Weight Loss, but Not at Any Cost: Risks and Challenges in Patients with Osteoarthritis

Osteoarthritis (OA) is a prevalent joint disorder characterised by the deterioration of the entire joint. Among its primary risk factors, obesity significantly contributes to OA onset and progression. Weight reduction in individuals with OA can alleviate pain, enhance joint function, and potentially delay or prevent the need for surgical interventions. However, despite these benefits, the potential risks and detriments associated with weight loss in OA patients warrant careful evaluation. This review synthesises available data on the multifaceted effects of weight loss interventions in OA patients, including risks of weight regain, malnutrition, sarcopenia, joint instability, bone density reduction, and psychoemotional stress due to fluctuating weight. A comprehensive search was conducted across major databases, identifying studies that assessed the physical, mental, and quality of life impacts of weight loss in knee and hip OA populations. Rapid weight loss may destabilise joints, lead to muscle and bone loss, and increase the risk of malnutrition and osteoporosis. Additionally, psychological distress from weight loss failures or fluctuations can adversely affect mental health and quality of life, underscoring the need for balanced weight management strategies. Long-term weight loss maintenance remains a challenge, with high rates of weight regain observed in OA patients. Emerging anti-obesity drugs hold potential for more sustained outcomes, albeit with uncertainties remaining. By adopting a holistic approach that addresses both physical and mental aspects, healthcare providers can improve outcomes and quality of life for OA patients, tailoring strategies to reduce the potential harms associated with aggressive or unsupervised weight reduction efforts.