Objective To evaluate 1-year symptomatic improvement in obese patients with knee osteoarthritis (OA) on an intensive low-energy diet (LED) maintained by frequent consultations with a dietician compared to minimal attention.
Methods The LED programme consisted of group therapy with dietary consultations and two periods of a low-calorie diet of 810 kcal/day during weeks 0–8 and weeks 32–36. The control group only received dietary instruction and attention for 2 h at baseline, and at weeks 8, 32, 36 and 52. The primary end point (total Western Ontario and McMaster Universities (WOMAC) index) was assessed as the mean group difference during and after 1 year.
Results The study population consisted of 89 patients, 89% women, average age 63 years. After 1 year, mean weight loss in the LED group was −10.9 kg (11%) versus −3.6 kg (4%) in the control group (p<0.0001). There was no difference between the groups in total WOMAC index (p=0.11), although both groups improved. However, the LED intervention resulted in less WOMAC pain (7.7 mm), with a group mean difference of 7.2 mm (95% CI 1.0 to 13.4, p=0.022). After one year 14 (32.8%) responded to LED versus 7 (15.6%) to control, with an absolute benefit of 16.3% (−1.1& to 33.6%, p=0.066).
Conclusion Continuous reinforcement of a weight loss programme can be successful over a year in obese knee OA patients. Weight loss was statistically reflected only by a reduction in pain. However, the overall clinical benefits of the intervention on health should lead to a strong recommendation of weight loss in this group of patients.
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Funding This study was supported by grants from The Oak Foundation, Frederiksberg Hospital, Copenhagen Hospital, The Danish Rheumatism Association, Hørslev Fonden and Bjarne Jensen Fond. The dietary products and the dietician were supported by Dansk Droge A/S; none of the authors have received grants or personal fees from this company.
Competing interests AR Leeds is employed as medical director by the Cambridge Manufacturing Company (Cambridge Diet). Henning Bliddal, Arne Astrup and Robin Christensen have received travel grants from the Cambridge Manufacturing Company to attend scientific meetings.
Ethics approval This study was conducted with the approval of the local ethics committee of The Capital Region of Denmark.
Provenance and peer review Not commissioned; externally peer reviewed.