Formula Diet Reduces Weight, Improves Nutritional Status, and Increases Bone Mineral Density in OsteoarthritisWednesday, January 4, 2012
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.
Christensen 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