FItness and Wellness involves both diet and excercise. First some information on diet, because no one can exercise away a bad diet, and obesity has become a major problem in the US over the last 20 years, and has major implications for orthopaedic problems and treatment. It is essential to know some basic terminology. Food intake is a combination of protein, carbohydrates, and fats.

Protein is any of a class of nitrogenous organic compounds that have large molecules composed of one or more long chains of amino acids and are an essential part of all living organisms, especially as structural components of body tissues such as muscle, hair, etc., and as enzymes and antibodies. Carbohydrates consist of or containing a lot of sugars, starch, cellulose, or similar substances that can be broken down to release energy in the human body, and make up one of the main nutritional food groups. Fats are nutrients in food that the body uses to build cell membranes, nerve tissue (including the brain), and hormones. The body also uses fat as fuel. The amount of energy in each of these nutrients is as follows:

Protein 4 kcal/gram

Carbohydrates 4 kcal/gram

Fat 9 kcal/gram

Alcohol 7kcal/gram

A good general reference for diet can be found here: https://www.nal.usda.gov/programs/fnic

BMI(Body mass index) is a ratio of mass to surface area. Most biological processes take place on membranes(2 dimensional) and mass is 3D, so it is possible to add enough mass to out-strip the bodies metabolic ability to handle the excess demand of mass. It is measured in kilograms body weight over height in meters squared, so you need a chart or converter to obtain your BMI. https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.

BMI categories for adults

• Underweight. Less than 18.5.
• Healthy Weight. 18.5 to less than 25.
• Overweight. 25 to less than 30.
• Obesity. 30 or greater.
• Class 1 Obesity. 30 to less than 35.
• Class 2 Obesity. 35 to less than 40.
• Class 3 Obesity. (Severe Obesity) 40 or greater.

We recommend obtaining a body composition scale such as withings, https://www.withings.com/us/en/scales. It is helpful to track your weight and composition on a daily basis and this will connect to your home Wifi network and cell phone apps to keep you informed of changes and trends over time.

Use of the GPL-1 agonist drugs (Ozempic, Wegovy, etc.) is revolutionizing the treatment of obesity, and we refer many patients to the bariatric weight loss center at Princeton Medical Center.

We also recommend myfitnesspal to record diet and excercise. https://www.myfitnesspal.com/ It has a database of thousands of foods to log intake and plan menus.

I summarized a major study of orthopaedics and obesity:

Obesity Treatment in Orthopaedic Surgery

            Weight loss is a critical aspect for patients with obesity who are undergoing orthopaedic procedures.  Weight loss can improve obesity-related issues such as diabetes, cardiovascular disease, and obstructive sleep apnea which may reduce surgery complications, minimize long-term joint stress, and improve the surgical outcome.

Nutrition:  Diets rich in vegetables, fruits, lean proteins, and whole grains will help with weight loss.  When looking at your plate, half of the plate should be composed of nonstarchy vegetables.  The remainder of the plate should be split equally to contain a lean protein source and a whole grain food item.

Caloric Reduction:  A well-balanced, calorie-restricted diet is best for weight loss.  A calorie reduction of 500 to 1,000 calories from your typical daily intake can make a difference and still allow you to meet your daily energy requirements.  Ideally, you should aim for a total daily caloric allowance of 1,200 to 1,800 calories.

Exercise:  Consistent exercise is a great addition to a restricted calorie diet for weight loss and overall health.  Aquatic exercise programs, aerobics, and resistance training are all helpful.

Bariatric Surgery:  Bariatric surgery is a safe and effective method for weight loss and may be an option for patients with obesity who qualify because of the severity of their disease.

Lifestyle:  Lifestyle modifications along with community support are effective, especially for inspiration and accountability.

Postoperative Weight Management:  The following habits have helped promote weight maintenance:  eating breakfast daily, weighing in at least weekly, watching television less than 10 hours per week, and exercising an average of one hour daily.  The addition of medication to lifestyle behaviors may improve weight maintenance.  It is possible to lose weight after joint replacement surgery, but studies have shown that many patients do not lose weight afterward.  You should develop appropriate expectations and strategies for weight loss before and after surgery.

Endocrine:  Type 2 diabetes, thyroid disease, polycystic ovarian disease, fatty liver disease, and low testosterone in men are endocrine abnormalities associated with obesity.  While these should be noted and optimized, treatment remains best directed toward obesity itself.

Conclusion:  Obesity is a complex and multifaceted disease, and these patients are at increased risk of surgical complications including blood clots, infection, and joint dislocation.  Patients should strive for a BMI of 40 or less prior to undergoing joint replacement surgery.

Some tips from the Bariatric Service:

General Guidelines:

Diet should be a high protein, high fiber, low carb diet using the following guidelines:

• Protein 60-80gms/day
• Fiber minimum of 25-35 gms/day
• Carbs 50-100 gms/day (typically the lower on the range the better the weight loss however that may be difficult to sustain)

                                (This is for total carbs if you look at net carbs this takes into account the fibers so you subtract the amount of fiber from the total carbs)

Eat on a Schedule every 3-4 hrs

Track your food intake in a paper journal or using an app on your phone : “Lose It”, “My Fitness Pal”

Exercise a minimum of 30 mins a day 3xs a week

You can do meal replacements such as high protein shakes or bars use the following guidelines’
• Shake should be 15 g of Protein or Higher & under 200 calories (I recommend Premier Protein you can find this at Walmart, Shoprite and in bulk at Sam’s Club and Costco- try the smaller quantities first to find which you like then go for the bulk)
• Protein bars the higher the protein typically the better- and the carbs should be under 10-15 gms but the lower the better (I recommend Quest bars- the cereal bar version tastes the best you can find these on line and sometimes in Walmart and Shoprite)
• Also Quest makes protein chips that are 21 g of protein, 130 calories and 4g carbs and 2g fiber- the BBQ ones are awesome! They actually have a newer Tortilla version that is even better! It gives you the crunch you want but fills you up with Protein so you don’t crave like with regular chips (You can find these at Walmart, Vitamin Shop and online).