Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis

Abstract

This review aims to assess by meta-analysis of randomised controlled trials (RCTs) changes in pain and function when overweight patients with knee osteoarthritis (OA) achieve a weight loss. Systematic searches were performed and reference lists from the retrieved trials were searched. RCTs were enclosed in the systematic review if they explicitly stated diagnosis of knee OA and reported a weight change as the only difference in intervention from the control group. Outcome Measures for Arthritis Clinical Trials III outcome variables were considered for analysis. Effect size (ES) was calculated using RevMan, and meta-regression analyses were performed using weighted estimates from the random effects analyses. Among 35 potential trials identified, four RCTs including five intervention/ control groups met our inclusion criteria and provided data from 454 patients. Pooled ES for pain and physical disability were 0.20 (95% CI 0 to 0.39) and 0.23 (0.04 to 0.42) at a weight reduction of 6.1 kg (4.7 to 7.6 kg). Meta-regression analysis showed that disability could be significantly improved when weight was reduced over 5.1%, or at the rate of .0.24% reduction per week. Clinical efficacy on pain reduction was present, although not predictable after weight loss. Metaregression analysis indicated that physical disability of patients with knee OA and overweight diminished after a moderate weight reduction regime. The analysis supported that a weight loss of .5% should be achieved within a 20-week period-that is, 0.25% per week. Being overweight is an important factor in osteoarthritis (OA), and obese subjects are at high risk of developing OA in the knee.1 The average body weight of the increasing number of elderly people has steadily risen in recent years. 2The obesity problem appears across multiple age groups, 3 and there is reason to believe that the obesity-related knee OA will increase in both numbers and severity.4 5 Obesity must be taken seriously in any discussion concerning health issues, 6 including that of the bone and joints.7 Current European evidence-based recommendations for the management of knee OA, devised by the European League Against Rheumatism, include weight loss as a sensible option in overweight patients with knee OA. However, this recommendation is primarily supported by expert opinion 8 ; meta-analysis of randomised controlled trials (RCTs; ie, category 1a evidence) is yet to be undertaken.The objective of this systematic review and meta-analysis was to assess and quantify whether the clinical benefits (changes in pain and functional disability) 9 are evident in patients with knee OA after weight loss. Applying the rules of evidence-based medicine, 10 11 with focus on quality (ie, magnitude and intensity) of the intervention, 12 we aimed to meta-analyse 13 and present doseresponse efficacy estimates of weight loss in obese patients with knee OA. METHODSRetrieval of published studies A systematic literature search was carried out to identify and locate all controlled and preferably randomised trial...

Role of Weight Reduction Versus Physical Therapy in Management of Obese Patients With Knee Osteoarthritis.

“…Results of the present study were in agreement with meta analysis made by Christensen et al, (15) which indicated that physical disability of patients with knee OA and overweight diminished after a moderate weight reduction regimen. The analysis supported that a weight loss of >5% should be achieved within 20 weeks period.…”

“…Results of the present study agreed also with the results of Christensen et al, (15). They also used Lequesne index to assess knee function while walking speed and VAS was used to assess knee pain.…”

Prevention of Incident Knee Osteoarthritis by Moderate Weight Loss in Overweight and Obese Females

“…In a systematic review on the effects of weight loss on knee OA patients, a weight loss of at least 5% of body weight was indicated for symptomatic relief (22). Losing 5 kg or 5% of body weight has also been indicated as the minimum weight loss necessary for a positive and clinically relevant effect on cardiovascular risk profile, including significant reduction of blood pressure and improved glucose tolerance (23).…”

Meta-analysis: Acupuncture for Osteoarthritis of the Knee

“…However, 2 effective nonpharmacologic treatments are exercise (14) and weight loss (15). Some patients with osteoarthritis, however, may have difficulty exercising or losing weight.…”