Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial

Objective: We wanted to assess the effect of rapid diet-induced weight loss on the function of obese, knee osteoarthritis (OA) patients. Methods: Eighty patients with knee OA, 89% women (n = 71), were recruited. Mean (SD) body-mass index (BMI) was 35.9 (5.1) kg/m(2) and age 62.6 (11.1) years. Patients were randomized to either a low-energy diet (LED 3.4 MJ/day), or a control diet (5 MJ/day). The LED group had weekly dietary sessions, whereas the control group was given a booklet describing weight loss practices. Changes in body weight and body composition were examined as independent predictors of changes in knee OA symptoms. Symptoms were monitored by the Western Ontario and McMaster Universities' (WOMAC) OA index. Results: The LED and control group lost a mean (SE) of 11.1 (0.6)% and 4.3 (0.6)%, respectively, with a mean difference being 6.8% (95% confidence interval (CI): 5.5 to 8.1 %; P < 0.0001). The decrease in body fat percent was higher in the LED group, 2.2% (1.5 to 3.0%; P < 0.0001). The total WOMAC index improved in the LED group (P < 0.0001), but not in the control group (P = 0.12), mean difference: -219.3 mm (-369.2 to -69.4 mm; P = 0.005). The 'Number Needed to Treat (NNT)' to ensure an improvement in WOMAC greater than or equal to 50% was 3.4 (2.1 to 8.8) patients. Changes in total WOMAC index were best predicted by the reduction of body fat percent, with a 9.4% (4.8 to 13.9%) improvement in WOMAC for each percent of body fat reduced (P = 0.0005). Conclusions: In our patients with knee OA, a weight reduction of 10% improved function by 28%. LED might be of advantage to control diet because of the rapidity of weight loss and a more significant loss of body fat. (C) 2004 Published by Elsevier Ltd on behalf of OsteoArthritis Research Society International.