New study suggests weight loss drugs like Ozempic could help with knee pain. Here’s why there may be a link

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The drug semaglutide, commonly known by the brand names Ozempic or Wegovy, was originally developed to help people with type 2 diabetes manage their blood sugar levels.

However, researchers have discovered it may help with other health issues, too. Clinical trials show semaglutide can be effective for weight loss, and hundreds of thousands of people around the world are using it for this purpose.

Evidence has also shown the drug can help manage heart failure and chronic kidney disease in people with obesity and type 2 diabetes.

Now, a study published in the New England Journal of Medicine has suggested semaglutide can improve knee pain in people with obesity and osteoarthritis. So what did this study find, and how could semaglutide and osteoarthritis pain be linked?

Pormezz/Shutterstock

Osteoarthritis and obesity

Osteoarthritis is a common joint disease, affecting 2.1 million Australians. Most people with osteoarthritis have pain and find it difficult to perform common daily activities such as walking. The knee is the joint most commonly affected by osteoarthritis.

Being overweight or obese is a major risk factor for osteoarthritis in the knee. The link between the two conditions is complex. It involves a combination of increased load on the knee, metabolic factors such as high cholesterol and high blood sugar, and inflammation.

For example, elevated blood sugar levels increase the production of inflammatory molecules in the body, which can damage the cartilage in the knee, and lead to the development of osteoarthritis.

Weight loss is strongly recommended to reduce the pain of knee osteoarthritis in people who are overweight or obese. International and Australian guidelines suggest losing as little as 5% of body weight can help.

But losing weight with just diet and exercise can be difficult for many people. One study from the United Kingdom found the annual probability of people with obesity losing 5% or more of their body weight was less than one in ten.

Semaglutide has recently entered the market as a potential alternative route to weight loss. It comes from a class of drugs known as GLP-1 receptor agonists and works by increasing a person’s sense of fullness.

Semaglutide for osteoarthritis?

The rationale for the recent study was that while we know weight loss alleviates symptoms of knee osteoarthritis, the effect of GLP-1 receptor agonists was yet to be explored. So the researchers set out to understand what effect semaglutide might have on knee osteoarthritis pain, alongside body weight.

They randomly allocated 407 people with obesity and moderate osteoarthritis into one of two groups. One group received semaglutide once a week, while the other group received a placebo. Both groups were treated for 68 weeks and received counselling on diet and physical activity. At the end of the treatment phase, researchers measured changes in knee pain, function, and body weight.

As expected, those taking semaglutide lost more weight than those in the placebo group. People on semaglutide lost around 13% of their body weight on average, while those taking the placebo lost around 3% on average. More than 70% of people in the semaglutide group lost at least 10% of their body weight compared to just over 9% of people in the placebo group.

A man outdoors holding his knee.
Osteoarthritis of the knee is the most common type of osteoarthritis. SKT Studio/Shutterstock

The study found semaglutide reduced knee pain significantly more than the placebo. Participants who took semaglutide reported an additional 14-point reduction in pain on a 0–100 scale compared to the placebo group.

This is much greater than the pain reduction in another recent study among people with obesity and knee osteoarthritis. This study investigated the effects of a diet and exercise program compared to an attention control (where participants are provided with information about nutrition and physical activity). The results here saw only a 3-point difference between the intervention group and the control group on the same scale.

The amount of pain relief reported in the semaglutide trial is also larger than that reported with commonly used pain medicines such as anti-inflammatories, opioids and antidepressants.

Semaglutide also improved knee function compared to the placebo. For example, people who took semaglutide could walk about 42 meters further than those on the placebo in a six-minute walking test.

How could semaglutide reduce knee pain?

It’s not fully clear how semaglutide helps with knee pain from osteoarthritis. One explanation may be that when a person loses weight, there’s less stress on the joints, which reduces pain.

But recent studies have also suggested semaglutide and other GLP-1 receptor agonists might have anti-inflammatory properties, and could even protect against cartilage wear and tear.

While the results of this new study are promising, it’s too soon to regard semaglutide as a “miracle drug” for knee osteoarthritis. And as this study was funded by the drug company that makes semaglutide, it will be important to have independent studies in the future, to confirm the findings, or not.

The study also had strict criteria, excluding some groups, such as those taking opioids for knee pain. One in seven Australians seeing a GP for their knee osteoarthritis are prescribed opioids. Most participants in the trial were white (61%) and women (82%). This means the study may not fully represent the average person with knee osteoarthritis and obesity.

