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

BackgroundWeight 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.