It’s curious and not altogether reassuring to discover in your retirement that some of the things you told your patients for 40 years were wrong.
I would tell any fat person suffering from osteoarthritis of the hip that he or she should lose weight. I won’t go into the question of whether saying this ever had any practical effect on anyone: I rather doubt it.
But it turns out that even if the advice had been followed, it wasn’t very good, at least with regard to pain in the hip.
A study of 2,752 patients with radiologically proved osteoarthritis, of either the hip or the knee, showed that those who lost five per cent or more of their weight suffered just as much pain from their hips as those who didn’t.
Some of my honour was spared by the fact that those with osteoarthritis of the knee suffered much less pain if they lost weight. In fact, it often disappeared entirely. Not all my advice was wrong.
On the matter of losing weight, Wallis Simpson was quite wrong when she said that you could never be too thin. As for being too rich, I have no experience.
A study of weight loss in healthy people over the age of 70, with an average weight of 75kg, showed that weight loss in the elderly was not a good sign. This is not exactly news: it used to be drummed into medical students that weight loss was a sinister sign and should always be enquired into. But it seems that, with the fattening of the population, which has brought with it an
ever greater and more forlorn desire for slimness, the lesson has been forgotten.
More than 16,500 healthy people over 70 – ‘healthy’ meaning with no known disease likely to cause death – were followed up for an average of four years and five months. Men who lost five per cent of their weight in the interval had a third higher chance of dying, and women a quarter higher chance. Men who lost ten per cent of their weight were nearly three times as likely to die as those whose weight held steady, while women were more than twice as likely to die.
Relative risks must always be treated with caution because a high relative risk is perfectly compatible with a low or trivial absolute risk.
But, in this instance, it is not so: the risk of dying after the age of 75 is not trivial, and a two- or three-times-greater risk is not to be disregarded. Of each 100 men of those who lost ten per cent or more of their weight, 30 died within four years and five months.
So far, so clear: but, as usual, the message is slightly less clear than it appears at first sight to be. There is no distinction in the figures between those who lost weight deliberately and those who lost weight involuntarily. However, since few people manage to lose ten per cent of their weight deliberately unless they have a very pressing need to do so, which these people did not have, this is probably not very important.
There might also have been sub- groups within the population in whom weight loss might have been a good thing, in some sense or other.
The paper does not, unfortunately, tell us whether the huge effort necessary to lose weight, if crowned with success, prolongs life or shortens it – or merely makes it seem longer.
The paper had one interesting locution new to me: mortality event. So much more accurate, don’t you think, than that loosest of terms, death?