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Effects of a 4-week Dietary Behavior Modification Program on Disability, Pain, Weight, and Body Mass Index in Overweight Individuals with Knee Osteoarthritis

Khwansirin Chantawat, Chakree Chumvisoot Wattanasiri, Theera Rittirod, Theerasak Boonwang, Donlaya Promkeaw

Abstract

Objective: This study evaluated the effects of a 4-week dietary behavior modification program on disability, pain, weight, and body mass index (BMI) in overweight adults with osteoarthritis knee (OA knee).
Material and Methods: An assessor-blinded study was conducted among adults aged 45–75 years with OA knee and BMI 25.0–29.9 kg/m². Participants who reported a pain score of 4 of 10 or greater on the numeric rating scale were enrolled. They (n= 18) were allocated to a 4-week dietary program emphasizing the Thai food-based dietary guidelines (50% vegetables and fruits, 25% whole-food carbohydrates, 25% lean protein), with 3 meals/day, no calorie counting, and food diaries. Outcomes were assessed at baseline and 4 weeks in random order, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for disability, weight, BMI, and visual analog scale (VAS) for pain.
Results: After 4 weeks, there were significant improvements in weight and BMI, alongside WOMAC score, with clinically meaningful reductions in knee pain on the VAS. The dietary approach demonstrated good adherence via diaries and lacked adverse events related to dieting.
Conclusion: The 4-week dietary behavior modification program grounded in Thai food-based dietary guidelines can positively influence weight, pain, and disability outcomes in overweight individuals with OA knee, supporting weight management as a pivotal nonpharmacological strategy.

 Keywords

Functional limitation; nutrition; obesity; degenerative joint; weight loss

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References

Safiri S, Kolahi AA, Smith E, Hill C, Bettampadi D, Mansournia MA, et al. Global, regional and national burden of osteoarthritis 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017. Ann Rheum Dis 2020;79:819-28. PubMed

Raud B, Gay C, Guiguet-Auclair C, Bonnin A, Gerbaud L, Pereira B, et al. Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis. Sci Rep 2020;10:3601. PubMed

Sinha D, Dash SS, Kachhwaha R. Systematic review on treatment of knee osteoarthritis. Himal J Health Sci 2024;9:17-23. Himalayan Journal of Health Sciences

Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol 2006;33:2271-9. PubMed

Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA 2013;310:1263-73. PubMed

Messier SP, Resnik AE, Beavers DP, Mihalko SL, Miller GD, Nicklas BJ, et al. Intentional weight loss in overweight and obese patients with knee osteoarthritis: is more better? Arthritis Care Res (Hoboken) 2018;70:1569-75. PubMed

Ostendorf DM, Caldwell AE, Zaman A, Pan Z, Bing K, Wayland LT, et al. Comparison of weight loss induced by daily caloric restriction versus intermittent fasting (DRIFT) in individuals with obesity: study protocol for a 52-week randomized clinical trial. Trials 2022;23:718. PubMed

Arciero PJ, Arciero KM, Poe M, Mohr AE, Ives SJ, Arciero A, et al. Intermittent fasting two days versus one day per week, matched for total energy intake and expenditure, increases weight loss in overweight/obese men and women. Nutr J 2022;21:36. PubMed

King LK, Stanaitis I, Hung V, Koppikar S, Waugh EJ, Lipscombe L, et al. National Institute of Health and Care Excellence clinical criteria for the diagnosis of knee osteoarthritis: a prospective diagnostic accuracy study in individuals with type 2 diabetes. Arthritis Care Res (Hoboken) 2025;77:623-30. PubMed

Sirichakwal PP, Sranacharoenpong K. Practical experience in development and promotion of food-based dietary guidelines in Thailand. Asia Pac J Clin Nutr 2008;17(Suppl 1):63-5. PubMed

Sirichakwal PP, Sranacharoenpong K, Tontisirin K. Food based dietary guidelines (FBDGs) development and promotion in Thailand. Asia Pac J Clin Nutr 2011;20:477-83. PubMed