It’s also important to consider semaglutide can have a range of side effects, including gastrointestinal symptoms and fatigue.

There are some concerns that semaglutide could reduce muscle mass and bone density, though we’re still learning more about this.

Further, it can be difficult to access.

I have knee osteoarthritis, what should I do?

Osteoarthritis is a disease caused by multiple factors, and it’s important to take a multifaceted approach to managing it. Weight loss is an important component for those who are overweight or obese, but so are other aspects of self-management. This might include physical activity, pacing strategies, and other positive lifestyle changes such as improving sleep, healthy eating, and so on.

Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney and Christina Abdel Shaheed, Associate Professor, School of Public Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • The Not-So-Sweet Science Of Sugar Addiction

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    One Lump Mechanism Of Addiction Or Two?

    In Tuesday’s newsletter, we asked you to what extent, if any, you believe sugar is addictive; we got the above-depicted, below-described, set of responses:

    • About 47% said “Sugar is chemically addictive, comparable to alcohol”
    • About 34% said “Sugar is chemically addictive, comparable to cocaine”
    • About 11% said “Sugar is not addictive; that’s just excuse-finding hyperbole”
    • About 9% said “Sugar is a behavioral addiction, comparable to video gaming”

    So what does the science say?

    Sugar is not addictive; that’s just excuse-finding hyperbole: True or False?

    False, by broad scientific consensus. As ever, the devil’s in the details definitions, but while there is still discussion about how best to categorize the addiction, the scientific consensus as a whole is generally: sugar is addictive.

    That doesn’t mean scientists* are a hive mind, and so there will be some who disagree, but most papers these days are looking into the “hows” and “whys” and “whats” of sugar addiction, not the “whether”.

    *who are also, let us remember, a diverse group including chemists, neurobiologists, psychologists, social psychologists, and others, often collaborating in multidisciplinary teams, each with their own focus of research.

    Here’s what the Center of Alcohol and Substance Use Studies has to say, for example:

    Sugar Addiction: More Serious Than You Think

    Sugar is a chemical addiction, comparable to alcohol: True or False?

    True, broadly, with caveats—for this one, the crux lies in “comparable to”, because the neurology of the addiction is similar, even if many aspects of it chemically are not.

    In both cases, sugar triggers the release of dopamine while also (albeit for different chemical reasons) having a “downer” effect (sugar triggers the release of opioids as well as dopamine).

    Notably, the sociology and psychology of alcohol and sugar addictions are also similar (both addictions are common throughout different socioeconomic strata as a coping mechanism seeking an escape from emotional pain).

    See for example in the Journal of Psychoactive Drugs:

    Sweet Preference, Sugar Addiction and the Familial History of Alcohol Dependence: Shared Neural Pathways and Genes

    On the other hand, withdrawal symptoms from heavy long-term alcohol abuse can kill, while withdrawal symptoms from sugar are very much milder. So there’s also room to argue that they’re not comparable on those grounds.

    Sugar is a chemical addiction, comparable to cocaine: True or False?

    False, broadly. There are overlaps! For example, sugar drives impulsivity to seek more of the substance, and leads to changes in neurobiological brain function which alter emotional states and subsequent behaviours:

    The impact of sugar consumption on stress driven, emotional and addictive behaviors

    However!

    Cocaine triggers a release of dopamine (as does sugar), but cocaine also acts directly on our brain’s ability to remove dopamine, serotonin, and norepinephrine:

    The Neurobiology of Cocaine Addiction

    …meaning that in terms of comparability, they (to use a metaphor now, not meaning this literally) both give you a warm feeling, but sugar does it by turning up the heating a bit whereas cocaine does it by locking the doors and burning down the house. That’s quite a difference!

    Sugar is a behavioral addiction, comparable to video gaming: True or False?

    True, with the caveat that this a “yes and” situation.

    There are behavioral aspects of sugar addiction that can reasonably be compared to those of video gaming, e.g. compulsion loops, always the promise of more (without limiting factors such as overdosing), anxiety when the addictive element is not accessible for some reason, reduction of dopaminergic sensitivity leading to a craving for more, etc. Note that the last is mentioning a chemical but the mechanism itself is still behavioral, not chemical per se.

    So, yes, it’s a behavioral addiction [and also arguably chemical in the manners we’ve described earlier in this article].

    For science for this, we refer you back to:

    The impact of sugar consumption on stress driven, emotional and addictive behaviors

    Want more?

    You might want to check out:

    Beating Food Addictions: When It’s More Than “Just” Cravings

    Take care!

