Beyond Ozempic: Igniting a Lifestyle Revolution in American Healthcare

Consider being one of the many Americans requiring a hip or knee replacement due to osteoarthritis. Intense discomfort, diminished physical activity, and an inability to execute numerous everyday tasks — the indications can be genuinely crippling.

However, if you are classified as obese or overweight, there’s a high probability that your orthopedic surgeon will deny you treatment. As one patient recounted to the New York Times regarding her physician, “He advised me to return after losing 30 pounds.”

She is not alone in this experience. A survey indicates that fewer than half of orthopedic surgeons are willing to operate on patients with a body mass index over 40. Individuals with type 2 diabetes, cardiovascular issues, and hypertension encounter similar obstacles when seeking necessary surgeries.

All these conditions share a common root issue: persistent systemic inflammation. Ironically, the very inflammation-driven “metabolic” state that can lead someone to require a joint replacement is often the reason their physician refuses to conduct that surgery.

Fortunately, some physicians are striving to alter this conventional approach by employing a method known as “lifestyle medicine.” This specialty focuses on evidence-based interventions regarding patients’ behavioral choices to prevent, manage, and even reverse diseases associated with chronic systemic inflammation.

While recent pharmaceuticals, like GLP-1 medications such as Ozempic, Wegovy, and Zepbound, can serve as vital instruments in managing metabolic disorders, they do not represent an all-encompassing solution. These medications can initiate a patient’s weight loss journey, but without lasting behavioral modifications, patients will have to remain on the drugs indefinitely to sustain their weight loss. Moreover, these medications do not address other contributors to chronic inflammation, such as inadequate sleep and lack of physical activity. Lifestyle medicine, conversely, can assist patients in making continuous and effective behavioral modifications to combat inflammation.

This discipline incorporates six foundational elements of health that have proven effective in diminishing systemic chronic inflammation: a diet that balances the beneficial and harmful bacteria in the gut, physical exercise, sleep, stress control, enhancing social ties, and minimizing the use of harmful substances.

Enhancing one health pillar can positively influence others. For instance, an improvement in nutrition can lead to better sleep. Alleviating inflammation due to insufficient sleep may act as a catalyst for some patients to begin experiencing weight loss.

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Contrary to what television promotions might assert, there is no singular “magic” pill or injection for good health. Additionally, tackling weight loss or diabetes alone will not resolve a patient’s complete issue. Addressing systemic inflammation remains the most efficient, scientifically validated approach available to enhance health in a comprehensive manner.

Lifestyle medicine offers the evidence and framework necessary for this form of care. The hospital where I am employed has developed a standardized program specifically focused on treating metabolic conditions in relation to painful musculoskeletal issues.

Recent data suggests that this care model can be effective for patients aiming to optimize their health before surgery. A recent study conducted at New York’s Hospital for Special Surgery, which I co-authored, examined 54 patients with metabolic conditions, including obesity, who were seeking elective orthopedic surgery. Among them, 13 initially could not schedule surgery because of their metabolic issues, including obesity. By the conclusion of the program, 85% had improved their health sufficiently to qualify for surgery.

Achieving such results requires more than the management of medication. For optimal success, programs must be tailored to meet the specific objectives that patients set for themselves. For example, a patient may wish to lose weight, enhance their sleep quality, and alleviate pain. Clinicians can then create plans aimed at achieving those distinct goals.

A significant motivating factor is encouraging patients to look beyond their present discomfort and envision the lives they will lead following their success. One of my patients dreamed of traveling to Italy with her grandchildren. Another had a desire to see Paul McCartney perform live. These ambitions made adhering to our lifestyle medicine plan much more achievable.

Currently, there are more than two hundred lifestyle medicine programs active across the nation. Yet, only two focus on preparing patients for orthopedic surgery by addressing metabolic and musculoskeletal issues. This situation must be rectified. The entire medical community should adopt lifestyle medicine as an essential aspect of treating osteoarthritis. Patients warrant no less.