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The content displayed in this transcript is the intellectual property of Ashley Buck and the OA Action Alliance. You may not reuse, republish, or reprint such content without written consent. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS or the U.S. Government. This transcript was automatically generated in Zoom, and edited for clarity, however, the OAAA cannot guarantee there are no mistakes or errors.

September 21, 2022

Title: Mind the Gap: Exploring Nutritional Health and Weight Management Interests of Individuals with Osteoarthritis

Presenter: Ashley Buck, MS

INTRODUCTION:

(Katie Huffman) Hello, and welcome to the Osteoarthritis Action Alliance Lunch and Learn Webinar for September 21, 2022. Our presenter today is Ashley Buck. Ms. Buck is a PhD student in the Human Movement Science Curriculum at the University of North Carolina at Chapel Hill and is a member of the Pietro Simone Lab Group in the MOTION Science Institute. Her primary research interests are in exploring the impacts of ACL injury on knee biomechanics and biochemistry to further understand the development of post-traumatic Osteoarthritis. She completed her Bachelor of Science in Sports Medicine at Pepperdine University (2016) and her Master of Science in Kinesiology at Seattle University (2022). At Seattle University, she worked under Dr Sarah Shultz assisting in research surrounding Osteoarthritis and lower extremity biomechanics in children with obesity. Ms. Buck is a member of the Osteoarthritis Action Alliance Weight Management Task Group. Her presentation today is titled Mind the Gap: Exploring Nutritional Health and Weight Management Interests of Individuals with Osteoarthritis.

PRESENTATION: 

Ashley Buck: Awesome! Thank you, Katie, and thank you everyone for joining me today. I will be presenting the findings from one of our recent studies, which was examining the nutritional and weight management topics of interest for individuals with Osteoarthritis. I will also touch on the discrepancy between what patients want to know and what information healthcare professionals are discussing with their patients.

And so, to begin, here are just a few disclosures. I want to say thank you to everyone who contributed to this project, because although I’m the one presenting our work today, this project could not have been possible without the OA Action Alliance, all of the co-authors. and all other contributing individuals. So, thank you, to everyone who participated in this project. To give a quick overview of today’s presentation, I will discuss the nutritional-based topics of interest for individuals with OA as well as the format in which these patients prefer to receive this nutritional education information. I will also touch on the specific topics that health care professionals report discussing with their patients regarding their OA management, and I will touch on the next steps, moving forward to use this information, to optimize OA treatment and management for these patients.

Arthritis is one of the leading causes of disability in the United States and worldwide. It is also the most common form of arthritis. It is characterized by pain in the joints, and most commonly affects the hands, hips, and knees. It is estimated that 32.5 million adults in the US have OA, and this comes with both economic and personal burden. It has been estimated that about 136 billion dollars are spent annually on the treatment and management of OA, and while those associated economic burdens are significant, there are also personal burdens that are notable, such as the associated pain, stiffness, functional impairments, as well as overall reductions and sleep and quality of life. OA is a chronic and progressive disease, and so there is no cure or disease modifying drug therapy. Therefore, the focus is now largely on risk factor modification as well as disease and symptom management.

OA has a multitude of risk factors, including increasing age, being overweight or having obesity, and previous injury to name a few. And while some of those risk factors are modifiable, many people still go on to develop OA, and therefore, the focus is now largely on disease and symptom management for the individuals that develop OA. Getting more into OA management, many interventions are aimed at reducing and managing pain, yet disease management still remains a challenge due to the chronic and progressive nature of the disease. Some common approaches to osteoarthritis management include corticosteroids, assistive devices, self-management or self-efficacy, prescription pain management and oftentimes joint replacement surgery. Additionally, and their new guidelines, The American College of Rheumatology highlighted strong recommendations for self-advocacy and self-management programs for the management of knee and hip OA, and for the purpose of this presentation I will largely be focusing on the self-management of OA.

The first important strategy for a management that I’m going to discuss is weight loss and exercise due to its known impact on reducing joint loading. Specifically, it has been found that a ten-pound weight loss can reduce joint loading by about forty pounds. However, it is also important to both the individuals with OA and obesity. It may be difficult for them to adapt an active lifestyle as this may have not been part of their previous lifestyle habit. Although I would also like to point out that low activity levels, or lack of exercise are not the only contributing factors to obesity and osteoarthritis, and therefore many people who are active who develop OA. Additionally, some challenges with this practice are accessibility as well as functional status. So, if someone’s joint pain is inhibiting them from our taking in an active lifestyle as well as motivation and socioeconomic status-so whether these individuals have the means to pay for, say, a gym membership to partake in exercises that help the joints, such as swimming or yoga, or the elliptical. But overall research to date has shown that exercise and weight loss are some of the most effective ways to manage OA due to the reductions in joint loading and information, as well as the overall improvements and sleep mental health, and quality of life.

