Frequency of Weight Loss Instruction Provision to Patients with Obesity and Hip or Knee Osteoarthritis: A Case-Series

Objective For obese patients, weight loss interventions (WLI) are recommended as first-line management for the conservative treatment of hip or knee osteoarthritis (OA), as weight loss slows the progression of OA and improves postoperative outcomes in patients that go on to need definitive treatment with total joint arthroplasty. Despite this consensus, it is unknown what percentage of orthopaedic specialists include WLI as part of their conservative care for this condition. This study aims to determine the frequency of WLI provision compared to physical therapy (PT) or pharmacotherapy (Pharm) for obese patients with hip or knee OA. Methods One hundred fifty electronic health records were reviewed retrospectively of patients with obesity and the diagnosis of either hip or knee OA with the following variables recorded: the documentation of WLI (e.g., nonspecific weight-loss recommendations, specific consumer weight-loss resource/strategy or one developed by the provider, or referral to medical or surgical weight loss specialists), PT, Pharm, subject BMI (30-34.99, 35-39.99, 40+) and date of initial presentation (before or after the U.S. Food and Drug Administration [FDA] approval of GLP-1 receptor agonists for weight loss in June 2021). Results Providers offered WLI (23.33% of patients) significantly less often than pharmacotherapy (91.33%, OR 35.00 CI [12.57-139.56], p<0.001) and PT (71.33%, OR 15.40 [CI: 6.69-43.09], p<0.001). Among the subgroups, patients in the 40+ BMI category received the highest frequency of WLI (50%). Conclusion Despite WLI being a first-line intervention for obese patients with hip and knee OA, providers offer WLI less frequently than Pharm or PT. Providers offered WLI significantly more to patients with a BMI of 40+ kg/m 2 . There are opportunities for providers to offer structured WLI and referrals to medical and surgical weight loss specialists to improve clinical outcomes even prior to surgical optimization.