Weight loss for osteoarthritis (OA)

Introduction

High blood pressure, type 2 diabetes, high cholesterol, heart disease and stroke are related to our lifestyle and environment, not just our genetic make-up.(1) The same can be said for osteoarthritis. Indeed, achieving a healthy weight with diet and exercise is a mainstay of treatment for ‘worn-out’ joints.(2, 3) We tend to search for ‘quick fixes’ when it comes to aching joints and expanding waistlines, but it is important to try achievable lifestyle changes before we resort to medical and surgical interventions. Read on to learn more about osteoarthritis, its relationship to obesity, and how to manage both with weight loss.

What is osteoarthritis (OA)?

OA is a common cause of pain and altered joint function in adults.(4) The knee is the most common joint affected.(5) OA was previously considered to be the result of ‘wear and tear’, but current research suggests that underlying inflammation affects all components of the joint, including joint surface cartilage, nearby bone, the joint capsule and surrounding soft tissues.(6) Damage to the joint organ manifests as worsening pain, tenderness, reduced range of motion, bony swelling, joint deformity and instability.(7) Fortunately, weight loss can improve joint pain and function by reducing the load on weight-bearing joints and reducing the background level of inflammation in the body.(8-11)

Weight loss as treatment for OA

A number of studies support weight loss as a treatment for OA.(12) Weight loss can be achieved through a combination of reduced energy intake and increased physical activity.(12, 13) Overweight and obese adults who used this method over 18 months lost around 11% of their body weight and reported a 50% reduction in the level of knee pain. Almost 40% of these people reported little or no knee pain by the end of the study.(14)

There are a number of reasons for the success of weight loss in the treatment of OA. First, obesity directly increases the load through weight bearing joints, such as your knees, hips and spinal joints.(9) Second, adipose (fatty) tissue releases inflammatory proteins that contribute to joint damage all over the body.(1) By lowering your weight through diet and exercise, you can reduce the load through your joints and the level of inflammation in your body.(14)

Achieving weight loss

Diet

The goal of a good diet plan is to sustainably lower energy intake to below a target level, often between 1000 to 1500 calories per day. There are a number of conventional diet options discussed below.

• Balanced low-energy diets can involve portion-controlled meals or low-energy versions of the Mediterranean diet, which have been shown to reduce weight in the long term(15) and reduce the risk of heart disease and diabetes.(13, 16)

• Low-fat diets require that fat contributes to less than 30% of your energy intake, which increases energy consumption and promote fat loss.(17)

• Low-carbohydrate diets aim for less than 130 grams of carbohydrate intake per day. These diets seem to be more effective for short-term weight loss than low-fat diets, but the weight loss is generally not sustained for longer than 12 months.(18)

• High-protein diets seem to improve weight maintenance because they make you feel full (so you don’t eat as much) and stimulate heat production in your body (which uses energy).(17)

• Very low calorie diets involve an energy intake of 200 to 800 calories per day. These diets produce a greater initial weight loss than conventional diets but are not superior in the long term and have a number of side effects.(19)

Exercise

Evidence suggests that at least 30 minutes of exercise 5-7 days per week prevents weight gain and improves heart health.(14, 19) To lose weight, you should exercise alongside lower energy intake to augment the effects of a healthy diet and to improve muscle mass.(9)

Recommendations

Overall, management of weight through diet and exercise requires a lifestyle change. Major changes to your diet and exercise should occur with professional guidance. At Surecell, we can provide tailored education and support as you alter your daily habits. We recommend a variety of nutrition and exercise options to manage your OA and weight. Even if you are not overweight, settling on a routine of healthy meals and enjoyable aerobic and strength training on most days will benefit your general health.

Support available at Surecell

If you are looking for a tailored diet and exercise program, we offer exercise physiology, personal training and gym facilities, nutrition advice, as well as medical support such as platelet-rich plasma (PRP) injections to treat joint pain from OA . Feel free to contact our friendly staff on 03 9822 9996 for a consultation, or send us a message by filling in our contact form.

References

1. Bray GA, Kim KK, Wilding JPH, World Obesity F. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017;18(7):715-23.

2. Robson EK, Hodder RK, Kamper SJ, O'Brien KM, Williams A, Lee H, et al. Effectiveness of Weight-Loss Interventions for Reducing Pain and Disability in People With Common Musculoskeletal Disorders: A Systematic Review With Meta-Analysis. J Orthop Sports Phys Ther. 2020;50(6):319-33.

3. Yusuf E, Nelissen RG, Ioan-Facsinay A, Stojanovic-Susulic V, DeGroot J, van Osch G, et al. Association between weight or body mass index and hand osteoarthritis: a systematic review. Ann Rheum Dis. 2010;69(4):761-5.

4. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26(3):355-69.

5. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-96.

6. Loeser RF, Goldring SR, Scanzello CR, Goldring MB. Osteoarthritis: a disease of the joint as an organ. Arthritis Rheum. 2012;64(6):1697-707.

7. Zhang W, Doherty M, Peat G, Bierma-Zeinstra MA, Arden NK, Bresnihan B, et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis. 2010;69(3):483-9.

8. Ratneswaran A, LeBlanc EA, Walser E, Welch I, Mort JS, Borradaile N, et al. Peroxisome proliferator-activated receptor delta promotes the progression of posttraumatic osteoarthritis in a mouse model. Arthritis Rheumatol. 2015;67(2):454-64.

9. Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28(1):5-15.

10. Sellam J, Berenbaum F. Is osteoarthritis a metabolic disease? Joint Bone Spine. 2013;80(6):568-73.

11. Oliveria SA, Felson DT, Cirillo PA, Reed JI, Walker AM. Body weight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee. Epidemiology. 1999;10(2):161-6.

12. Wluka AE, Lombard CB, Cicuttini FM. Tackling obesity in knee osteoarthritis. Nat Rev Rheumatol. 2013;9(4):225-35.

13. Sayon-Orea C, Razquin C, Bullo M, Corella D, Fito M, Romaguera D, et al. Effect of a Nutritional and Behavioral Intervention on Energy-Reduced Mediterranean Diet Adherence Among Patients With Metabolic Syndrome: Interim Analysis of the PREDIMED-Plus Randomized Clinical Trial. JAMA. 2019;322(15):1486-99.

14. Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-73.

15. Flechtner-Mors M, Ditschuneit HH, Johnson TD, Suchard MA, Adler G. Metabolic and weight loss effects of long-term dietary intervention in obese patients: four-year results. Obes Res. 2000;8(5):399-402.

16. Salas-Salvado J, Bullo M, Babio N, Martinez-Gonzalez MA, Ibarrola-Jurado N, Basora J, et al. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011;34(1):14-9.

17. Hall KD, Guo J. Obesity Energetics: Body Weight Regulation and the Effects of Diet Composition. Gastroenterology. 2017;152(7):1718-27 e3.

18. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS, Jr., Brehm BJ, et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166(3):285-93.

19. Tsai AG, Wadden TA. The evolution of very-low-calorie diets: an update and meta-analysis. Obesity (Silver Spring). 2006;14(8):1283-93.