Optimising body weight in people with obesity prior to knee or hip arthroplasty: A feasibility study utilising a dietitian‐led low inflammatory diet

Abstract

BackgroundWeight loss is recommended for people with obesity prior to undergoing total knee or hip arthroplasty. This study aimed to determine the feasibility of implementing a dietitian‐led low‐inflammatory weight‐loss diet for people with obesity awaiting arthroplasty. Secondary aims were to report weight change, patient‐reported outcomes, diet compliance, surgery deferment and diet acceptability.MethodsEligible participants were enrolled across two sequential periods; Usual Care (UC) was recruited, followed by an intervention period with a dietitian‐led weight‐loss programme (DT). Assessments occurred at baseline, 6‐month and pre‐surgery (11–12 months from baseline). Predefined diet feasibility outcomes included: (i) recruitment rate ≥60%, (ii) ≥60% of DT group reporting ≥10% improved compliance with low‐inflammatory diet by pre‐surgery, (iii) all DT participants attending ≥60% of dietitian consultations, (iv) proportion of DT group losing ≥5% weight double that of UC by pre‐surgery.ResultsNinety‐seven people participated (UC, n = 47, DT, n = 50). Baseline variables were similar between groups. None of the diet feasibility criteria were fulfilled: 52% of eligible people consented; 57% of DT group improved diet compliance; 72% of DT Group attended ≥60% of dietitian appointments; 31.4% of DT group lost ≥5% weight (compared to 20.6% of UC). Compared to UC group at pre‐surgery, DT group demonstrated modest weight loss (−1.7 kg (95%CI ‐3.5,0.2) versus −0.4 kg (−2.5,1.6)), and decreased waist circumference (−4.8 cm (−6.9,‐2.8) versus −2.2 cm (−5.2,0.7)). Three DT participants declined surgery due to improved symptoms.ConclusionUtilisation of a dietitian‐led low‐inflammatory weight‐loss diet was not feasible in this cohort. Suboptimal diet compliance likely explains the modest weight loss results.

Remote Delivery of Partial Meal Replacement for Weight Loss in People Awaiting Arthroplasty

“…These include the absence of a control group or randomisation, as well as the short-term follow up period of 12 weeks. However, based on previous research in this patient population group [ 31 ], we are confident that minimal weight loss would have occurred amongst those not involved in the PMR weight loss program. The generalisability of the study findings is also limited by the small sample ( n = 29) of participants awaiting TKA or THA recruited from a single public arthroplasty centre.…”

“…A recent systematic review indicated that while short-term, nonsurgical, preoperative weight loss interventions before TKA and THA produce statistically significant weight loss, it is not known whether the weight loss is clinically significant (defined as a 5% change in weight) or sufficient to improve outcomes after arthroplasty [ 30 ]. Recent attempts to manage obesity amongst participants undergoing pre-surgery optimisation have failed to achieve significant weight loss [ 31 ]. Clinical trials are clearly needed to inform both how weight loss is best achieved and how much weight loss is required to reduce the risks associated with obesity.…”