Another self-management practice is dietary and nutritional modifications. It has been found that these nutritional modifications do yield favorable weight loss results, and therefore decrease joint loading and can improve symptoms overall. It has also been found that dietary modifications can reduce systemic joint inflammation, induced weight loss, and anti-inflammatory nutritional patterns should be considered key components in OA management. However, evidence is conflicting surrounding the effectiveness of certain foods and nutrients and their ability to reduce OA symptoms. For example, the vitamins d and k, and ginger and berries have been found to be effective in reducing symptoms in some cohorts, however, the evidence is still limited. Additionally, dietary and nutritional modifications do assume a certain level of health literacy for these individuals, and there are oftentimes constraints surrounding healthcare provider nutritional guidance. It has been found that most healthcare providers do not feel equipped enough to provide nutritional guidance for OA management, and less than 30% of healthcare providers actually provide this obesity counseling.

Research has found that most individuals with OA do believe that what they eat can affect their symptoms. Specifically, almost 80% of individuals with OA are interested in receiving nutritional counseling. However, only 7.6% of those individuals actually recorded receiving nutritional counseling from their health care provider. It has also been found that most dietary and nutritional modifications are made without the proper consultation of a health care professional. This may lead individuals to turn towards other resources, such as websites and social media for this information, but it should be noted that the quality of web-based information on diet and OA management varies greatly and is questionable. Unfortunately, it still remains unclear what patients are receiving sufficient nutrition education with regards to their OA and symptom management, and therefore the primary purpose of our study was to determine the nutritional and weight management, topics of interest for individuals with OA as well as their preferred delivery methods.

Our secondary aim was to determine whether there is a disconnect between what patients want to know and what information healthcare providers provide for OA management during clinical interactions with their patients. A group of inter-professional individuals developed two separate surveys for this project. One was a survey for patients with OA, and the other survey was for healthcare providers who provide guidance for individuals with OA. The patients were asked about nutritional topics of interest for OA management across four separate domains, as well as asked their preferred delivery method. So, for example, whether it was to talk with health care professionals, or to consult printed materials, websites in person or virtual classes, videos, emails, et cetera.

The health care, professional survey also included topics of nutrition-based discussion and during clinical interactions across the same four domains that were provided to the patients. Those four domains were: strategies for weight management and a healthy lifestyle, vitamin, minerals, and other supplements, food and nutrients that may reduce inflammation, and diets for weight loss.

Now, a quick look at our respondent demographics. The average age for our patient respondents was about sixty years old, and a majority identified as female, were white, and hadn’t received a college degree. Moreover, over three out of four of the health care profession of respondents were made up of either rehabilitation professionals, or primary care and subspecialty positions.

And now, looking at our results for the first domain regarding strategies for weight, loss and a healthy lifestyle. Almost two thirds of patients indicated interest towards learning about what foods may make their OA symptoms worse, and over half of the respondents indicated interest in general information about food and nutrients to reduce information. So, it can be seen from these top two categories that individuals with OA are interested in symptom management rather than behavior modifications or lifestyle modifications. Previous research has shown that weight and nutritional beliefs differ across BMI statuses, and therefore we stratified the patient responses based on BMI category.

The first thing I want to point out is that, regardless of BMI status, the top two rank categories remain the same. So, patients were still interested in learning about reducing their symptoms and reducing inflammation. However, individuals without obesity were more interested in general nutrition advice, whereas those with obesity were more interested in weight loss and weight management topics as a whole. The top vitamins, minerals, and supplements of interest were glucose, main vitamin d and omega three fatty acids. Patients also showed interest in spices and herbs, fruits and vegetables, and the Mediterranean diet. However, it should be noted that a lot of the evidence and research is still limited surrounding all of these vitamins, minerals, and supplements.

We then compared the nutritional topics of interest for patients with OA, and whether or not the health care professionals reported discussing these topics with their patients. We found a host of topics that had a greater than twenty percent discrepancy between those two responses. And the first thing I want to draw attention to is the topic of interest for individuals with OA was food that may make OA symptoms worse. However, only forty two percent of health care professionals report discussing this with their patients. Other professionals mostly reported discussing weight loss strategies and special dietary considerations for other conditions. Despite OA patients indicating that they were less interested in these topics, it may seem as if health care providers discuss topics which align more closely with those with OA and obesity. We discovered an overall discrepancy between what healthcare providers are discussing, and what patients want to know.

