Comparison of weight loss interventions in overweight and obese adults with knee osteoarthritis: A systematic review and network meta-analysis of randomized trials

s u m m a r yObjective: To ascertain the comparative effectiveness of weight-loss strategies for osteoarthritis (OA) to develop rational treatment algorithms aimed at improving OA-related symptoms in overweight/obese individuals.Method: Medline, Embase, CINAHL, Scopus, and Web of Science were searched from inception to June 2023 for observational studies and randomized trials.Network meta-analyses were performed using a frequentist approach.Effect sizes for pain and function were computed as standardized mean differences (SMDs), while weighted mean differences were computed for body weight.Results: 14 RCTs on knee OA (KOA) (3215 participants) with 7 interventions: diet (D); exercise (E); diet and exercise (DE); pharmacological (L); psychological (P); psychological, diet, and exercise (PDE); and Mediterranean diets (M) were networked.For weight change (kg), all interventions significantly outperformed control comparators, with benefits ranging from -7.0 kg (95% CI: -12.1 to -2.0 kg) for the most effective approach (PDE) to -4.9 kg (95% CI: -6.8 to -3.0 kg) for the least effective approach (D).In terms of SMDs for pain, only PDE (-1.2, 95% CI: -2.2 to -0.3), and DE (-0.6, 95% CI: -1.0 to -0.2) outperformed control comparators in improving the pain.Regardless of the chosen intervention, prediction intervals from metaregression analysis indicated that significant pain relief may be anticipated when patients achieve at least a weight reduction of 7.4%.Conclusions: PDE and DE interventions may offer the most effective approach for weight loss, potentially leading to significant improvements in pain and physical function among overweight/obese individuals with KOA if they achieve more than 7.4% weight loss.