Comparison of weight loss interventions in overweight and obese adults with knee osteoarthritis: A systematic review and network meta-analysis of randomized trials

Abstract

Objective

To ascertain the comparative effectiveness of weight-loss strategies for osteoarthritis (OA) to develop rational treatment algorithms aimed at improving OA-related symptoms in overweight/obese individuals.

Method

Medline, Embase, CINAHL, Scopus, and Web of Science were searched from inception to June 2023 for observational studies and randomized trials. Network meta-analyses were performed using a frequentist approach. Effect sizes for pain and function were computed as standardized mean differences (SMDs), while weighted mean differences were computed for body weight.

Results

14 RCTs on knee OA (KOA) (3215 participants) with 7 interventions: diet (D); exercise (E); diet and exercise (DE); pharmacological (L); psychological (P); psychological, diet, and exercise (PDE); and Mediterranean diets (M) were networked. For weight change (kg), all interventions significantly outperformed control comparators, with benefits ranging from −7.0 kg (95% CI: −12.1 to −2.0 kg) for the most effective approach (PDE) to −4.9 kg (95% CI: −6.8 to −3.0 kg) for the least effective approach (D). In terms of SMDs for pain, only PDE (−1.2, 95% CI: −2.2 to −0.3), and DE (−0.6, 95% CI: −1.0 to −0.2) outperformed control comparators in improving the pain. Regardless of the chosen intervention, prediction intervals from meta-regression analysis indicated that significant pain relief may be anticipated when patients achieve at least a weight reduction of 7.4%.

Conclusions

PDE and DE interventions may offer the most effective approach for weight loss, potentially leading to significant improvements in pain and physical function among overweight/obese individuals with KOA if they achieve more than 7.4% weight loss.