And to reiterate, patients want to know how to improve their OA symptoms and reduce inflammation, and they want information on things such as vitamin d and omega three fatty acids. However, the evidence is conflicting in this space. Initially, those without obesity preferred generic information and nutrition, education and ways to reduce inflammation, whereas those with obesity had a larger focus on weight management topics. Healthcare providers may not be providing nutritional education surrounding foods that affect OA symptoms because there are limited conclusive data to inform evidence-based decision making. Therefore, healthcare providers may be more likely to provide information on what has been shown to be effective, such as weight loss to reduce joint loading, and inflammation. They also discussed topics that align more closely with those of interest of individuals with OA and obesity. However, health care professionals should be conscious of this gap, and clearly communicate a lot of literature to patients. They should also aim to communicate the relationship between nutrition, weight, and OA symptoms in a compassionate and sensitive manner to address our secondary aim.

We then assessed the format that patients prefer to receive this nutrition education information. We found that patients indicated greater interest towards a passive format to receive this information rather than interactive formats. So, they were more interested in handouts and brochures and websites for online classes, whereas they were less interested in in-person classes in social media messaging. I do want to note that the survey data in question did occur during the height of the Covid pandemic, and therefore, patients may have been more uncomfortable with in-person interactions during this time, and there is also a bias against information on social media which began to take a new form during the pandemic, and this may have also altered patient responses.

However, altogether patients preferred a passive format for receiving information, and this allows for them to process and understand information at a self-directed speed and requires less group interaction and personal exposure. It has been previously found that passive formats are not the best approach for weight management or weight loss programs, though. That said, it has been found, that online interventions have been shown to be a cost-effective management approach for those with chronic health conditions, and therefore, we suggest that it may be that health care professionals web-based interventions can be a beneficial compromise that allows for individuals with OA to receive information in more passive formats, while also maintaining the key characteristics of a successful weight management program. For example, shared decision making is a key component to successful disease management. The healthcare professional understands clinical and evidence-based treatments, while the patient can provide insight into what they are interested in as well as their preferred format.

And so now we ask the question, what are the next steps? How can we use this information? How can we optimize the management of OA? And we believe that the first of all this is to disseminate knowledge as research is conducted, and the OA Action Alliance specifically acknowledges the lack of evidence or conflicting evidence regarding specific nutrients and supplements and their impacts on OA symptoms.

We aim to develop evidence-based resources for patients surrounding OA management for specifically education, exercise, and weight loss which are effective interventions. In managing OA, however, the implementation of these strategies does assume a certain level of health literacy, again, and they require a modification of lifestyle behaviors, and maybe that health education facilitates compliance in behavior and lifestyle modification, and therefore improve the long-term outcomes of these weight management interventions. Thus, messaging across different media and among healthcare professionals must clearly communicate the connection between nutrition, weight, and OA symptoms, without placing judgment or blame on the individual with OA. Moreover, health care. Professionals should communicate research effectively and sensitively given that individuals with OA do prioritize symptom management. Health care professionals can use these findings to reframe their approach in discussions to address symptom management in a way that better resonates with patients. Healthcare providers should also aim to disseminate the lack of evidence surrounding certain foods and diets in improving joint symptoms, and all the resources that are developed by the OA Action Alliance, while considering the patients interest and providing clear messaging on the role of nutrition, healthy weight, and joint health.

So, the take home message here is that nutrition and dietary habits are cornerstones and chronic disease management. Little is known about how specific nutrition interests of patients align with the topics discussed by health care professionals, and that is what we aimed to discover in this project, and we demonstrated a discrepancy between what healthcare professionals are discussing with patients, and what information individuals with OA want to know. We also found that, regardless of BMI status, individuals with OA are interested in nutrition and topics to improve OA symptoms and reduce overall inflammation. Individuals with OA are willing to receive this information in a variety of formats, but they generally prefer passive formats. It should be noted that passive formats may not be the best strategy for weight loss, or weight management programs, but moving forward, it is important that healthcare professionals communicate the lack of evidence in this space surrounding specific nutrition topics or foods and nutrients in producing OA symptoms. They should clearly communicate this, but also do it in a sensitive manner, as well as do it in the format in which the patients will be receptive. Thank you, everyone for joining. I appreciate your time, and if you have any questions, I think we will open it up, and there’s my contact information as well.

QUESTION AND ANSWER:

Katie Huffman: That’s great. Thank you so much, Ashley. Thank you for that presentation and thank you for all of the work you contributed to moving this research forward as mentioned. If you do have any questions, feel free to type them into the chat, and we’ll be happy to present them.

