can relate. If you have one bad habit, it leads to other bad habits.

 

Raquel Masco:

Yeah.

 

Stacy Courtnay:

But if you can just start one good habit, it leads to other good habits. Can you elaborate on that from your experience?

 

Raquel Masco:

The major change for me has been eliminating sugar from my diet. It's highly inflammatory. So, I had to cut that out. We do cookies and cakes everywhere, donuts, there's always cinnamon bun things opening up.

 

It makes me swell. I live in Texas, and it gets hot out here. And so, I was drinking a lot of sweet tea. And I looked in the mirror one day, and I was like, "What is this?" I had swollen up like a balloon, and I was in a lot of pain.

 

My right hip joint is the major point of contention for me. And it was bad. It was like, "OK, you just have to stop eating the sugar if you don't want to see yourself swelling like this, and you don't want to be in this pain." One thing led to me adopting a sweetener that works for me. And also for me, the combination of foods that can cause inflammation.

 

So, just changing that has been amazing. It has been transformational.

 

PROMO:

Want to help grow our movement and conquer arthritis as a volunteer? There are lots of ways to get involved with the Arthritis Foundation and make an even greater difference. To get going, check out https://www.arthritis.org/volunteerarthritis-dot-org-slash-volunteer.

 

Stacy Courtnay:

Michelle, what do you think about the Mediterranean diet, the anti-inflammatory diet? I mean there's a million diets out there. People say, "Well, have you cut out gluten? Have you tried the raw diet? Have you tried juicing?" What are your thoughts on that?

Michelle McLeod:

I think the most important thing is to figure out what works for you as an individual. So, what works for me might not work for somebody else. I think one of the consistent take-homes about the Mediterranean diet is that it's got this well-balanced diet of healthy fats, in combination with a lot of plant-based protein and fiber that makes it kind of an ideal diet to follow.

 

Stacy Courtnay:

What do you think about intermittent fasting?

 

Michelle McLeod:

There continues to be some research being performed on: What are the benefits of intermittent fasting? I can speak anecdotally with friends who have done it. And some people like it and can tolerate it, and for others it's really challenging. I can't say that I've ever tried intermittent fasting.

 

With individuals who feel like, "I’m going to try this," cutting out gluten." And for them, that might not be medically necessary to do. But is that ultimately harmful to them? Maybe not. What works for one person may not work well for another.

 

Stacy Courtnay:

What about you, Raquel? Any special diet tips?

 

Raquel Masco:

You have to find what works for you, right? Because we all have a different system. For me, it was realizing sometimes when I had salads with arugula, avocado and romaine, it did something weird to me. I love all of those things. But together they were like, "We're going to give you problems, girl."

 

And so I had to stop eating them together. Not all together, but just separately. I'm allergic to apples and grapes. They cause issues. So, you know, talking with your physician for sure so you know what's right for you. And working with your health care team to be sure that you're doing things that are right. But yeah, if you feel bad after eating it, then cut it out.

 

If you feel your joints are swollen after eating it, then there's probably some issues. So, listen to your body. And to your gut. And what it's telling you, literally and figuratively.

 

Stacy Courtnay:

We all know the importance of having support, a support system, when you're on a weight-loss journey or exercise journey. I know things are much easier when my husband and I are both trying to eat healthy.

 

There's also a lot of apps, free apps, that can help keep you accountable for your habits. Michelle, you said you are a yoga instructor. Tell us a little bit about some other exercise that would be appropriate for somebody with arthritis and where to start. Because I know taking that first step is the hardest part if you're in pain.

 

Michelle McLeod:

My advice, as far as physical activity and fitness is, above and beyond, find something that you enjoy doing, that you will continue to do. Listening to Raquel speak about how sometimes even moving an inch was really challenging. And I certainly acknowledge that: taking that first step can be extremely challenging.

 

One of my friends who is a personal trainer posted this quote on social media the other day, and I loved it because I totally agree. And the quote was that, “Walking is to fitness as flossing is to dental hygiene. Super effective and totally ignored.”

 

It can be as simple as starting to incorporate walking into your life. And, if walking is challenging, start small.

 

The social support around dieting, it's the same thing. Find a buddy to work out with. Keeping it simple, starting small. It does not have to be high-intensity. Tai chi has been shown to be one of the most effective forms of exercise for arthritis, generally speaking.

 

Sticking with things that maybe don't require a lot of equipment or a lot of travel, something that's just very accessible.

 

Stacy Courtnay:

And I would say, I would add "low impact" to that as well.

 

Michelle McLeod:

Sure.

 

Stacy Courtnay:

What about you, Raquel? What do you do?

 

Raquel Masco:

I started taking this bootcamp type thing in the park and jumping jacks. Sick for days. I come from a long line of hard-headed women. And you do think, "Well, I feel better. My body will come along." And your body says, "Nope." Because we're good here in the low impact area. So, I do walk. And I'll take a walk sometimes here; I'll walk down the street, and I walk at a park.

