Obesity management is changing with there being a greater focus on incretin medications. However, with this comes concerns about the impact of these medications and weight loss programs on diet quality. Therefore, the primary aims of this pilot study was to assess the adequacy of the nationally available Healthy Weight For LifeTM (HWFL) programs(1) on diet quality and the impact of adding personalised medical nutrition therapy (MNT) consultations from an Accredited Practising Dietitian to the HWFL programs on diet quality. Secondary aims include assessing the difference in anthropometric measures and knee osteoarthritis outcomes (for those in the HWFL Osteoarthritis program) between intervention and usual care groups.
An 18-week randomised controlled trial was conducted. Participants were randomised to the usual care arm (HWFL program as usual) or the HWFL+MNT arm. Diet quality was assessed using the Australian Eating Survey – Heart version food frequency questionnaire(2), with diet quality assess as % energy from nutrient-dense core food. Weight and knee osteoarthritis outcomes using the knee osteoarthritis outcome scores, were self-reported and used to assess outcomes. An intention-to-treat analysis was undertaken using generalised linear mixed models with post-estimations reported as mean (95% CI) to assess within and between group differences.
Forty participants (75% female, 62±10years, 78% with osteoarthritis) were recruited. Baseline diet quality was poor (34% energy from non-core foods). Post-intervention both intervention and usual care groups significantly improved their diet quality and reduced weight, but there were no significant differences between groups. Sub-scores for knee osteoarthritis function significantly improved in the intervention compared to the control group (mean between group difference 17.4, 95%CI 1.6, 33.1, p=0.03), though after correcting for multiple testing this was no longer significant.
Both the intervention and usual care arms significantly improved diet quality and reduced their weight. The HWFL program coaching provides nutrition information, practical resources and strategies to help participants lose weight(1). Therefore, significant improvements in both the usual care and HWFL+MNT intervention arms were anticipated. For those with knee osteoarthritis significant improvements in knee osteoarthritis function was reported in the intervention group. While this did not remain significant after correcting for multiple testing, more research on the role of a dietitian on osteoarthritis outcomes is needed(3), therefore future interventions should explore this further.