Henning Bliddal on Osteoarthritis: weight loss is key to improvement

Posted On: 14th August 2019

“Obesity is widely acknowledged as a risk factor for both the incidence and progression of osteoarthritis and has a negative influence on outcomes. Loss of at least 10% of body weight, coupled with exercise, is recognised as a cornerstone in the management of obese patients with osteoarthritis, and can lead to significant improvement in symptoms, pain relief, physical function and health related quality of life.”

Henning Bliddal is professor of rheumatology and director of the Parker Institute at Frederiksberg hospital, Copenhagen. His clinical research aims to increase the knowledge of treatments for the major groups of arthritis, including degenerative musculoskeletal diseases such as osteoarthritis. The most common type of arthritis in the UK, osteoarthritis is a condition that causes joints to become painful and stiff.  Prof Bliddal’s research showed that weight loss with total diet replacement programmes (TDRs) and weight maintenance for four years improved symptoms in obese people with osteoarthritis and also reduced their heart age by 5 years.

Loss of at least 10% of body weight, coupled with exercise, is recognised as a cornerstone in the management of obese patients with osteoarthritis

Professor Bliddal explains that, as well as the weight loss achieved by TDRs, his research showed that patients became generally healthier. The majority of these patients, prior to the study, were lacking in vitamins and had poor nutritional status. And with healthiness comes happiness: his research demonstrates that a 10% weight loss results in an increase of 30% regarding general quality of life.

A sense of belonging and improved quality of life are important factors in successful weight loss maintenance

Too often for people on diet programmes, the issue is not losing the weight, but the challenging period that comes afterwards. Professor Bliddal has demonstrated the solution for this: support groups that meet on a regular basis, led by a dietitian. These groups give patients a sense of belonging by offering advice for the future, helping them to maintain the weight loss and maintain their improved knee joints in the long term.

The future for weight loss linked to arthritis is bright. Professor Bliddal’s team is also running a study evaluating the effect of weight loss in a group of obese patients with the arthritis of gout. The study is a trial where half the patients receive intensive weight loss in the form of TDRs as well as supervision from a clinical dietitian and the other half get the usual care that would be received by a patient with gout. Publication of the results is eagerly awaited.

Communities and groups advocating TDRs are needed for the future of weight loss

In terms of the future for weight loss, Henning Bliddal believes that more communities and groups advocating TDRs are needed. Furthermore, prevention is key to long term success. Evidence shows that certain population sub-groups experience sudden weight gain, such as post-natal women or recently retired sportspeople, increasing their risk of developing arthritis. Developing programmes for these specific subgroups could prove an extremely effective way of preventing weight gain and its related conditions.

Commenting on the research done at the Parker Institute in Copenhagen, Professor Anthony Leeds, Chairman of TDMR Europe, said ‘The Danish experience with weight loss using TDR delivered in a secondary care setting provides the solid evidence-base for effective weight loss as a primary intervention in people with knee osteoarthritis (KOA) and obesity. The DROPLET study run from GP practices around Oxford showed that larger amounts of weight loss (7 to 10kg) can also be delivered by commercial providers in a community-based setting after referral by GPs.  Taken together these trials provide the evidence base for planning an ‘upscaling’ of weight loss with TDR in people with osteoarthritis delivered both in secondary care and on a larger scale in the community after referral from primary care by GPs.