Obesity substantially impacts rheumatic and musculoskeletal diseases: time to act

Obesity is a major health problem and risk factor for many chronic health conditions, including rheumatic and musculoskeletal diseases (RMDs). Around 7 in 10 adults with RMD live overweight or with obesity. Obesity not only increases the risk of developing RMDs. It worsens disease activity, pain, and fatigue; impairs treatment responses; and thereby reduces quality of life and physical function. Further, obesity can amplify or drive several comorbidities that are more prevalent in RMDs including hypertension, cardiovascular disease, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease. Moreover, reciprocal risk arises since RMDs make it harder to be physically active and maintain a healthy weight, especially in the context of an obesogenic environment. In this viewpoint, we review relevant evidence to suggest obesity confers distinctive, important challenges in care and daily living for many patients with RMDs. With the advent of several highly effective drugs for obesity, we also highlight research needs including that for robust clinical trials to test the efficacy and effectiveness of these therapies as part of the management of inflammatory RMDs, as primary agent or adjuvant to immune targeted therapeutics. Implementing such weight management strategies should provide a much-needed holistic approach to the care of our patients.