Obesity, knee osteoarthritis, and polypathology: factors favoring weight loss in older people

Pilar Isla Pera,1 Ma Carmen Olivé Ferrér,1 Montserrat Nuñez Juarez,2 Esther Nuñez Juarez,3 Loreto Maciá Soler,4 Carmen López Matheu,1 Assumpta Rigol Cuadra,1 María Honrubia Pérez,1 Diana Marre5 1School of Nursing, University of Barcelona, 2Department of Rheumatology, Musculoskeletal Clínic Institute Hospital Clínic, 3Institut Català de la Salut, Barcelona, 4Nursing Department, University of Alicante, Alicante, 5Universitat Autònoma de Barcelona, Barcelona, Spain Aim: We aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss.Background: Various studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective.Design: A phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman.Findings: Participants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as “obese” and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories.Conclusion: Dietary self-management without prohibitions helped participants to make chang