Patient Perspectives and Experiences Regarding Pre-surgery Weight Loss Requirements For the Morbidly Obese Seeking Hip and Knee Replacement

Abstract

Abstract Objective Achieving recommended pre-surgery weight loss prior to elective hip and knee replacement is challenging for many morbidly obese patients despite available weight loss programs and education. This study aimed to identify 1) barriers and facilitators to weight loss, and 2) patient perceptions of helpful interventions. Willingness to participate in future clinical trials not requiring weight loss was also discussed. Methods 18 patients with morbid obesity (BMI > 40 kg/m2) with advanced hip and/or knee arthritis seeking arthroplasty care were recruited for one of three virtual semi-structured focus groups. Nine patients at different weight loss stages attended the focus groups. Transcripts were analyzed using inductive thematic analysis to identify barriers and facilitators to weight loss and helpful interventions. Results Patients reported physical, social, and environmental factors impacting their ability to remain motivated and disciplined to obtain their weight loss goals. Barriers and facilitators to pre-surgery weight loss included: 1) desperation; 2) food culture; 3) weight loss as a “lonely journey” requiring social and clinical support; and 4) uncontrollable factors of everyday life. Ideal weight loss interventions were described as sustainable, simple, and including clinical and peer support. There was low interest in a clinical trial that does not require weight loss prior to arthroplasty. Conclusion Approaches to weight loss for morbidly obese patients with hip and knee osteoarthritis may be most effective if they provide explicit, simple directions for dieting that minimize required meal-prep time, coupled with periodic clinician follow-ups and the opportunity for peer support for those that desire it.