Do I really want to be going on a bloody diet? Gendered narratives in older men with painful knee osteoarthritis.

PURPOSE: Small reductions in body weight can decrease osteoarthritic knee pain. Intuitively this should provide a strong incentive for weight-loss. However many people undergoing knee joint replacement (KJR) are categorised as obese. Gender theories can help us to understand differential responses to illness and therefore make an important contribution to rehabilitation. We aimed to explore barriers to weight loss in a group of older men with osteoarthritis.

MATERIALS AND METHODS: We conducted 12 in-depth interviews, before and 1 year after surgery, with six obese men listed for KJR. Analysis was influenced by constructivist grounded theory. We abstracted conceptual themes from the data through constant comparison.

RESULTS: We identified the following themes: (1) I am big and healthy and don't need to lose weight; (2) being this size isn't good for me; (3) men don't have to worry about that sort of thing; (4) I am not as active as I used to be; (5) I have worked hard all my life; (6) what is the point in trying anyway?

CONCLUSIONS: Gendered narratives can make it challenging for men to lose weight. Healthcare professionals cannot ignore the influence of gender on rehabilitation and should consider gender specific strategies. Implications for rehabilitation Men may not associate being overweight with being unhealthy. Men may take pride in being in good shape and may respond better to weight loss strategies that focus on fitness not body size. Men may link weight gain with decrease in activity levels rather than overeating. Health care professionals should challenge the assumption that weight loss will follow surgery. Health care professionals cannot ignore the influence of gender on the success of rehabilitation.