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Formula Diet Reduces Weight, Improves Nutritional Status, and Increases Bone Mineral Density in Osteoarthritis

Regular readers will be well aware of the rather close relationship between obesity and risk for osteoarthritis. Indeed, the vast majority of patients with severe osteoarthritis are significantly obese and at considerable risk of gaining even more weight due to decreasing levels of physical activity, chronic pain, and depression.

Although weight loss has been well-documented to reduce pain, increase mobility, and improve quality of life in patients with osteoarthritis, achieving and maintaining weight loss is particularly challenging in these patients. Being both sedentary and elderly, most patients have markedly reduced caloric requirements. Thus, creating an energy deficit often requires the use of formula diets and/or nutritional supplements to avoid nutritional deficiencies while restricting calories.

A study by Pia Christensen and colleagues from the University of Copenhagen, now published in the European Journal of Clinical Nutrition, shows how the use of such low-calorie formula diets can not only help patients with osteorarthritis lose weight, but also help improve their nutritional status and strengthen their bones.

Christensen and colleagues enrolled 192 obese patients (mean BMI ~37 kg/m2) with knee osteoarthritis into an intense weight-loss program (the Cambridge Weight Plan) consisting of an 8-week formula weight-loss diet 415-810 kcal per day, followed by 8 weeks on a hypo-energetic 1200 kcal per day diet with a combination of normal food and formula products.

A total of 175 patients (91%), completed the 16-week program and had a body weight loss of 14.0  kg, consisting of 1.8  kg lean body mass and 11.0  kg fat mass.

During the 16-week intervention, plasma levels of vitamin D and B12 as well as bone mineral density increased significantly, findings that would be difficult, if not impossible, to achieve without the use of nutritional supplements.

Given the special challenges that patients with osteoarthritis face when trying to lose weight (either to simply reduce their pain and improve their mobility or in preparation for knee-replacement surgery), this study shows that using a calorie-restricted formula diet and nutritional supplements can not only help patients lose weight but also improve their nutritional status and bone health (not to be discounted especially in patients preparing for surgery).

In our own anecdotal experience, the use of low-calorie formula diets in patients with osteoarthritis, either in preparation for surgery or as a means to sustain significant weight loss, has been most rewarding and certainly provides a treatment option that cannot be safely or effectively achieved with ‘real’ food alone.

Clearly, the extended and/or intermittent use of medically supervised nutritionally balanced and optimised formula diets provides a reasonable approach to weight management in sedentary elderly obese patients, especially those immobilised by severe osteorarthritic pain.

Berlin, Germany

ResearchBlogging.orgChristensen P, Bartels EM, Riecke BF, Bliddal H, Leeds AR, Astrup A, Winther K, & Christensen R (2011). Improved nutritional status and bone health after diet-induced weight loss in sedentary osteoarthritis patients: a prospective cohort study. European journal of clinical nutrition PMID: 22190136


  1. Here’s a possible alternative:

    I was severely obese and required bilateral hip replacements at a very young age due, in large part, to my severe obesity.

    Over the past year and a half, I have lost 186 lbs. and counting – which is about 49 per cent of my starting body weight – on the Weight Watchers Program, without Bariatric surgery. I find the program to be exceptional. You are eating regular food and the program is balanced in that it also teaches and incorporates daily “Good Health Guidelines” to ensure you are getting, among other things, all of your body’s daily nutritional requirements and activity.

    While Dr. Sharma calls me a “severe outlier,” my point is that it can be done without necessarily the use of a “formula diets.”

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  2. Thanks so much for this. I am age 43, BMI above 50 and scheduled for gastric bypass. Osteo arthritis in my knees (and slightly in my hips) was only diagnosed six months ago (July 2011). It may well have been present for some time but it only became apparent and started to become difficult / restricting my movements this year.

    Was not sure whether to consider a VLCD (very low calorie diet) like Cambridge Diet pre-op or even post op for first month or so, whilst having to live on liquids, but this research suggests the extra nutritional value from the formula food would be extremely useful.

