Expert consensus on obesity combined with osteoarthritis (2025 edition)_West China Medical Journal

Authors：

 Obesity Research Branch of the Biophysical Society of China , Zhengzhou Central Hospital Affiliated to Zhengzhou University , Beijing Jishuitan Hospital Zhengzhou Hospital , Obesity and Diabetes Proactive Health Professional Committee of China Association for Promotion of Health Science and Technology

Corresponding?author：

Obesity Research Branch of the Biophysical Society of China, Email: lhklzdavid716@zzu.edu.cn

Keywords：

Obesity; osteoarthritis; joint replacement; metabolic and bariatric surgery; weight management

DOI：

10.7507/1002-0179.202508264

Video：

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Abstract Full text Figures/Tables Video References Cited by

Obesity and osteoarthritis (OA) are two major global public health challenges, and their comorbidity has been steadily increasing in China, presenting new challenges in clinical diagnosis and treatment. Obesity combined with OA differs from other OA subtypes in terms of diagnosis, assessment, and treatment, requiring an integrated approach to weight management and joint protection. In response, the Obesity Research Branch of the Biophysical Society of China, in collaboration with multidisciplinary experts, developed this expert consensus based on a systematic review of recent evidence from evidence-based medicine, employing the Delphi method. This consensus introduces the innovative “obesity-OA” dual-axis assessment concept and proposes a tiered treatment protocol for different obesity grades and OA stages, which includes conservative treatment, weight-loss medications, metabolic and bariatric surgery, and joint replacement surgery. The consensus also covers multidisciplinary evaluation, perioperative management, and postoperative follow-up, resulting in 6 core themes with 17 recommendations. The goal is to provide a scientific and systematic clinical practice guide for the standardized diagnosis and treatment of obesity combined with OA in China.

Citation： Obesity Research Branch of the Biophysical Society of China, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Beijing Jishuitan Hospital Zhengzhou Hospital, Obesity and Diabetes Proactive Health Professional Committee of China Association for Promotion of Health Science and Technology. Expert consensus on obesity combined with osteoarthritis (2025 edition). West China Medical Journal, 2025, 40(12): 1891-1900. doi: 10.7507/1002-0179.202508264 Copy

