Dose response relationship between weight loss and improvement in quality of life in persons with symptomatic knee osteoarthritis

Abstract

Purpose: It has been established that weight reduction has the ability to decrease pain and disability in knee osteoarthritis (OA) in a doseresponse manner. A greater weight loss causes incremental improvement in disease specific symptoms and function. Whether this improvement leads to commensurate improvements in quality of life remains unknown. This study examined whether there is a doseresponse relationship between incremental weight loss and non-disease specific quality of life measures in knee OA sufferers. Methods: Consecutive participants with knee OA enrolled in a weight loss program, "Healthy weight for life", as part of the full "Integrated Osteoarthritis Management TM Program" were selected. This program is a structured remotely delivered 18 week knee and hip arthritis disease management program that systematically integrates intensive weight loss as part of its tailored interventions in the management of knee and hip OA. This program was conducted with the aim of a 7-10% loss of body weight by dietary intervention over 18 weeks. The participants were provided online and written healthy eating advice and lifestyle education and tools together with targeted telephone motivation and support. The dietary habits were changed over 3 phases: phase 1 -motivational weight loss utilizing low calorie diet meal replacement, with controlled portions, and free foods for 6 weeks; phase 2 -consolidation weight loss for 6 weeks and phase 3 -short term weight maintenance. All participants in this cohort received the same strength / balance / mobility exercise tools, instruction, support and encouragement. All participants were assessed at baseline, 6 weeks and 18 weeks for body weight and non-disease specific measure of quality of life, assessed by SF-12 instrument. The SF-12 measures general health status from the patient's point of view. It includes 8 concepts commonly represented in health surveys: physical functioning, role functioning physical, bodily pain, general health, vitality, social functioning, role functioning emotional, and mental health. Results are expressed in terms of two meta-scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). The PCS and MCS scores have a range of 0 to 100 and have a mean score of 50 and a standard deviation (SD) of 10 in a healthy US population. Thus, scores greater than 50 represent above average health status. The dose-response relationships between five weight-change categories (10% weight loss, 9.9-7.5%, 7.4-5%, 5-2.4% and <2.5%) and change in SF-12 scores were assessed using repeated measures ANCOVA and controlled for baseline BMI and gender. Results: 2175 (71% females) persons were enrolled in this study. Mean age, height and weight was 64 years (SD ± 8.6), 1.66m (SD ± 0.09) and 95.3 (SD ± 17.4) respectively. The mean body mass index (BMI) was 34.4 (SD ± 5.2) with 81.7% of participants being obese at baseline. 2002 (92%) of participants had a >2.5% reduction in body weight. 1832 (84.4%) participants completed the final SF-12 questionnaires an...

Acceptability of financial incentives for maintenance of weight loss in mid-older adults: a mixed methods study

“…Each phase includes a portion-controlled eating plan (including KicStart™ meal replacements), recommendations for gentle activity and personalised symptom and progress tracking, along with personal motivation, support and advice from the centralised HWFL Care Support Team (HWFL team) via phone, SMS, email, and mail. More than 80% of participants complete the program [ 34 ] and participants lose an average of 7% of their baseline weight over the 18 weeks [ 35 ]. The HWFL program is not an incentive-based program, but the service provider and one health insurer were interested in exploring the potential use of financial incentives as part of a long-term weight loss maintenance program.…”

Meal replacement soups and shakes: do they have a place in public health practice to manage weight loss?

“…Past participants of the program have lost on average, approximately 7-8% of their baseline weight. 9,10 We undertook qualitative research to investigate an additional maintenance phase for HWFL participants. Six focus groups were conducted during November 2016, with 28 English-speaking participants who had completed HWFL within the past year (53.6% of participants were male, 46.4% female, 85.7% aged 55 years and older, 82.1% from most advantaged areas, 96.4% from major cities; 60.7% of whom had maintained their weight loss or lost further weight after completing the program).…”

Healthy Weight for Life programme: Evaluating the practice and effectiveness of a weight loss maintenance programme in the private health insurance setting

“…The LTMP design was inspired by research-based evidence of the impact of the HWFL programme 11,12 and informed by a combination of guidelines for the management of adult overweight and obesity 14,15 as well as ‘practice wisdom’. 16 Although a specific theoretical framework was not articulated, the LTMP is underpinned by established and effective behaviour change strategies including goal setting, self-monitoring, feedback and reinforcement as illustrated in Figure 2.…”

“…11 More than 80% of participants complete the programme and lose on average of between 7.5% and 8.3% of their initial body weight. 11,12 Development of the HWFL long-term maintenance programme (phase 4)…”