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  3. Also, as you mention, once people with osteo-arthritis have restricted movement, we are very limited in how much “physical activity” we can do in order to lose weight or even maintain an existing weight.

    I spent 3 months on crutches last summer (July – September 2011) after a traumatic knee injury (which then did not recover quickly due to the residual osteo-arthritis). During the months on crutches my weight went up a few pounds, and my body shape became rotund. Simply not walking on a daily basis seemed to cause even more fat to accumulate round my belly, even though my weight gain was very small.

    Fortunately I have been mobile since October and am beginning to walk normally again (although stairs are still a challenge). Attempting to run or contemplating a 2 or 3 mile walk would still be difficult ….. but I am beginning to see that all of these things might become possible again once my weight decreases further.

    Since I came off the crutches I have lost just over 15 lbs and already feel much lighter and more agile, and walking short distances is no longer daunting and difficult.

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  4. Everyone I know who has been on one of those has gained back the weight they lost plus extra (a lot extra) within a few years. As a matter of fact, those very low calorie liquid diets are the reason why at least three people in my extended family went from slightly fat (BMI probably under 35) to very fat (BMI almost certainly over 45). Any study that doesn’t look at outcomes after weight regain is useless, since the majority of people do regain.

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  5. I’m definitely with DeeLeigh on this one. The very real long-term negative effects of a VLCD not only usually erase the initial positive results, but also set the stage for even worse results in the future due to the terrible effect such diets have on one’s metabolism.

    A VLCD is perhaps sustainable in the short term under strict medical supervision, but totally unmanageable and indeed dangerous in the long term. Scientists, get back to your drawing boards!

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  6. Diet and exercises both are important for people with osteoarthritis. Exercises not only help with weight loss but also with the osteaorthritis itself as it improves the scaffolding around the joint. You can lean more about exercises for osteaorthritis at http://www.ExercisesFor

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  7. Hi Doc:
    Just a thought on the low calorie half formula diet–it is like anyother weight managment program, once stopped and the previous normal is returned to the weight has no choice but to return. Bariatric surgery like Weight Watchers nad other diets needs to be maintained to be effective very few could spend the rest of there lives on a half liquid suppliment diet, a few could spend a long time on Weight Watchers: both of these programs are the same they must be continued to work just like post-bariatric sugery diets must be maintained. The sad part that a lot of people don’t realize is that anasethia is weight dependent ml of medication to kilo of body wight–if a patient gets to much anasethia they could easily end up doing a Michal Jackson impersonation.

    After a two year wait and all the weight wise modules I finally got into the Weight Wise clinic–the dietian and psychologist decided to put me on the diabetic carb counting plan, which is not easy. I started at a BMI of 43 and by the time I got in I was down to 34 on mostly my own effortand have plataued at just over 200 lbs for over 10 months. I have arthritis in my right foot which means brisk walking and other exersizes is more than a challenge. If I coud get the name of the liquid suppliment used in this study it would be interesting information, the name was not given in the study quoted.

    However, to the other postings, as doctor Sharma has siad, regaining the lost weight is almost a gerantee

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  8. Actually DeeLeigh and NewMe: yes you do have point that VLCD’s are very often unsustainable long term, and can lead to weight re-gain.

    In fact I am living proof of that. I did attempt a previous VLCD (not Cambridge, another provider) about 4 years ago. Lost 50 lbs (did not stay on the program long enough to reach goal) and put it back on again …. but at that point I was attempting the VLCD with a football sized stomach, so when I returned to “normal” food my appetite of a football sized stomach person also returned

    For me, considering using a VLCD for a month pre-bypass surgery and possibly post bypass surgery (liquid stage) is less daunting, as I know it will be only a temporary measure ….. and I will be able to consume very little post op anyway.

    Obviously this does not perhaps answer the conundrum of whether a very restrictive VLCD is the absolute best option for other osteo-arthritis patients who are not going for surgery.

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