Imagine being one of the millions of Americans who needs a hip or knee replacement because of osteoarthritis, but being told you must lose weight first.

As one patient told the New York Times, “[My doctor] told me to come back when I had lost 30 pounds.”

Fewer than half of orthopedic surgeons will operate on patients with a body mass index above 40. Patients with type 2 diabetes, cardiovascular disease and high blood pressure face similar barriers to the surgeries they need.

These conditions share a common underlying cause: chronic systemic inflammation. Ironically, the condition that can push someone to the point of needing a joint replacement can also be the reason a doctor refuses to perform it.

Recent medications such as GLP-1 drugs like Wegovy and Zepbound can jumpstart a patient’s weight loss. But without lasting changes in daily behavior, patients may need to stay on these medications indefinitely. Lifestyle medicine helps patients make sustainable, consistent changes that target inflammation at its source.

This discipline focuses on six pillars of health that have been shown to reduce chronic systemic inflammation:

1. Nutrition that supports a healthy balance of gut bacteria

2. Regular physical activity

3. Restorative sleep

4. Effective stress management

5. Strong social connections

6. Avoiding and reducing the use of
 risky substances

Improving one pillar can have a positive impact on the others. When nutrition improves, for example, sleep often improves too. Reducing inflammation caused by poor sleep may be the turning point that helps some patients begin to lose weight.

New data show this model of care can work for patients who want to improve their health before surgery. One recent study at New York’s Hospital for Special Surgery followed 54 patients with metabolic conditions, including obesity, who were seeking elective orthopedic surgery. Thirteen of them were initially unable to schedule surgery because of those conditions. By the end of the lifestyle medicine program, 85% had improved their health enough to qualify for surgery.

Achieving results like these takes more than managing medications. To be successful, programs must be personalized around goals patients set for themselves. A patient may want to lose weight, sleep better and reduce pain. Clinicians can then build a plan that targets those specific goals in daily, practical ways.

Today, more than 200 lifestyle medicine programs operate across the country. Yet only two are designed to prepare patients for orthopedic surgery by treating both metabolic and musculoskeletal conditions. That needs to change.

The medical community must embrace lifestyle medicine as a core element of treating osteoarthritis and related conditions. Patients deserve care that does more than manage symptoms. They deserve support to transform the habits that drive disease in the first place. ν

Heidi Prather, DO, is an attending physiatrist and medical director of the Lifestyle Medicine Program at Hospital for Special Surgery. This piece originally appeared in “Salon.”