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  • The Exercises That Help Keep Breast Cancer At Bay

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    For women, our lifetime risk of being diagnosed with breast cancer is about 1 in 7, before we take into account any added risk or protective factors.

    For men, it’s more like 1 in 556, which again, is before taking into account any added risk or protective factors.

    Here’s a good place to start on improving those odds: How To Triple Your Breast Cancer Survival Chances

    And for that matter, check out: 8 Signs On Your Breast You Shouldn’t Ignore

    And for those concerned (or even just curious) about the pros and cons of menopausal HRT when it comes to breast cancer:

    The Hormone Therapy That Reduces Breast Cancer Risk & More ← this is actually very important to understand, as otherwise it’s easy to accidentally self-sabotage and increase one’s overall mortality risk

    So, what’s this about exercise and breast cancer?

    There are two things to focus on

    No, not those.

    Well, yes, those, but also: aerobic exercise and resistance training.

    A research team (Dr. Alice Avancini et al.) analysed data from 22 randomized controlled trials (total n=968 participants) that investigated the effects of exercise on various pro-inflammatory biomarkers (mostly interleukin variants, but also c-reactive proteins) that are known to increase breast cancer reoccurrence risk.

    What they found was:

    ❝Exercise induced small to large significant reductions in IL-6 (SMD = -0.85; 95% CI = -1.68 to -0.02; p =.05) and TNF-α (SMD = -0.40; 95% CI = -0.81 to 0.01; p =.05) and a trend for a decrease in CRP.

    When stratifying by exercise mode, trends toward reduction in IL-6 and TNF-α were observed for combined exercise, whilst changes were not generally affected by exercise program duration❞

    Source: Effects of exercise on inflammation in female survivors of nonmetastatic breast cancer: a systematic review and meta-analysis

    The “combined exercise” mentioned?

    Aerobic exercise and resistance training.

    This is important, because as regular 10almonds readers may remember…

    What Your Metabolism Says About How Aggressive Breast Cancer Is Likely To Be For You ← this makes a huge difference to survival chances

    So, this study’s findings are very consistent with that, because:

    • Aerobic training increases cardiovascular fitness, improving metabolism
    • Resistance training increases muscle mass, improving metabolism*

    *because muscle “costs” calories to maintain, prompting an increase in metabolism, whereas fat prompts our metabolism to slow, to conserve energy to face the obvious food shortage that must be coming

    See also: Stop Cancer 20 Years Ago

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    Here’s the best book we’ve read on breast cancer survival:

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  • Managing Sibling Relationships In Adult Life

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    Managing Sibling Relationships In Adult Life

    After our previous main feature on estrangement, a subscriber wrote to say:

    ❝Parent and adult child relationships are so important to maintain as you age, but what about sibling relationships? Adult choices to accept and move on with healthier boundaries is also key for maintaining familial ties.❞

    And, this is indeed critical for many of us, if we have siblings!

    Writer’s note: I don’t have siblings, but I do happen to have one of Canada’s top psychologists on speed-dial, and she has more knowledge about sibling relationships than I do, not to mention a lifetime of experience both personally and professionally. So, I sought her advice, and she gave me a lot to work with.

    Today I bring her ideas, distilled into my writing, for 10almonds’ signature super-digestible bitesize style.

    A foundation of support

    Starting at the beginning of a sibling story… Sibling relationships are generally beneficial from the get-go.

    This is for reasons of mutual support, and an “always there” social presence.

    Of course, how positive this experience is may depend on there being a lack of parental favoritism. And certainly, sibling rivalries and conflict can occur at any age, but the stakes are usually lower, early in life.

    Growing warmer or colder

    Generally speaking, as people age, sibling relationships likely get warmer and less conflictual.

    Why? Simply put, we mature and (hopefully!) get more emotionally stable as we go.

    However, two things can throw a wrench into the works:

    1. Long-term rivalries or jealousies (e.g., “who has done better in life”)
    2. Perceptions of unequal contribution to the family

    These can take various forms, but for example if one sibling earns (or otherwise has) much more or much less than another, that can cause resentment on either or both sides:

    • Resentment from the side of the sibling with less money: “I’d look after them if our situations were reversed; they can solve my problems easily; why do they resent that and/or ignore my plight?”
    • Resentment from the side of the sibling with more money: “I shouldn’t be having to look after my sibling at this age”

    It’s ugly and unpleasant. Same goes if the general job of caring for an elderly parent (or parents) falls mostly or entirely on one sibling. This can happen because of being geographically closer or having more time (well… having had more time. Now they don’t, it’s being used for care!).

