VLCDs for Knee OA: Safe, Effective, and Underused

Plato Weight Management
Jun 8
3 min read

Updated: Jun 9

A Very Low-Calorie Diet (VLCD) is a medically supervised nutrition plan providing fewer than 800 kcal per day, typically delivered through nutritionally complete soups, shakes, or formulated meal replacements. Used short term—typically over 12 to 16 weeks—VLCDs are designed to produce rapid, clinically significant weight loss in a safe and structured way. For people with obesity-related knee osteoarthritis (OA), VLCDs can play a critical role in reducing joint pain, improving function, and preserving mobility—simply by relieving excess load on the knees.

Why VLCDs Matter in Knee OA Care

NICE guidelines recommend VLCDs in cases where rapid weight loss is clinically indicated, such as in patients with type 2 diabetes or those approaching surgical thresholds. This approach has already been implemented across the NHS in the Type 2 Diabetes Path to Remission Programme, with proven feasibility and safety, as demonstrated in the DiRECT and DROPLET trials.

Why Speed Matters

Data from Dabare et al. (2017) show that within five years, nearly 60% of people with severe knee OA and 40% with moderate OA require joint replacement.

But it’s not just about avoiding surgery. In those years, people often experience:

Chronic pain and limited mobility
Sleep issues and loss of independence
Escalating medication and injection use
Work loss or early retirement
Declining mental health

That’s why acting fast is essential.

A VLCD can help people achieve over 11% weight loss in just 12 weeks—far more than traditional diets. In fact, a 2023 study found VLCD participants reached the same weight loss in one month that Mediterranean diet participants needed three months to achieve.

Amplifying Physiotherapy Results

Weight loss alone helps, but its impact multiplies when paired with physiotherapy.

During the early stages of rehab, patients need reduced pain to fully engage in strength and mobility work. VLCDs accelerate this:

Reducing joint load and inflammation
Enabling faster exercise progression
Preventing compensatory injuries
Increasing adherence and motivation

This synergy ensures that patients don’t just lose weight—they move better, hurt less, and recover faster.

The Practical VLCD Approach

As used in the Bennell study, the KNEED program follows a structured plan:

Two daily formulated meal replacements
One self-prepared, whole-food meal

This hybrid model balances consistency and real-life sustainability. It also reduces decision fatigue—critical for long-term adherence.

Role of the Dietitian

A registered dietitian oversees every step of the VLCD process:

Tailors the meal plan to each patient
Ensures protein and micronutrient adequacy
Adjusts for comorbidities or medication interactions
Provides support during the transition to the Mediterranean diet

Appendix X (not shown here) includes a sample day plan and excluded food list for added clarity.

Addressing Safety Concerns

VLCDs challenge the common perception that “under 1200 kcal is unsafe.” When done properly, they’re fortified with essential nutrients and used under clinical supervision.

A review found average weekly losses of 1.5–2.5 kg with no major safety issues when monitored.

To ensure safety:

GPs should review medication and complete baseline labs
A 4-week follow-up is advised for those on insulin or antihypertensives
Patients at risk of sarcopenia or disordered eating should be carefully screened

Conclusion

VLCDs aren’t fringe—they’re an underused, evidence-based intervention with the power to rapidly transform outcomes in people with obesity-related knee OA. When paired with physiotherapy and expert support, they offer a scalable, cost-effective way to delay surgery, reduce pain, and improve quality of life.

Fast weight loss isn’t just about numbers—it’s about restoring function and dignity, fast.