BACKGROUND: Exercise is recommended to manage hip osteoarthritis, but weight loss recommendations are conflicting.
OBJECTIVE: To evaluate the efficacy of a weight loss diet added to exercise on change in hip pain.
DESIGN: 2-group superiority randomized trial. (ClinicalTrials.gov: NCT04825483).
SETTING: Community.
PARTICIPANTS: 101 adults with hip osteoarthritis and overweight or obesity.
INTERVENTION: Both the exercise only group and very-low-calorie diet (VLCD) plus exercise group were provided with a 6-month home exercise program via 5 telehealth consultations. The VLCD plus exercise group also received a VLCD via 6 telehealth consultations.
MEASUREMENTS: The primary outcome was 6-month change in hip pain severity (11-point scale; range 0 to 10, with higher scores indicating worse pain; minimum clinically important difference of 1.8). Secondary end points included other measures of hip pain, physical function, quality of life, body weight, body composition, and adverse events.
RESULTS: 99 (98%) and 95 (94%) participants provided 6- and 12-month primary outcomes, respectively. Although VLCD plus exercise lost 8.5% more weight than exercise only, VLCD plus exercise was not more effective for change in hip pain severity (mean difference, -0.6 units [95% CI, -1.5 to 0.3]) at 6 months. Between-group differences for other secondary outcomes at 6 months favored VLCD plus exercise except Hip Disability and Osteoarthritis Outcome Score (HOOS) pain and function. At 12 months, weight, body mass index, HOOS pain and function, and overall hip improvement, but not quality of life and physical activity, favored VLCD plus exercise. There were no serious related adverse events.
LIMITATION: Participants were unblinded.
CONCLUSION: Adding a weight loss diet to exercise did not change hip pain but improved most secondary outcomes.
PRIMARY FUNDING SOURCE: National Health and Medical Research Council.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
A small short-term study using largely outmoded VLCD for weight loss (as opposed to GLP1 meds). There's not much to be learned here.
Physician rater
This study is of little use in clinical practice of pain medicine since the interventions did not differ for effect on pain. The study can be used to inform patients not to expect pain relief with weight loss. The very low calorie diet may be expected to have a negative effect on quality of life.
Physician rater
It may be a little late in the disease process for weight loss to reverse hip pain caused by OA.
Physician rater
Low-calorie weight loss interventions in hip osteoarthritis do not add pain relief beyond exercise alone; however, there appear to be other secondary benefits.
Physician rater
Exceptionally well conducted study with 12-month follow-up and includes the costs of the intervention. Exercise and weight loss by very low-calorie diet compared with exercise only did not differ in the reduction of hip pain intensity at 6- and 12-month follow-up in patients with hip osteoarthritis pain and BMI >= 27. The combined therapy was superior in reducing the Disability and Osteoarthritis Outcome Score at 12 months. Therefore, clinicians are encouraged to recommend exercise and weight loss for obese patients with hip osteoarthritis pain. The authors did not present the distribution of the patients in obesity categories and a moderator analysis of the effects of BMI at the beginning of the study and weight loss during the study on pain and function. Therefore, we do not know whether patients with BMI > 35 or > 40 benefit more from weight loss than patients with BMI 27 to 35.
, McMaster University