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2. Li Z, Chen Y, Shen Z. Global shifts in osteoarthritis subtype trends among older adults due to elevated BMI: an age-period-cohort analysis based on the global burden of disease database. Front Public Health, 2025, 13: 1518572.
3. Dorais M, Martel-Pelletier J, Raynauld JP, et al. Impact of oral osteoarthritis therapy usage among other risk factors on knee replacement: a nested case-control study using the Osteoarthritis Initiative cohort. Arthritis Res Ther, 2018, 20(1): 172.
4. GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol, 2023, 5(9): e508-e522.
5. Allen KD, Thoma LM, Golightly YM. Epidemiology of osteoarthritis. Osteoarthritis Cartilage, 2022, 30(2): 184-195.
6. Blagojevic M, Jinks C, Jeffery A, et al. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage, 2010, 18(1): 24-33.
7. Nedunchezhiyan U, Varughese I, Sun AR, et al. Obesity, inflammation, and immune system in osteoarthritis. Front Immunol, 2022, 13: 907750.
8. Sampath SJP, Venkatesan V, Ghosh S, et al. Obesity, metabolic syndrome, and osteoarthritis-an updated review. Curr Obes Rep, 2023, 12(3): 308-331.
9. 陳耀龍, 李幼平, 杜亮, 等. 醫學研究中證據分級和推薦強度的演進. 中國循證醫學雜志, 2008, 8(2): 127-133.
10. Buchanan WW, Kean CA, Kean WF, et al. Osteoarthritis. Inflammopharmacology, 2024, 32(1): 13-22.
11. 賈笛, 韋佳佳, 段修權, 等. 基于全球視角的中國骨關節炎疾病負擔分析. 現代預防醫學, 2022, 49(13): 2401-2405.
12. Long H, Liu Q, Yin H, et al. Prevalence trends of site-specific osteoarthritis from 1990 to 2019: findings from the Global Burden of Disease Study 2019. Arthritis Rheumatol, 2022, 74(7): 1172-1183.
13. Deshpande BR, Katz JN, Solomon DH, et al. Number of persons with symptomatic knee osteoarthritis in the US: impact of race and ethnicity, age, sex, and obesity. Arthritis Care Res (Hoboken), 2016, 68(12): 1743-1750.
14. Grotle M, Hagen KB, Natvig B, et al. Obesity and osteoarthritis in knee, hip and/or hand: an epidemiological study in the general population with 10 years follow-up. BMC Musculoskelet Disord, 2008, 9: 132.
15. Toivanen AT, Heli?vaara M, Impivaara O, et al. Obesity, physically demanding work and traumatic knee injury are major risk factors for knee osteoarthritis--a population-based study with a follow-up of 22 years. Rheumatology (Oxford), 2010, 49(2): 308-314.
16. Sanchez-Santos MT, Judge A, Gulati M, et al. Association of metabolic syndrome with knee and hand osteoarthritis: a community-based study of women. Semin Arthritis Rheum, 2019, 48(5): 791-798.
17. Swain S, Sarmanova A, Mallen C, et al. Trends in incidence and prevalence of osteoarthritis in the United Kingdom: findings from the Clinical Practice Research Datalink (CPRD). Osteoarthritis Cartilage, 2020, 28(6): 792-801.
18. Scott D, Blizzard L, Fell J, et al. Prospective study of self-reported pain, radiographic osteoarthritis, sarcopenia progression, and falls risk in community-dwelling older adults. Arthritis Care Res (Hoboken), 2012, 64(1): 30-37.
19. McLaughlin T, Ackerman SE, Shen L, et al. Role of innate and adaptive immunity in obesity-associated metabolic disease. J Clin Invest, 2017, 127(1): 5-13.
20. Tussiwand R, Gautier EL. Transcriptional regulation of mononuclear phagocyte development. Front Immunol, 2015, 6: 533.
21. Gl?ersen M, Steen Pettersen P, Neogi T, et al. Associations of body mass index with pain and the mediating role of inflammatory biomarkers in people with hand osteoarthritis. Arthritis Rheumatol, 2022, 74(5): 810-817.
22. Vázquez-Vela ME, Torres N, Tovar AR. White adipose tissue as endocrine organ and its role in obesity. Arch Med Res, 2008, 39(8): 715-728.
23. Xie C, Chen Q. Adipokines: new therapeutic target for osteoarthritis?. Curr Rheumatol Rep, 2019, 21(12): 71.
24. 李超哲, 孫炳慧. 肥胖、高血壓與骨關節炎相關研究進展. 臨床醫學進展, 2025, 15(2): 1859-1863.
25. Wang T, He C. Pro-inflammatory cytokines: the link between obesity and osteoarthritis. Cytokine Growth Factor Rev, 2018, 44: 38-50.
26. 許吉昊, 季明亮, 任可, 等. 代謝綜合征與骨關節炎關系的研究進展. 中國骨與關節雜志, 2021, 10(11): 867-872.
27. 中國骨關節炎診療指南專家組, 中國老年保健協會疼痛病學分會, 黃東, 等. 中國骨關節炎診療指南(2024 版). 中華疼痛學雜志, 2024, 20(3): 323-338.
28. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
29. Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res, 2016, 474(8): 1886-1893.
30. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser, 2000, 894: 1-253.
31. Gold GE, Cicuttini F, Crema MD, et al. OARSI Clinical Trials Recommendations: hip imaging in clinical trials in osteoarthritis. Osteoarthritis Cartilage, 2015, 23(5): 716-731.
32. 中華人民共和國國家衛生健康委員會醫政司. 肥胖癥診療指南(2024 年版). 中華消化外科雜志, 2024, 23(10): 1237-1260.
33. 中華醫學會外科學分會甲狀腺及代謝外科學組, 中國醫師協會外科醫師分會肥胖和代謝病外科專家工作組. 中國肥胖及代謝疾病外科治療指南(2024 版). 中國實用外科雜志, 2024, 44(8): 841-849.
34. Liu S, Yu J, Wang L, et al. Weight-adjusted waist index as a practical predictor for diabetes, cardiovascular disease, and non-accidental mortality risk. Nutr Metab Cardiovasc Dis, 2024, 34(11): 2498-2510.
35. Xu J, Wang A, Meng X, et al. Obesity-stroke paradox exists in insulin-resistant patients but not insulin sensitive patients. Stroke, 2019, 50(6): 1423-1429.
36. Alshuweishi Y, Almufarrih AA, Abudawood A, et al. Patterns of lipid abnormalities in obesity: a comparative analysis in normoglycemic and prediabetic obese individuals. J Pers Med, 2024, 14(9): 980.
37. 中華醫學會糖尿病學分會. 中國糖尿病防治指南(2024 版). 中華糖尿病雜志, 2025, 17(1): 16-139.
38. Collins NJ, Misra D, Felson DT, et al. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11(0 11): S208-228.
39. Dobson F, Hinman RS, Roos EM, et al. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage, 2013, 21(8): 1042-1052.
40. 中國心血管疾病患者居家康復專家共識編寫組. 中國心血管疾病患者居家康復專家共識. 中國循環雜志, 2022, 37(2): 108-121.
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West China Medical Journal

Expert consensus on obesity combined with osteoarthritis (2025 edition)

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