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Tackling obesity in knee osteoarthritis

Nature Reviews Rheumatology volume 9, pages 225–235 (2013)Cite this article

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Abstract

Obesity and knee osteoarthritis (OA), two of the most common chronic diseases, are often comorbid. Obesity increases the risk of knee OA by a variety of mechanisms, such as increased joint loading and changes in body composition, with detrimental effects related to metainflammation and behavioural factors, including diminished physical activity and subsequent loss of protective muscle strength. These complex interactions present a challenge to the managing physician. The risk of knee OA related to weight gain and obesity begins from an early age. Weight loss reduces the risk of incident knee OA, and, in established disease, reduces symptoms, improves function and is likely to reduce disease progression. We review strategies to facilitate weight loss, with particular reference to their application in people with knee OA. Although knee OA presents intrinsic barriers to weight management, weight loss is possible at all stages of disease. Exercise or muscle strengthening are desirable for general health and to improve function, but are not essential to achieve weight loss and a successful symptomatic result. The degree of weight loss required to achieve benefit might be greater with increasing disease severity. Finally, we outline the need for a societal approach to tackle obesity-related OA.

Key Points

  • Obesity increases the risk of knee osteoarthritis (OA) by a variety of mechanisms, including altered joint loading and factors associated with increased adiposity such as metainflammation

  • Weight loss reduces the risk of OA, and, in established disease, improves symptoms and might reduce disease progression

  • Weight loss is achievable in people with all stages of OA

  • The most effective weight-loss strategies to reduce symptoms in those with OA use a combination of dietary restriction and muscle-strengthening strategies

  • Although levels of physical activity are often diminished in people with OA, lack of exercise does not preclude weight loss

  • Limiting weight gain throughout life is the most effective strategy to reduce the risk of developing obesity-related OA

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Figure 1: Mechanisms relating obesity to OA.
Figure 2: Obesity and OA: a vicious cycle.
Figure 3: The potential pros and cons of the role of exercise in weight loss in OA.

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Authors and Affiliations

  1. School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, VIC, Australia

    Anita E. Wluka & Flavia M. Cicuttini

  2. School of Public Health and Preventive Medicine, Monash University, 43–51 Kanooka Grove, Clayton, 3168, VIC, Australia

    Cate B. Lombard

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  1. Anita E. Wluka
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  2. Cate B. Lombard
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  3. Flavia M. Cicuttini
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All authors made substantial contributions to researching data for the article, discussions of content, writing and review and/or editing of the manuscript before submission.

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Correspondence to Anita E. Wluka.

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Wluka, A., Lombard, C. & Cicuttini, F. Tackling obesity in knee osteoarthritis. Nat Rev Rheumatol 9, 225–235 (2013). https://doi.org/10.1038/nrrheum.2012.224

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