    It can also happen because of being female—daughters are more commonly expected to provide familial support than sons.

    And of course, that only gets exacerbated as end-of-life decisions become relevant with regard to parents, and tough decisions may need to be made. And, that’s before looking at conflicts around inheritance.

    So, all that seems quite bleak, but it doesn’t have to be like that.

    Practical advice

    As siblings age, working on communication about feelings is key to keeping siblings close and not devolving into conflict.

    Those problems we talked about are far from unique to any set of siblings—they’re just more visible when it’s our own family, that’s all.

    So: nothing to be ashamed of, or feel bad about. Just, something to manage—together.

    Figure out what everyone involved wants/needs, put them all on the table, and figure out how to:

    • Make sure outright needs are met first
    • Try to address wants next, where possible

    Remember, that if you feel more is being asked of you than you can give (in terms of time, energy, money, whatever), then this discussion is a time to bring that up, and ask for support, e.g.:

    “In order to be able to do that, I would need… [description of support]; can you help with that?”

    (it might even sometimes be necessary to simply say “No, I can’t do that. Let’s look to see how else we can deal with this” and look for other solutions, brainstorming together)

    Some back-and-forth open discussion and even negotiation might be necessary, but it’s so much better than seething quietly from a distance.

    The goal here is an outcome where everyone’s needs are met—thus leveraging the biggest strength of having siblings in the first place:

    Mutual support, while still being one’s own person. Or, as this writer’s psychology professor friend put it:

    ❝Circling back to your original intention, this whole discussion adds up to: siblings can be very good or very bad for your life, depending on tons of things that we talked about, especially communication skills, emotional wellness of each person, and the complexity of challenges they face interdependently.❞

    Our previous main feature about good communication can help a lot:

    Save Time With Better Communication

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  • 7 Invisible Eating Disorders

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    It’s easy to assume that anyone with an eating disorder can be easily recognized by the resultantly atypical body composition, but it’s often not so.

    Beyond the obvious

    We’ll not keep them a mystery; the 7 invisible eating disorders discussed by therapist Kati Morton in this video are:

    • OSFED (Other Specified Feeding or Eating Disorder): a catch-all diagnosis for those who don’t meet the criteria for more specific eating disorders but still have significant eating disorder behaviors.
    • Atypical Anorexia: characterized by all the symptoms of anorexia nervosa (especially: intense fear of gaining weight, and body image distortion) except that the individual’s weight remains in a normal range.
    • Atypical Bulimia: similar to bulimia nervosa, but the frequency or duration of binge-purge behaviors does not meet the usual diagnostic criteria and thus can fly under the radar.
    • Atypical Binge-Eating Disorder: has episodes of consuming large amounts of food without compensatory behaviors (e.g. purging), but the episodes are less frequent and/or intense than typical binge-eating disorder.
    • Purging Disorder: purging behaviors such as self-induced vomiting or laxative abuse without having binge-eating episodes (thus, this not being binging, and nothing obvious is happening outside of the bathroom).
    • Night Eating Syndrome: consuming excessive amounts of food during the night while being fully aware of the nature of the eating episodes, which disrupts sleep and leads to guilt.
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  • Getting Flexible, Starting As An Adult: How Long Does It Really Take?

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    Aleks Brzezinska didn’t start stretching until she was 21, and here’s what she found:

    We’ll not stretch the truth

    A lot of stretching programs will claim “do the splits in 30 days” or similar, and while this may occasionally be true, usually it’ll take longer.

    Brzezinska started stretching seriously when she was 21, and made significant flexibility gains between the ages of 21 and 23 with consistent practice. Since then, she’s just maintained her flexibility.

    There are facts that affect progress significantly, such as:

    • Anatomy: body structure, age, and joint flexibility do influence flexibility; starting younger and/or having hypermobile joints does make it easier.
    • Consistency: regular practice (2–3 times a week) is crucial, but avoid overdoing it, especially when sore.
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  • Simple, 10-Minute Hip Opening Routine

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    Hips Feeling Stiff?

    If so, Flow with Adee’s video (below) has just the solution with a quick 10-minute hip-opening routine. Designed for intermediates but open to all, we love Adee’s work and recommend that you reach out to her to tell her what you’d like to see next.

    Other Methods

    If you’re a book loverwe’ve reviewed a fantastic book on reducing hip pain. Alternatively, learn stretching from a ballerina with Jasmine McDonald’s ballet stretching routine.

    Otherwise, enjoy today’s video:

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    Learn to Age Gracefully

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