OBJECTIVE: To determine the variable most closely related to symptomatic relief of osteoarthritis (OA) of the knee in response to a weight control program. METHODS: Twenty-two patients diagnosed with knee OA whose body mass index (BMI) was more than 26.4 were treated with a low calorie diet, an appetite suppressant, and nonsteroidal antiinflammatory drugs for 6 weeks. The patients were instructed to follow a walking program. We analyzed BMI, percent body fat, the average number of steps per day by pedometer, and the metabolic correlates of obesity (blood pressure, fasting blood serum glucose, total cholesterol, triglycerides, and serum insulin) at the beginning and end of therapy. The correlation between the change in each variable and the remission score (delta score) using the Severity Index of Lequesne, et al was evaluated. RESULTS: Delta score of knee OA was more strongly associated with reduction in percent body fat (p = 0.0013, r = 0.62) than other variables. Significant correlation was also observed between the number of steps per day and delta score (p = 0.0031, r = -0.58). No other variable, including weight loss, was significantly correlated with delta score. There was a significant correlation between delta percent body fat and the number of steps per day (p = 0.012, r = -0.62). CONCLUSION: In a weight control program, decreasing body fat and increasing physical activity are more important than body weight loss or decreasing other indices of obesity in producing symptomatic relief of knee OA, although there is not necessarily a cause and effect relationship between body fat and OA score.

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