Yusuf E, Nelissen RG, Ioan-Facsinay A, Stojanovic-Susulic V, DeGroot J, van Osch G, et al. Association between weight or body mass index and hand osteoarthritis: a systematic review. Ann Rheum Dis 2010;69:761-5. PubMed

Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res 2018;11:851-6. PubMed

Kuptniratsaikul V, Rattanachaiyanont M. Validation of a modified Thai version of the Western Ontario and McMaster (WOMAC) osteoarthritis index for knee osteoarthritis. Clin Rheumatol 2007;26:1641-5. PubMed

Aksaranugraha S. Modified WOMAC scale for knee pain. ASEAN J Rehabil Med 2000;9:82-5. rehabmed.or.th

Ciaffi J, Mancarella L, Pederzani G, Lisi L, Brusi V, Pignatti F, et al. Efficacy, safety, and tolerability of a very low-calorie ketogenic diet in women with obesity and symptomatic knee osteoarthritis: a pilot interventional study. Nutrients 2024;16:3236. PubMed

Webb EJ, Osmotherly PG, Baines SK. Effect of dietary weight loss and macronutrient intake on body composition and physical function in adults with knee osteoarthritis: a systematic review. J Nutr Gerontol Geriatr 2022;41:103-25. PubMed

Jiang X, Nelson AE, Cleveland RJ, Beavers DP, Schwartz TA, Arbeeva L, et al. Precision medicine approach to develop and internally validate optimal exercise and weight-loss treatments for overweight and obese adults with knee osteoarthritis: data from a single-center randomized trial. Arthritis Care Res (Hoboken) 2021;73:693-701. PubMed

Sadeghi A, Zarrinjooiee G, Mousavi SN, Abdollahi Sabet S, Jalili N. Effects of a Mediterranean diet compared with the low-fat diet on patients with knee osteoarthritis: a randomized feeding trial. Int J Clin Pract 2022;2022:7275192. PubMed

Lawford BJ, Hinman RS, McManus F, Lamb KE, Egerton T, Keating C, et al. How does exercise, with and without diet, improve pain and function in knee osteoarthritis? A secondary analysis of a randomized controlled trial exploring potential mediators of effects. Arthritis Care Res (Hoboken) 2023;75:2316-27. PubMed

Ellegaard K, Guldberg-Møller J, Boesen M, Kristensen LE, Gudbergsen H, Jensen L, et al. Change in ultrasound-based knee joint inflammatory markers after weight loss in patients with osteoarthritis: a prospective cohort study [abstract]. Ann Rheum Dis 2022;81(Suppl 1):882. OpenAlex

Bennell KL, Keating C, Lawford BJ, Kimp AJ, Egerton T, Brown C, et al. Better Knee, Better Me™: effectiveness of two scalable health care interventions supporting self-management for knee osteoarthritis - protocol for a randomized controlled trial. BMC Musculoskelet Disord 2020;21:160. Scholars@Duke

Dolatkhah N, Toopchizadeh V, Barmaki S, Salekzamani Y, Najjari A, Farshbaf-Khalili A, et al. The effect of an anti-inflammatory in comparison with a low caloric diet on physical and mental health in overweight and obese women with knee osteoarthritis: a randomized clinical trial. Eur J Nutr 2023;62:659-72.

DOI: http://dx.doi.org/10.31584/jhsmr.20261492

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About The Authors

Khwansirin Chantawat
Master of Science in Health Promotion Through Integrative Medicine, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai 57100,
Thailand

Chakree Chumvisoot Wattanasiri
Department of Applied Thai Traditional Medicine, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai 57100,
Thailand

Theera Rittirod
Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen 40000,
Thailand

Theerasak Boonwang
Department of Sports and Health Science, School of Health Science, Mae Fah Luang University, Chiang Rai 57100,
Thailand

Donlaya Promkeaw
Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai 57100,
Thailand

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2023 (June)
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