Physiotherapist-Led Weight Management for People with Osteoarthritis

Welcome Back Rheumatology Fans,I have previously commented that “weight loss for Osteoarthritis is the best bang-for-buck treatment we have currently”:This slide occasionally gets me in hot water with other Physio’s and MSK Professionals but that doesn’t matter to me really, I stand by it and if anything I am becoming more wedded to this stance.Anyway… Ben Steele-Turner is an unstoppable force of Osteoarthritis information and dietary advice. I have shameless updated much of my teaching based on his answers to my questions.NOW HE IS PUBLISHING AS PART OF HIS PhD. His first article is open access HERE.I have written a short summary below but please click on the link and read the article in full.Physiotherapist-Led Weight Management for People with OsteoarthritisThis scoping review provides the most comprehensive overview to date of how weight management (WM) is currently understood, implemented, and perceived within physiotherapist-led care for people with osteoarthritis (OA). With 79 records included across 22 countries, the review highlights substantial variability in practice, persistent uncertainty around scope of practice, and a widespread need for improved training and confidence among physiotherapists.Why Weight Management Matters in OAThe evidence linking excess bodyweight to OA (particularly knee OA) is robust. Weight loss of as little as 7% can reduce pain, while more significant reductions can slow structural progression and reduce joint replacement risk. Despite strong guideline recommendations, weight management remains underprovided in OA care. Physiotherapists, who frequently work with people with OA and often have longer consultation times, may be well placed to address this gap.Current Practice: Highly Variable and Often MinimalAcross studies, the proportion of physiotherapists who reported including weight management ranged from very high (over 80% in some survey responses) to extremely low when actual practice was audited. For example, only 12% of individuals with knee OA in one prospective study reported receiving any weight management support during physiotherapy, and note audits showed weight management discussions documented in only about 10% of encounters. People with OA also consistently reported that weight management was either not addressed or addressed only superficially.Scope of PracticePhysiotherapists and people with OA expressed mixed views about whether weight management should fall within physiotherapy’s remit. Many clinicians felt it sat outside traditional physiotherapy roles, often preferring referral to dietitians (admittedly I do this!). However, people with OA who participated in a physiotherapist-led diet-plus-exercise trial reported positive perceptions, especially when physiotherapists had received additional training. This suggests that scope-of-practice concerns may be alleviated when physiotherapists feel more adequately prepared.Confidence and SkillsA recurring theme across the literature is discomfort discussing weight. Physiotherapists commonly feared damaging rapport, felt unsure how to raise weight sensitively, or believed that effective weight management strategies were outside their expertise. Many reported feeling untrained in nutrition or behavioural counselling, and physiotherapy students also identified weight management as a major skill gap.These concerns were echoed by people with OA, who sensed that physiotherapists had limited time and limited practical advice to offer. When weight management was addressed, it was often brief, generic, and lacking actionable support.Education Changes PracticePromisingly, trials of targeted weight management education, such as e-learning modules or structured upskilling programmes, showed clear improvements in physiotherapists’ confidence, knowledge, and attitudes. One physiotherapist-led intervention combining exercise with a structured very low-energy diet yielded clinically significant weight loss and symptom improvements, demonstrating feasibility and safety when clinicians are appropriately trained.Further Resources This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit rheumatologyphysio.substack.com/subscribe