OBJECTIVE: To assess the effectiveness of weight loss interventions on pain and disability in people with knee and hip osteoarthritis (OA) and spinal pain. DESIGN: Intervention systematic review. LITERATURE SEARCH: Eight online databases and clinical trial registries. STUDY SELECTION CRITERIA: Randomised controlled trials of any weight loss intervention (eg, diet, physical activity, surgical, pharmaceutical) that reported pain or disability outcomes of people with knee or hip OA, or spinal pain. DATA SYNTHESIS: We calculated mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI). We used the Cochrane risk of bias tool to assess risk of bias and GRADE to judge credibility of evidence. RESULTS: 22 trials with 3602 participants. There was very low to low credibility evidence for a moderate effect of weight loss interventions on pain intensity (10 trials, n = 1,806, SMD -0.54, 95%CI -0.86 to -0.22, I2 = 87%, p < 0.001) and a small effect on disability (11 trials, n = 1,821, SMD -0.32, 95%CI -0.49 to -0.14, I2 = 58%, p < 0.001) compared to minimal care for people with OA. For knee OA there was low to moderate credibility evidence that weight loss interventions were not more effective than exercise only for pain intensity or disability (4 trials n = 673, SMD -0.13, 95%CI -0.40 to 0.14, I2 = 55%; 5 trials, n = 737, SMD -0.20 95%CI -0.41 to 0.00, I2 = 32%). CONCLUSIONS: Weight loss interventions may have small to moderate improvements on pain and disability for OA compared to minimal care. There was limited and inconclusive evidence for weight loss interventions targeting spinal pain.

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