TDMR Europe welcomes World Arthritis Day (WAD) 2024. Taking place annually on 12th October, WAD is a global awareness day aimed towards increasing knowledge of the existence and impact of rheumatic and musculoskeletal diseases (RMDs) among all relevant audiences. This year, WOD is focused on helping people living with RMDs make evidence-informed choices in partnership with their healthcare professionals to improve their overall health and quality of life. In this context, TDMR Europe stresses the need to raise awareness of the role of weight loss in tackling osteoarthritis in people with obesity or overweight.
The role of weight loss in improving osteoarthritis in people with obesity
According to the National Institute for Health and Excellence (NICE), osteoarthritis is more common in people with obesity, among other risk groups. The NICE Guidance “Osteoarthritis in over 16s: diagnosis and management” argues that weight loss can help improve the quality of life and physical function and reduce pain in people with osteoarthritis and obesity. The Guidance also claims that “losing 10% of their body weight is likely to be better than 5%”.
Research shows the effectiveness of low and very-low energy diet
In a recent webinar organised by TDMR Europe, Professor Henning Bliddal, Director of the Parker Institute, a clinical research unit of rheumatology at Frederiksberg University Hospital, Copenhagen, demonstrated that weight loss with total diet replacement (TDR) and meal replacement products (MRPs) can help people with obesity and knee osteoarthritis lose weight and improve their health.
Prof Bliddal presented the results of the CAROT study, a two-year trial that enrolled 192 patients with obesity and knee osteoarthritis. The trial had two phases, the first (16 weeks) consisting of a dietary intervention with low-energy diet (LED) and the second (52 weeks) a randomized, three group controlled study of maintenance of weight loss by either continuing dietary instruction (and use of one meal replacement product daily), exercise, or a control group.
Prof Bliddal showed that at the end of the first phase “two out of three participants had very significant pain relief and better function”. According to Prof Bliddal, “with a 16-week programme you can make people a lot better in, should we say, no time, in a simple way”.
A three-year follow up study divided participants into two groups, providing either an “ordinary” diet combined with one MRP per day or reintroduction of five weeks of TDR every four months (nine episodes of 5 weeks TDR over 3 years). Prof Bliddal explained that during this trial, the rate of knee replacement was lower than expected and while patients were reluctant to exercise, they managed to maintain their weight loss over those three years.
In order to take the Danish evidence a step further and apply it to the United Kingdom, Versus Arthritis the UK’s largest arthritis charity funded a feasibility trial of a package of care for people awaiting knee surgery, led by Professor Hamish Simpson at the University of Edinburgh. Published in February 2024 this study showed that a package of care including weight loss giving an average 11.2kg weight loss with TDR (10.4% compared to 1.2% in the control group) was feasible. Symptoms, including pain, stiffness and physical function improved more in the intervention than the control group. Ten percent of intervention participants cancelled their surgery because symptoms were so improved. Adherence to interventions was 100% except for exercise therapy and the overall positive effect on participants’ quality of life suggests that this combination of weight loss with TDR, exercise therapy, use of insoles, and analgesia optimisation, should be offered to the many thousands of people in the UK languishing with pain and social isolation due to immobility while they await knee surgery.
Three months later another study exploring the role of low-energy diet (LED) in addressing obesity and knee osteoarthritis was published. The POWER randomised control trial, published in the British Journal of Sports Medicine, examined the effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, run in Melbourne, Australia.
The POWER trial is the first study to show that a physiotherapist-delivered 800kcal/d LED incorporating two MRPs daily and an exercise program is safe and effective for weight loss compared to exercise alone in people with obesity and knee osteoarthritis. Participants lost 8.1% body weight over six months (compared to just 1% in control participants).. As the researchers have stressed, “this study provides the first proof-of-concept evidence of an alternate allied health clinician delivery model for weight loss in people with knee osteoarthritis, which may guide future research and policy in the face of rising obesity rates and challenges facing healthcare systems”.
The rising burden of osteoarthritis
Osteoarthritis affects millions in Europe, with the Economist Intelligence Unit estimating that the number of people affected in Western Europe was 57 million in 2019, growing by 54% over the past 30 years.
European countries have reported annual osteoarthritis-related costs in the billions of Euros, with direct and indirect healthcare costs reaching 7.2 and 4.6 billion Euros respectively (Economist Intelligence Unit)
In addition to these substantial healthcare costs, osteoarthritis also impacts Europe’s economy by causing absenteeism and early retirement, necessitating income support or disability allowance payments. Some people with osteoarthritis may also need some degree of nursing and social care.
In the light of these findings, it is urgent for governments across Europe to take note of the research showing the effectiveness of weight loss in tackling osteoarthritis in people with obesity and introduce science-based measures in the public health sector, including TDR and MRP diet programmes.
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
Footnotes:
Total Diet Replacements (TDRs) which include very low calorie diets (VLEDs) and low calorie diets (LEDs), are specifically formulated programmes that are based around formula foods that aim to replace the whole of the daily diet. These formula foods are nutritionally balanced with key vitamins, minerals, high quality protein, essential fats, fibre and other nutrients, and are designed to replace conventional foods for a period to facilitate optimal weight loss. They provide controlled energy intake lower than can be achieved with a reduced intake of normal foods.
Meal replacements (MRPs) are products presented as a replacement for one or two meals of the daily diet. They are used alongside conventional food, as part of an energy restricted diet, to facilitate and maintain weight loss. MRPs are low-calorie meals taken in place of breakfast, lunch or dinner. They contain between 200kcal and 250kcal and come in pre-rationed form. This makes it easier for people who are looking to lose or maintain weight to control their calorie intake, as they no longer need to control their portions like they would need to do with ‘normal foods’.
Aris Myriskos
TDMR Europe Secretariat