Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine, ANNALS-25-00045. https://doi.org/10.7326/ANNALS-25-00045 Dr. Michelle Hall et al.
Points
- A randomized trial assigned 101 adults with hip osteoarthritis and obesity to either a home exercise program or exercise combined with a very-low-calorie diet.
- At the six-month mark, adding the diet did not produce a clinically meaningful difference in the primary outcome of hip pain severity compared to exercise alone.
- The diet group experienced significantly greater weight loss and improvements in most secondary outcomes at six months, except for specific measures of hip pain and function.
- By twelve months, the benefits for the diet group extended to include improved hip pain and function scores as measured by the HOOS subscales.
- Despite the lack of a primary outcome benefit, 82% of participants in the diet group achieved a body weight loss of over 5% compared to only 16% in the exercise-only group.
Summary
In a 2-group superiority randomized trial (NCT04825483), researchers evaluated the efficacy of adding a very-low-calorie diet (VLCD) to exercise in overweight or obese adults with hip osteoarthritis. The study included 101 participants, with one group receiving a 6-month home exercise program via telehealth and the other receiving the same exercise program plus a VLCD supported by a dietitian. The primary outcome was the 6-month change in hip pain severity on an 11-point scale.
At 6 months, the addition of a VLCD was not superior to exercise alone for the primary outcome of hip pain severity, showing a mean difference of -0.6 units (95% CI, -1.5 to 0.3), which did not meet the minimum clinically important difference of 1.8. The VLCD plus exercise group lost 8.5% more body weight, and 82% of its participants achieved a weight loss of greater than 5%, compared to 16% in the exercise-only group. All secondary outcomes at 6 months, including quality of life and physical function, favored the VLCD plus exercise group, except for the HOOS pain and function subscales.
A follow-up at 12 months, with 94% of participants retained, showed that the benefits for the VLCD plus exercise group were maintained for weight, BMI, and overall hip improvement. Notably, the between-group differences for HOOS pain and function became apparent at 12 months, favoring the VLCD plus exercise intervention. The study, limited by the unblinded nature of the participants, concluded that while adding a VLCD to exercise did not improve the primary pain outcome at 6 months, it did improve most secondary outcomes and delayed measures of hip-specific pain and function.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00045
References Hall, M., Hinman, R. S., Knox, G., Spiers, L., McManus, F., De Silva, A. P., Sumithran, P., Harris, A., Murphy, N. J., Cicuttini, F., Hunter, D. J., Messier, S. P., & Bennell, K. L. (2025). Efficacy of a very-low-calorie weight loss diet plus exercise compared with exercise alone on hip osteoarthritis pain: A randomized controlled trial. Annals of Internal Medicine, ANNALS-25-00045. https://doi.org/10.7326/ANNALS-25-00045
