Table 2.
Summary of weight loss recommendation in knee osteoarthritis guidelines (n = 13).
| AAOS 2021 [36] | VADoD 2020 [38] | Zhanga 2020 [32] | ACR 2019 [3] | OARSIa 2019 [4] | ESCEO 2019 [34] | ISR 2019 [29] | RACGPa 2018 [37] | TLARa 2017 [30] | PANLAR 2016 [31] | NICE 2014 [39] | EULAR2013 [27] | MSR 2013 [33] | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Is weight loss recommended? | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | EGY_press_logoY |
| LoE | Moderate | NR | Level A | Moderate (Overall level of certainty) | Knee: Strong | NR | Level 1-3 | Very low | Level Ia, IIa | NR | Knee: Ib | NR | |
| SoR | Moderate | Weak | 1 | Strongly recommended | Core but optional | Core: Strong | NR | Strongly recommended | 9.71 | NR | 8.7 | Grade A | |
| Target group | Overweight and obese | Overweight and obese |
|
Overweight or obese | Knee: NR | Overweight | Overweight |
|
BMI≥25 | overweight or obese who have associated functional limitations | Overweight or obese | Overweight | |
| Recommendation on magnitude of weight loss | NR | NR | NR | ≥5% of body weight. There is dose-response relationship. |
NR | NR | NR | Minimum weight loss target 5–7.5% for those with BMI≥25 | NR | NR | NR | NR | |
| Weight loss strategies | Diet and exercise combined | Self-management program including exercise and weight loss | NR | Concomitant exercise program | Exercise with or without dietary weight management, regardless of comorbidity | NR | Exercise (aerobic activities) | Diet and exercise combined | Lifestyle alteration. Diet and exercise programmes. |
Refer to NICE guideline for obesity on evidence of the most effective weight loss strategies. | Diet and exercise. Also included individualised strategies for weight loss maintenance |
NR | |
| Pharmacological weight management | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | |
| Surgical weight management | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Bariatric surgery for BMI≥40 | Not mentioned | |
| Priority in relation to other recommendations | No 10th of 27 recommendations | 3rd in the algorithm of management | No 4th of 16 recommendations | 3rd on the figure following exercise, self-efficacy and self-management programs. | Part of core recommendations | No 1 of 16 recommendations. Part of “core set” recommendations | No 13th of 16 recommendations | 1st point in the plain language summary. 3rd point in Core Long-term management |
No 2nd of 11 recommendations | In “Key priorities for implementation”, part of a “core treatment”. No 6th of 43 recommendations |
3rd and 8th of 11 recommendations. | 2nd in the algorithm on management of knee and hip osteoarthritis No 3rd of 16 recommendations. |
Abbreviation.
AAOS: American Academy of Orthopaedic Surgeons.
ACR: American College of Rheumatology.
BMI: body mass index.
ESCEO: European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases.
EULAR: European League Against Rheumatism.
ISR: Italian Society for Rheumatology.
LoE: level of evidence.
NICE: National Institute for Health and Care Excellence.
MSR: Malaysian Society of Rheumatology.
NR: not reported.
OA: osteoarthritis.
OARSI: Osteoarthritis Research Society International.
PANLAR: Pan American League of Associations for Rheumatology.
RACGP: Royal Australasian College of General Practitioners.
SoR: strength of recommendation.
TLAR: Turkish League Against Rheumatism.
VADoD: Department of Veterans Affairs and Department of Defence.
Guidelines also included weight management in addition to weight loss recommendation.