Table 3.
Summary of weight loss recommendation in hip osteoarthritis guidelines (n = 11).
| VADoD 2020 [38] | Zhanga 2020 [32] | ACR 2019 [3] |
OARSIa 2019 [4] |
ISR 2019 [29] |
RACGPa 2018 [37] |
AAOS 2017 [35] |
PANLAR 2016 [31] |
NICE 2014 [39] |
EULAR 2013 [27] |
MSR 2013 [33] |
|
|---|---|---|---|---|---|---|---|---|---|---|---|
| Is weight loss recommended? | Y | Y | Y | Y | Y | Y | N | Y | Y | Y | Y |
| LoE | NR | Level A | Moderate | Hip: Conditional | Level 1-3 | Very low | Level B | NR | Hip: Ib | NR | |
| SoR | Weak | 1 | Strongly recommended | Hip: Good clinical practice statement | NR | Strongly recommended | Level I | NR | 8.7 | NR | |
| Target group | Overweight and obese | Overweight or obese | Overweight or obese | Hip: BMI≥30 | Overweight | Overweight (BMI≥25) or obese (BMI≥30) | NR | Overweight or obese who have associated functional limitations | Overweight or obese | Overweight | |
| Recommendation on magnitude of weight loss | NR | NR | ≥5% of body weight. There is dose-response relationship. |
NR | NR | Minimum weight loss target 5–7.5% for those with BMI≥25 | NR | NR | NR | NR | |
| Weight loss strategies | Self-management program, exercise and weight loss Refer to the current VA/DoD CPG for the management of adult overweight and obesity |
NR | Concomitant exercise program | Dietary management may be considered as a part of a healthy lifestyle regimen. | Exercise (aerobic activities) | Diet and exercise combined | NR | 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 | |
| Surgical weight management | 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 | 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 good clinical practice statement | 13th of 16 recommendations | 1st point in the plain language summary. 3rd point in Core Long-term management |
1st of 8 in nonpharmacological treatment modalities 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 |
Abbreviation:
AAOS: American Academy of Orthopaedic Surgeons.
ACR: American College of Rheumatology.
BMI: body mass index.
CPG: clinical practice guidelines.
EULAR: European League Against Rheumatism.
ISR: Italian Society for Rheumatology.
LoE: level of evidence.
OARSI: Osteoarthritis Research Society International.
MSR: Malaysian Society of Rheumatology.
N: no.
NICE: National Institute for Health and Care Excellence.
NR: not reported.
PANLAR: Pan American League of Associations for Rheumatology.
RACGP: Royal Australasian College of General Practitioners.
SoR: strength of recommendation.
VADoD: Department of Veterans Affairs and Department of Defence.
Y: yes.
Guidelines also included weight management in addition to weight loss recommendation.