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

Shahid A, Thirumaran AJ, Christensen R, Venkatesha V, Henriksen M, Bowden JL, Hunter DJ · Osteoarthritis and Cartilage

Separates losing weight from feeling better, and the two do not track. Every intervention beat control on weight, from −11.2 kg (95% CI −16.0 to −6.5) for psychological + diet + exercise down to −4.7 kg (−6.7 to −2.7) for diet + exercise. On pain, only diet + exercise beat control (−2.2 on a 0-20 scale, 95% CI −4.1 to −0.21); the intervention that took off the most weight did not (−3.9, 95% CI −8.4 to 0.5). Meta-regression put the threshold for anticipated pain relief at **at least 7% body-weight reduction**, whatever the route.

Population

2,800 participants across 13 randomized trials in overweight and obese adults with knee osteoarthritis

Intervention

Seven strategies networked against each other — diet, exercise, diet + exercise, pharmacological, psychological, psychological + diet + exercise, and Mediterranean diet

Comparator

Control comparators and each other

Limitations

**An Expression of Concern was published in Osteoarthritis and Cartilage in November 2024** (doi 10.1016/j.joca.2024.10.001). Recorded per CONTENT-GUIDE rule 8 with that flag attached; the 7% threshold it reports is consistent with the older weight-loss literature, but the paper should not be cited as if unqualified. Network meta-analysis compares interventions that were never randomised against each other, and pain estimates rest on 13 trials split across seven nodes.