Research shows TDR can improve osteoarthritis in people with obesity

Posted On: 17th June 2024

In a webinar hosted by TDMR Europe on 22nd May, Professor Henning Bliddal, Director of the Parker Institute, a clinical research unit of rheumatology at Frederiksberg University Hospital, Copenhagen, demonstrated that total diet replacement (TDR) can help people with obesity and knee osteoarthritis lose weight and improve their health.

Prof Bliddal presented the results of a three-phase study that he led which randomised 192 patients to a very-low energy diet (VLED) and a low-energy diet (LED) with formula diet products for eight weeks followed by two months of conventional food re-introduction diet at a low energy level (phase one). This was followed by a one year randomised controlled trial comparing weight maintenance with one meal replacement product (MRP) daily with a ‘knee exercises’ physiotherapy programme (phase two). During the third part of the trial (phase 3) over three years, divided into two groups, participants either followed an “ordinary” diet combined with a low-calorie meal replacement (MRP) per day or reintroduction of five weeks of TDR every four months (nine episodes of 5 weeks TDR over 3 years).

Explaining the impact of the trial on patients’ osteoarthritis, Prof Bliddal showed that at the end of the first phase “two out of three participants had very significant pain relief and better function”. “With a 16-week programme you can make people a lot better in, should we say, no time, in a simple way” he added.

According to Prof Bliddal, follow up evaluation showed that “participants lost fat but little lean body mass”. “As an interesting observation, they became healthier. A mark of this was the level of vitamin D, which was reduced on average in the participants at baseline but got into the normal range during the diet” he explained.

As Prof Bliddal explained, during the third phase of the study, the rate of knee replacement was very low and while patients followed little exercise, for four or more years they could maintain that weight loss.

Moreover, Prof Bliddal stressed: “we know that osteoarthritis is associated with increased risk of cardiovascular diseases in the elderly and people die earlier if they have large BMI and osteoarthritis in combination”. “We learnt the halfway with the first study that when you go to a VLED or LED…you can almost get out of your hypertensive medication, and you can drop the diabetes medicine” he emphasised.

Prof Bliddal also addressed the importance of exercise in people with obesity and osteoarthritis. “People ending up with osteoarthritis and overweight or obesity have very sedentary lifestyle and if you are going to change this you have to do some regular group work motivating people to exercise”. “I think this is a very important issue also with other means of weight loss that you have to take care of, increasing the exercise somehow and this is a job for health professionals, and I don’t think that people can make it on their own”, he added. Prof Bliddal also emphasised that such exercise programmes “must be individualised to some extent”, explaining that aerobic can be helpful but exercise “provoking” the knee (meaning exercise that gives high knee loading like running) should be avoided.

The prevalence of osteoarthritis and clinical management

Presenting existing research on the link between obesity and osteoarthritis, Prof Bliddal showed that an increase of one BMI point increases the risk of developing knee osteoarthritis by 15%. “It seems that having a BMI above 30 will give you almost double risk of acquiring hand osteoarthritis” he added. According to Prof Bliddal, 1kg weight loss decreases osteoarthritis symptoms by almost 3% and a weight loss of 5% can reduce knee replacements by 25%.

A lively Q&A with the audience followed Prof Bliddal’s presentation. Answering a question on whether the approach of his study could be a standard part of the management of osteoarthritis in Parker Institute’s rheumatology department, Prof Bliddal said “it would be wise to include it in the prescriptions you may give to rheumatological diseases, definitely”.

Research has shown that osteoarthritis is estimated to affect almost 40 million people in Europe as well as that the disease is among the fastest growing causes of disability worldwide. According to the National Institute for Health and Care Excellence (NICE), in the UK an estimated 5.4 million people are affected by knee osteoarthritis and 350.000 individuals are diagnosed with the disease every year.

The NICE guidance for osteoarthritis includes weight loss and that, where possible, 10% weight loss is better than 5%. Discussing the NHS soups and shakes programme, the diet programme that uses TDR to help people with obesity and type 2 diabetes improve their health, TDMR Europe Chair, Prof Anthony Leeds has stressed in the Times that “hundreds of thousands of people in Britain are waiting in pain for a joint replacement, and the same NHS soups and shakes programme could be offered to them”.

TDMR Europe works to help stakeholders develop a better understanding of formula diet foods and aims to increase awareness of the scientific evidence showing the effectiveness of these products in tackling obesity and improving related comorbidities. Find out more here.


Aris Myriskos

Press and Media Relations Office

TDMR Europe Secretariat