Obesity causes many joint problems and gout is one which has strong association with obesity. It has been found that prevalence of gout in obese people is very much higher than in persons having normal weight. American health statistics say that prevalence of gout is 1% ( 1 in 100 Americans sufferers from crystal arthropathy or gout) in general population but this is much higher in obese population. In obese population prevalence of gout increases to 6% in men and 2% in women which means one in sixteen obese people suffers from gout.
Gout is a disabling disease of joints in which uric acid levels increase in the blood. When uric acid levels reach to much higher value, it forms crystals which settle in different body tissues including joints. These crystals cause severe inflammation of joint tissue and result in gouty attack. The most commonly involved joint is big toe joint (first metatarso-phalyngeal joint) but ankle, knee, shoulder and other joints may be involved. Most commonly gouty attack occurs suddenly and joint swelling and pain settles over hours to days but in some case joint pain may persist for several weeks.
Obesity is a declared risk factor for gout. Research shows that excessive weight increases the risk of gout in two ways:
- People having excessive weight or obesity, suffer gouty attacks at earlier age than population with normal weight. On average obese people experience gouty attacks 3 years earlier than people with normal weight.
- Severity of obesity is directly related to severity of gout. It means that people with more severe obesity experience more frequent and severe attacks of gout.
How Obesity Contributes to Gouty Attacks?
The main factor behind increased risk of gout in obese people is insulin resistance. Obese people have metabolic syndrome and insulin resistance which increases uric acid levels in the body by causing overproduction of uric acid and reducing excretion of uric acid by the kidneys. Both, overproduction and under excretion builds uric acid levels in blood to higher values. At higher levels, chances of precipitation of uric acid in the form of crystals increase. This results in hyperuricemia and crystallization of uric acid in joints. Uric acid accumulated in joints set severe inflammatory reaction which causes excruciating pain and swelling of joints. Repeated attacks of gout can destroy the joint to an extent that patient may not be able to walk comfortably.
Higher uric acid levels not only cause gout but also damage blood vessels and increase the risk of heart attack and stroke. People with hyperuricemia suffer these conditions more often than the people having normal weight.
Effects of Weight Loss on Gout
Losing weight is an extra-ordinarily beneficial measure in getting rid of gouty attacks. Advice regarding weight loss is a part of prescription for patients who are obese and have gout. Research has shown that coming to normal weight reduces chances of future attacks of gout to less than half and many patients get complete cure of this painful condition.
Weight loss is not an easy way in people who are morbidly obese. People who have BMI more than 40 less often respond to conventional weight loss measures like dieting and exercise. For those who have severe obesity the only effective way of coming to normal weight is bariatric surgery. Bariatric or weight loss surgery has a number of procedures which reduce weight in matter of weeks. The only thing that should be kept in mind is that for this important surgery only dedicated bariatric surgery hospital should be selected to get maximum benefits of surgery with safety.
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