 

And for me, along with the walking, is having the right shoe. I need the right support, because osteoarthritis also affects my lower back. You know, the hip, knee and my feet. So, having the right shoe, the right support, not overdoing it. And you need to be mindful.

 

I've started rowing is what got me back. It was the first step of exercise and movement. Low impact. You're just on the rower, and it works over 80% of your muscles. It's not jarring, and it helped my posture. It’s helped me walk upright, and now I do some healthy weight-bearing exercises and work out with a personal trainer. And we modify, we accommodate. Having an accountability partner who really cares about you, and is invested in you, is important. Having your family or people that you're eating with come along is so important. So walking, rowing and weight training, that works for me.

 

Stacy Courtnay:

And then if you are flaring, just still getting up and moving a little bit.  I needed to get out, get some fresh air. Do what I can do, and then let my body recover, and then now, I'm taking it easier at the gym.

 

Raquel Masco:

Absolutely. Chair yoga, you know?

 

Stacy Courtnay:

Yeah, absolutely.

 

Raquel Masco:

Just your stretches, YouTube. It’s what I need as a person with osteoarthritis. You know, that modified lower impact movement, that's still movement.

 

Stacy Courtnay:

A few years ago, I did some exercise videos or exercise clips for the Arthritis Foundation. We were doing some really low-impact stretches and exercise little clips. So, when you are flaring or you're just getting started, those are also out there as resources on the Foundation’s page.

 

PROMO:

The Arthritis Foundation couldn’t do awesome things without your support. Your donation fuels our powerful movement to advance arthritis research and resources, like this podcast and much more. Every dollar makes a difference. Give a gift now at https://www.arthritis.org/?form=FUNMPPXNHEF&element=xtyuunbv.

 

Stacy Courtney:

The next topic is weight loss drugs. So, the Wegovy, the Ozempic. Michelle, give us your expertise of what you think about this.

 

Michelle McLeod:

This is definitely getting a lot of attention. The World Congress on Osteoarthritis just had their meeting in April of this year. One of the big, new pieces of research that came out of that meeting was looking at the effectiveness of semaglutide, which is like your Wegovy, or your Ozempic, on the improvement of knee OA symptoms.

 

Preliminary data has shown that there is a really positive effect using those weight loss drugs. They are not FDA-approved for OA at this time. I think that potentially is going to be the goal with some of these drugs that are on the market. Primarily for the indication of obesity and Type 2 diabetes.

 

So, we'll see what happens. This whole conversation has centered around the topic of weight loss. Because right now, it's the best tool that we have. There are no disease-modifying drugs on the market for osteoarthritis. This might be the gateway into the development of drugs that can truly make a difference for individuals.

 

Stacy Courtnay:

Now Raquel, have you considered taking this before?

 

Raquel Masco:

I have not. It's enough that I have to get allergy shots. I'm not really one with sticking myself. Am I going to judge? As long as people who have diabetes have access to their medications, as long as people who are sick can be well, then I'll support you. But not for me. I know that I need to eat right and to get myself up and move.

 

Michelle McLeod:

That's an important consideration, you are right. Currently, the drugs are administered through an injection. And so, it's not going to be for everyone. They do often come with a lot of gastrointestinal side-effects that may not be pleasant.

 

Stacy Courtnay:

Right. Any other weight loss drugs or supplements that you recommend, Michelle?

 

Michelle McLeod:

Not specifically. The challenge with supplements is that there's so many on the market that are not FDA-approved. You don't really know what's in them.

 

If you're taking some powdered greens, and you feel good taking them, and you can tolerate them, and you've had that conversation with your physician that it's safe for you to take, that's great.

 

Stacy Courtnay:

Let's talk a little bit about the TOPS clinical trial. The Arthritis Foundation is a major funder of this. Michelle, can you elaborate a little bit about that, please?

 

Michelle McLeod:

Yeah, absolutely. The TOPS study is The Osteoarthritis Prevention Study.  And it’s a multi-center study being hosted at Wake Forest University in North Carolina, under the direction of Steve Messier. And he and his team out of Boston, Chapel Hill and Sydney, Australia, have developed this randomized clinical trial to establish the efficacy of weight loss as a means to prevent osteoarthritis.

 

We've talked about weight loss as a treatment for people who have already been diagnosed with OA. And that can help prevent their symptoms. But can it effectively prevent osteoarthritis?

 

The study will be enrolling females who are at least 50 years old, who have obesity. These women will commit to being a part of this study over a four-year period, and they'll be randomized into a couple of different groups.

 

One group will be in the diet and exercise group, and so their first year will be committed to losing 10% of their body weight. And then years two through four will be maintaining that body weight. And they'll have imaging done over that period. And they'll continue to be observed to see who goes on to develop osteoarthritis and who does not. And in the second group, they'll have quarterly group meetings. They'll receive text messages and newsletters from the study team as kind of a check-in, seeing how they're doing.

 

Unfortunately, currently because there are no disease-modifying drugs, by the time we identify people who receive their diagnosis of OA, it's often so far progressed that it's hard to treat them. Right? They don't have a lot of options. Dr. Messier's team is looking at the effectiveness of dietary weight loss exercise and weight loss maintenance on preventing OA.

