Obesity, knee osteoarthritis, and polypathology: factors favoring weight loss in older people.
OBJECTIVE
We aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss.


BACKGROUND
Various studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective.


METHODS
A phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman.


RESULTS
Participants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as "obese" and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories.


CONCLUSIONS
Dietary self-management without prohibitions helped participants to make changes in the quantity and timing of some food intake and to lose weight without sacrificing some foods that were deeply rooted in their culture and preferences. Dietary education programs should focus on health-related quality of life and include scientific knowledge but should also consider affective factors and the problems perceived as priorities by patients.
School of Nursing, University of Barcelona, Barcelona, Spain.
Pilar
P
Isla Pera
School of Nursing, University of Barcelona, Barcelona, Spain.
M Carmen Olivé
MC
Ferrér
Department of Rheumatology, Musculoskeletal Clínic Institute Hospital Clínic, Barcelona, Spain.
Montserrat
M
Nuñez Juarez
Institut Català de la Salut, Barcelona, Spain.
Esther
E
Nuñez Juarez
Nursing Department, University of Alicante, Alicante, Spain.
Loreto
L
Maciá Soler
School of Nursing, University of Barcelona, Barcelona, Spain.
Carmen
C
López Matheu
School of Nursing, University of Barcelona, Barcelona, Spain.
Assumpta
A
Rigol Cuadra
School of Nursing, University of Barcelona, Barcelona, Spain.
María Honrubia
MH
Pérez
Universitat Autònoma de Barcelona, Barcelona, Spain.
Diana
D
Marre
diet; elderly; knee osteoarthritis; nursing; obesity; polypathology; therapeutic education