The more weight loss the better in overweight patients with knee OA
medwireNews: Overweight and obese older adults with knee osteoarthritis (OA) experience clinical and mechanistic benefits in line with their degree of weight loss, suggests a secondary analysis of the IDEA randomized controlled trial.
Among 240 participants aged an average of 65.8 years and with a baseline body mass index of 33.4 kg/m2, those who lost at least 20% of their bodyweight over 18 months showed better clinical and mechanistic outcomes on all measures, including pain, function, 6-minute walk distance, health-related quality of life, knee joint compressive force, and interleukin-6 levels (the primary inflammatory outcome), compared with those in the lowest groups for weight loss (<5.0% and 5.0–9.9% of bodyweight).
Moreover, patients with the greatest weight loss (≥20%) had 25% less pain, better function and significantly better physical health-related quality of life compared with those who lost 10.0–19.9% of their bodyweight.
These findings, write Stephen Messier (Wake Forest University, Winston-Salem, North Carolina, USA) and colleagues in Arthritis Care & Research, indicate that the”[ s]tandard of care for older, overweight and obese adults with knee OA should include, at minimum, a 10% weight loss using the techniques developed in previous successful weight loss trials such as IDEA and Osteoarthritis Healthy Weight for Life,” in accordance with recommendations from the National Institutes of Health.
And they comment: “An additional 10% weight loss has the added benefit of significantly improved physical health related quality of life, and a clinically important reduction in pain and improvement in function.”
In the IDEA trial, ambulatory but sedentary, community-dwelling individuals with knee OA were randomly assigned to attempt weight loss through interventions involving diet and exercise, diet alone or exercise alone. The current study performed a dose–response analysis of the first two of these groups. At the 18-month follow-up, 74, 59, 76, and 31 participants had lost less than 5%, 5–10%, 10–20%, and at least 20% of their bodyweight, respectively.
The researchers acknowledge that “[a]chieving significant weight loss without regain is difficult.” Therefore, they say, “to justify the effort needed by patients to achieve a more substantial intentional weight loss than what is proven effective in randomized clinical trials,” the benefits should be substantial.
They add that the current results indicate such positive outcomes and raise “an intriguing possibility that warrants further study.”
By Catherine Booth
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