Optimising body weight in people with obesity prior to knee or hip arthroplasty: A feasibility study utilising a dietitian‐led low inflammatory diet

Abstract

AbstractBackgroundWeight loss is recommended for people with obesity prior to undergoing total knee or hip arthroplasty. This study aimed to determine the feasibility of implementing a dietitian‐led low‐inflammatory weight‐loss diet for people with obesity awaiting arthroplasty. Secondary aims were to report weight change, patient‐reported outcomes, diet compliance, surgery deferment and diet acceptability.MethodsEligible participants were enrolled across two sequential periods; Usual Care (UC) was recruited, followed by an intervention period with a dietitian‐led weight‐loss programme (DT). Assessments occurred at baseline, 6‐month and pre‐surgery (11–12 months from baseline). Predefined diet feasibility outcomes included: (i) recruitment rate ≥60%, (ii) ≥60% of DT group reporting ≥10% improved compliance with low‐inflammatory diet by pre‐surgery, (iii) all DT participants attending ≥60% of dietitian consultations, (iv) proportion of DT group losing ≥5% weight double that of UC by pre‐surgery.ResultsNinety‐seven people participated (UC, n = 47, DT, n = 50). Baseline variables were similar between groups. None of the diet feasibility criteria were fulfilled: 52% of eligible people consented; 57% of DT group improved diet compliance; 72% of DT Group attended ≥60% of dietitian appointments; 31.4% of DT group lost ≥5% weight (compared to 20.6% of UC). Compared to UC group at pre‐surgery, DT group demonstrated modest weight loss (−1.7 kg (95%CI ‐3.5,0.2) versus −0.4 kg (−2.5,1.6)), and decreased waist circumference (−4.8 cm (−6.9,‐2.8) versus −2.2 cm (−5.2,0.7)). Three DT participants declined surgery due to improved symptoms.ConclusionUtilisation of a dietitian‐led low‐inflammatory weight‐loss diet was not feasible in this cohort. Suboptimal diet compliance likely explains the modest weight loss results.