Home 5 Hip & Knee OA Clinician Standards 5 Core Treatment 3 – Weight Management

 

 

 

 

Standards

1-3: Setting Up for Success
4-6: Core Treatments
7-9: Rounding out the OA Journey

CLINICIAN STANDARDS

Standard 6. Core Treatment 3: Weight Management

When an individual identifies weight management as a priority in their care plan, they should be offered weight management options that are tailored to support their individual needs. Use of shared decision-making techniques will ensure the individual’s priorities, goals, values and preferences are built into their weight management plan.

Overview

Key Messages for Weight Management

Carrying extra body weight:​

  1. Exerts additional mechanical stress on the lower limb joints; and ​
  2. May have a metabolic link to the disease progression​

Over time, increased stress on the joints from extra body weight can result in the production of inflammatory mediators from fat tissue, negatively impacting the health of joint cartilage, and causing loss of muscle mass and strength​. Effective weight management explores a wide range of strategies based on the individual’s needs and goals.

Healthy and safe weight management should be considered for all individuals with OA, but reducing extra body weight may be one goal of those individuals who have obesity​. Obesity is a chronic medical condition characterized by an excessive accumulation of body fat; it is a significant comorbidity in individuals with OA. Effective weight management explores a wide range of strategies based on the individual’s needs and goals. Use shared decision-making techniques to build a plan that considers:

  • Nutritional and/or weight management services to support lifestyle intervention and behaviour modification​
  • Coordination with exercise and physical activity plans​
  • Mental health support​
  • Referral to appropriate supporting clinicians to assist with:​
    • Pharmacological treatments or Surgery
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Introduction

A higher body weight and excess body fat have been linked with the development and progression of osteoarthritis (OA). This is due to additional mechanical stresses on the lower limb joints with higher body weight, and a metabolic and inflammatory relationship between body fat and OA disease progression. 1 Therefore, weight maintenance, or prevention of weight gain, is a foundational strategy in OA management. This is particularly important due to the risks of weight gain associated with both aging and inactivity.

1 Godziuk K, Kania-Richmond A, Hart D. Obesity: Implications for patients with osteoarthritis.

Weight reduction may also be beneficial for reducing OA symptoms and slowing disease progression.

Studies have shown that losing 5-10% of body weight can reduce joint forces/stresses and improve OA-related pain, physical function, and quality of life. Behaviour-based weight management approaches (using nutrition, activity and behavioural control strategies) usually result in sustained weight loss of 3-5% of body weight, however this could still be effective to improve symptoms.

For individuals who are overweight or obese, weight reduction may also be beneficial for reducing OA symptoms and slowing disease progression.

Although sustained weight loss might support reduction of symptoms, the body has mechanisms to defend against weight loss, and most individuals experience weight gain. Therefore, strategies and recommendations around weight management should focus on improvements in overall health, OA symptoms, and physical function rather than weight lost or numbers on a scale. Changing body composition (decreasing body fat without weight change) may also be beneficial.

 

Body Mass Index (BMI) is a screening tool used to classify normal, overweight and obesity in adults. It is calculated by dividing weight in kilograms by height in metres squared (kg/m2). 2

 

2 World Health Organization. Body mass index – BMI Copenhagen, Denmark: WHO Regional Office for Europe; 2021 [Available from: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi.

BMI only provides information about body size. It is not useful to identify the health status of an individual. When used in combination with waist circumference, it can indicate risk for obesity related illness such as diabetes, hypertension and cardiovascular disease. Another tool is the Edmonton Obesity Staging System(EOSS). The EOSS is a classification system which takes into account the comorbid and functional impact obesity has on an individual’s health to determine their stage of obesity (stage 0-4) and guide treatment options. 3

3 Sharma AM, Kushner RF. A proposed clinical staging system for obesity. International Journal of Obesity. 2009;33(3):289-95.

Collaborating on Weight Management

Weight bias is the negative attitudes, beliefs and assumptions towards individuals with obesity. One of the most important strategies to reduce weight bias is self-awareness. Clinicians should identify and address their own personal assumptions and attitudes about weight. Several resources are available including the Canadian Adult Obesity Clinical Practice Guidelines: Reducing Weight bias in Obesity Management Practice and Policy.

Understanding the individual’s health priorities, goals, values and preferences is the starting point for having a discussion around weight management for OA. This includes asking the individual for permission to discuss body weight, assessing their weight history, previous and current behaviour management strategies, and interest in additional strategies or supports. Caution and supervision around weight management may be needed in individuals who are at-risk for conditions such as malnutrition or sarcopenia.

 

All people, regardless of body size, are equally as susceptible to malnutrition and sarcopenia. 4, 5

 

4 Lee S, Kim TN, Kim SH. Sarcopenic obesity is more closely associated with knee osteoarthritis than is nonsarcopenic obesity: A cross‐sectional study. Arthritis & Rheumatism. 2012;64(12):3947-54.

5Jin WS, Choi EJ, Lee SY, Bae EJ, Lee T-H, Park J. Relationships among obesity, sarcopenia, and osteoarthritis in the elderly. Journal of Obesity & Metabolic Syndrome. 2017;26(1):36–44.

Malnutrition and sarcopenic obesity would significantly complicate the person’s efforts to participate in their OA treatment, and therefore these treatments should be addressed first. 6

6 Godziuk K, Prado CM, Woodhouse LJ, Forhan M. The impact of sarcopenic obesity on knee and hip osteoarthritis: A scoping review. BMC Musculoskeletal Disorders. 2018;19(1):1-10.

 

There are a range of strategies available to support weight management in OA based on the individual’s needs. Use shared decision-making techniques to create a plan that is tailored to the individual’s goals, values and preferences. This may incorporate: 7,8

 

7 Kahan S. Overweight and obesity management strategies. The American Journal of Managed Care. 2016;22(7):S186-S96.

8Obesity Canada. Canadian Adult Obesity Clinical Practice Guidelines (CPGs) Edmonton, Alberta: Obesity Canada; 2020 [Available from: https://obesitycanada.ca/guidelines/chapters/. :

  • Weight management services to support lifestyle intervention and behaviour interventions (nutrition, physical activity, sleep, stress reduction), to help the individual reach their health goal.
    • Examples provided in the Health Resource Matrix, in the Treatment Menu and on the Tables of Examples for the OA Treatments Toolbox.
  • Coordination and complementation with the individual’s exercise and physical activity care plan (Standard 5).
  • Referral to supports for mental health or psychotherapy, which may assist with managing sleep, stress, and chronic pain as well as eating behaviours such as emotional eating.
  • Referral to appropriate supporting clinicians
    • Possibly including referral to specialized multidisciplinary care for individuals with obesity.

    Continuing Education

    For some clinicians the skills required for offering the support described in this standard may be an evolving skill set. There are a number of resources provided in the Health Resources Matrix to explore continuing education.