QUESTION: I was wondering actually, if you could say a little bit about the survey development. I know you mentioned a few of the different items that were presented to patients in the different categories, such as vitamins and supplements the specific diets and nutrients. Could you say a little bit about how those items were selected to present to the patients?

ANSWER:(Ashley Buck) Yeah, definitely, that’s a great question. So, we had a group of interpersonal individuals. It consisted of researchers, physicians, nutritionists, um, a whole host of people, and everyone essentially contributed to a literature search to discover what topics are of interest in this space in general, and that’s where we came across things such as glucose, vitamin c and k, Fruits and vegetables. And then we develop a list of all of those items, and then categorize them essentially into the domains that you saw in the presentation, and from there these surveys were developed, and we also had a separate group of individuals look over the surveys to make sure that they were accurate, and they were addressing specific topics that were of interest in this space.

QUESTION: (Katie Huffman) Great Thank you for that explanation. We do have a few questions here in the chat. So first, do you have some resources that you can recommend, maybe, for existing OA resources that present information that may be evidence-based, even though it’s lacking. Do you know of any resources currently available that patients can refer to?

ANSWER: (Ashley Buck) Yeah so, the OA Action Alliance website, which is on the bottom of this slide right here, has a ton of resources already, and on this slide previously, this screenshot was taken from the OA Action Alliances website, and Katie might be able to send the link in the chat. But this has information under each of those tabs that explains what OA is how to manage it, ways to get connected, or stay active as well.

FOLLOW-UP: (Katie Huffman) Yeah, here’s that link to the web page on the OA Action Alliance website that Ashley’s referring to. Thank you.

COMMENTS: (Katie Huffman) And so we do have a few questions here from individuals that look some specific questions that I think maybe we’ll save for another time. We also have a question about getting a copy of this recording. Yes, we will be sending out a link to the recording later this week, once it’s ready.

QUESTION + ANSWER: Do any of the resources on the OA Action Alliance website talk about food? No, not at this time. That is what we see as the next step from this research is to develop those resources for patients with maybe some specific information about OA research that does exist on foods and nutrients.

QUESTION: Could you comment more about your statement that patients want to hear more about their symptoms versus behavior or lifestyle changes? Was this surprising? And how does a health care provider handle this?

ANSWER: (Ashley Buck) Yeah. So, if we go back to the results side when we were looking at what patients want to know, regardless of BMI status, they were interested in foods that may make their OA symptoms worse, and general information about foods and nutrients to reduce inflammation, and

I don’t think that finding was surprising. In my opinion, I think that a lot of the associated struggles with OA are due to the symptoms, because OA is a serious disease, and it’s not just the joint symptoms. The overall systemic information has an effect on their lifestyle on their sleep, and so patients may be at a point where they are interested in hearing more of, I don’t want to say a quick fix, but they want to address their symptoms directly, and may not see the long-term benefits of the connections of exercise, and weight, loss, and joint health, which is where we want healthcare providers to now come in and try to effectively communicate that research and that evidence, and saying that exercise and weight loss are the most effective ways to manage a way in the long term, because we think there is a lack of communication potentially, sometimes in clearly demonstrating to patients the long-term effects of exercise and weight loss.

COMMENT: (Katie Huffman) Thank you, Ashley, for that response. And just to follow up on a few of the comments from the patients, I did put into the chat a link to the Option Alliance website where we have two support groups described, and these support groups are facilitated by the Osteoarthritis Action Alliance, where patients can talk with other patients to hear about their experiences.

COMMENT: And then we have another comment here from someone in the Weight Management Task group who helped with this research that Ashley just described that the OA Action Alliance will be working on helping develop some of these materials that Ashley is saying are needed to help healthcare providers with this education to the patients that is, that has been expressed.

So, I think those are all of the questions I see in the chat. Ashley, do you have anything you want to add?

Ashley Buck: Um, no, I think. Yeah, I’m. Good.

Katie Huffman: Great. Well, thank you very much again for that presentation. I think it’s a topic of great interest to us, and I know to patients as well, and so we hope that the patients on the call today will be patient with us as we develop these resources. But hopefully, we can get some resources out there for you. Thank you everyone for joining today. We hope that you will consider joining next month’s presentation as well on Wednesday, the 19^th of October. The presenters will be Ellen Shanley and Chuck Thigpen from ATI physical therapy presenting Surprising Results of a Youth Injury Prevention Program. Thank you. I will be putting up a poll for your response after today’s Webinar, if you have a chance to take that before you leave, we would appreciate it. Otherwise, thanks so much, and have a great rest of your day.