 

Stacy Courtnay:

That's very fascinating. How many women are in the study?

 

Michelle McLeod:

I think the target is about 1,200 women over the course of the study.

 

Stacy Courtnay:

So, anyone in the U.S.?

 

Michelle McLeod:

The TOPS study is taking place in Boston, Massachusetts, Chapel Hill and Winston Salem, North Carolina, as well as Sydney, Australia.

 

Stacy Courtnay:

And if someone is interested in that, how would they enroll?

 

Michelle McLeod:

They could go to the Wake Forest University website on TOPS. And the website is hes.wfu.edu/tops.

 

Stacy Courtna:

OK, perfect. Is there anything else anybody wants to add before we move onto our social media comments?

 

Raquel Masco:

I need to make sure I add that when I was talking about doing research on foods that are anti-inflammatory, the number-one site was the Arthritis Foundation. The Foundation is a great resource, truly, for wanting to know what foods are anti-inflammatory and maybe inflammatory... and for exercises.

 

Stacy Courtnay:

OK, thank you.

 

PROMO:

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Stacy Courtnay:

I'm going to move on to some of our social media comments, when we asked people: “What are some things that you do to manage your weight?” And one person said, “Finding exercise and movement that I genuinely enjoy. Forcing yourself to do something you hate makes consistency difficult.”

 

Yes, I 100% agree with that. And this made me think about my two cousins, who are actually in their 60s, and they started an over-50 dance group called "Stayin' Alive." They're based here in Atlanta. But they will travel to festivals and fairs and basketball games, and they dance.

 

They are each others' accountability partners. So, they have practice four and five times a week. And in fact, they were on “Good Morning America” a couple weeks ago, just talking about how it is so important to be physically active. And to keep their weight in check. You definitely have to find something that you enjoy doing, or you're not going to keep it up.

 

Michelle McLeod:

Absolutely.

 

Stacy Courtnay:

Another comment: “Eating whole foods and not processed foods.” 100% agree with that. Raquel, I'm sure you agree with that as well?

 

Raquel Masco:

Yes.

 

Stacy Courtnay:

This quote made me laugh. "Brushing my teeth numerous times a day, because I don't like to eat when I have a fresh mouth."

 

Raquel Masco:

That's good.

 

Stacy Courtnay:

That is great, I love that. I'm going to put a star next to that one and remember that. Another comment was: "Meal planning and movement. Seated exercise and walking is a great cardio option, even if it is super slow, and your range is limited, just keep moving." I love that quote: "Walking is to fitness, as flossing is to dental health."

 

And our last comment is: “Limiting all sugars, measuring and weighing protein and carbohydrates to a serving. The amount we should be eating can be deceiving when portions are so large. And low- to no-impact functional weight training at least three times a week.” Agree with all of that as well. Because portion sizes are so huge. It is crazy how much food we are served at restaurants.

 

Michelle McLeod:

It's almost shocking what an actual portion looks like compared to what we're served at a lot of places. Yeah, I agree, that can be challenging.

 

Raquel Masco:

100%.

 

Stacy Courtnay:

We will wrap up and we can go around, and let's start with Raquel. What are your top three takeaways from our conversation today?

 

Raquel Masco:

I think how important community really is when you are living with arthritis. Just how uplifting and informative this podcast has been. How important it is to have people who get you and what you're going through. I liked that, you know, that walking is to health and fitness as flossing is to dental hygiene. Amazing. And do what's right for you, what works for you, managing your weight along with your arthritis diagnosis.

 

Stacy Courtnay:

Yes, I agree with all those. What about you, Michelle?

 

Michelle McLeod:

Yeah, I think my takeaways really echo what Raquel has already said. Keeping it simple and sticking with something that you will enjoy and will continue to do, and that you can maintain for a long period of time throughout life.

 

Being able to take a step back and give yourself some grace. And to also remember that two steps forward and one step back is still forward progress. So, even on those bad days, remember that the next day is a new opportunity.

 

Stacy Courtnay:

Yes, progress is not always linear. And I would say my top three, I'll go back to one of those social media comments: "Brushing my teeth numerous times a day, because I don't want to eat when I'm fresh mouth." I love that.

 

I love what Michelle said about walking is to fitness as flossing is to dental health. And then also just having a support system, accountability: husband, partner, app, friend,  group, whatever. This has been very, very helpful. I hope all of our listeners have learned a little bit from the three of us. And I appreciate the opportunity to host the podcast today. Thank you to Raquel and Michelle. Thank you so much.

 

Raquel Masco:

Thank you.

 

Michelle McLeod:

Likewise.

 

PODCAST CLOSE:

This podcast episode was brought to you in part by Amgen and Novo Nordisk.

The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation. Gifts from people like you make our podcast and other life-changing resources possible. You can donate at arthritis.org/donate. This podcast aims to help people living with arthritis and chronic pain live their best life. People like you. For a transcript and show notes, go to arthritis.org/podcast. Subscribe and rate us wherever you get your podcasts. And stay in touch!