Hootman says rates of obesity higher than 30 percent for people with arthritis raise a major concern, and noted that the states that have lower percentages tended to have more of a year-round outdoor activities culture.

“The good news is that we know increasing physical activity is safe for people with arthritis and it can help them lose weight,” says Hootman, who noted the CDC recommends six programs for people with arthritis. The Arthritis Foundation runs three of the programs.

Chicken or Egg?

The BRFSS collects self-reported information that can reveal correlations, but it is not designed to identify causal relationships – such as whether obesity is leading to arthritis or the other way around. It is a topic currently being explored by the scientific community.

“We do know from other studies that obesity increases the risk for particularly osteoarthritis,” Hootman says. But she also acknowledges the role arthritis can play in developing obesity. “Obesity and pain make a big circle, one of those cycles that’s hard to break. It’s harder to move, so you don’t expend calories,” says Hootman.

Stephen Messier, PhD, professor and director of the J.B Snow Biomechanics Laboratory at Wake Forest University in Winston-Salem, N.C., feels more certain that the increased rates of obesity are driving the increased rates of arthritis. “Obesity is the most modifiable risk factor for arthritis,” he says.

This can occur in two ways, Messier explains. One is the added pressure on the knee from weight. The other is inflammation caused from excess fat, as inflammation can degrade knee cartilage. “The good news to that is every pound that you lose, you lose up to 4 pounds of stress off your knee,” he says.

Rising obesity rates among younger adults can mean earlier onset of osteoarthritis, or OA, Messier says. As a result, he foresees an increase in the number of people needing knee replacements earlier in life, and possibly multiple joint replacements during their lifetimes and the increased risks of complications they can come with.

While patients are ultimately responsible for taking control of their diet and exercise – and, by extension, their joints – Messier would like to see the health system offer more support in these areas. “The ideal would be if after seeing a physician who advised you to lose weight, you would then work with the physician’s assistant who has a list of places in town with programs to help,” he says. “In order for this to work on a large scale there’s got to be some sense of connection with the patient over a long period of time, you can’t just tell the patient to lose weight and then don’t give them any direction after that.”