Answers to the most common questions about the KNEED Program.
Standard physiotherapy improves alignment, strength, and stability, but it does not reduce the load going through the knee — a major cause of pain and progression.
KNEED targets both. The program begins with a short VLCD phase, where patients typically lose 9–15 kg in 6 weeks. Since every 1 kg of body weight adds about 4 kg of pressure to the knee, this means a 36–60 kg reduction in joint load — a benefit physiotherapy alone cannot provide.
You then transition to a Mediterranean diet to support long-term, sustainable weight management. Research shows this approach can lead to 10–20% weight loss, reducing knee replacement risk by 20–40%.
By improving both joint function and joint load, KNEED delivers better results than physiotherapy alone.
Yes. The KNEED program is built on the same evidence base as the Better Knee, Better Me program in Australia — a leading, research-driven intervention for knee osteoarthritis.
This model demonstrated that, over 6 months, participants achieved meaningful weight loss, significant improvements in knee pain and function, and a reduced need for knee replacement surgery.
KNEED follows these evidence-based principles, combining dietitian-led weight loss with targeted physiotherapy to deliver proven, long-term benefits.
Yes. The KNEED program is delivered fully online. All dietitian and physiotherapy sessions take place through secure video calls, with the option of phone calls for dietitian sessions if preferred.
You will receive all required meal-replacement products and exercise equipment delivered directly to your home.
Your clinicians guide you step-by-step through your personalised plan, and you can complete the entire program from home — with no in-person visits required.
GLA:D is an excellent exercise and education program, but it does not include structured weight management — which is essential for people with weight-related knee osteoarthritis.
KNEED differs in several important ways:
Includes weight management
KNEED combines a VLCD and Mediterranean diet, typically leading to ~9 kg weight loss in 6 weeks (≈36 kg less knee load).
GLA:D offers minimal dietary support.
Longer, more personalised program
KNEED runs for 6 months with 1:1 physiotherapy adapted to your needs.
GLA:D is an 8-week group class program.
Fully remote and accessible
KNEED is delivered entirely online, with no travel or mobility barriers.
GLA:D requires in-person attendance, which can be challenging for some patients.
Stronger support between sessions
KNEED includes app reminders, video guidance, and clinician follow-up.
GLA:D does not routinely include app-based support.
Designed specifically for weight-related knee OA
GLA:D is for general knee OA.
KNEED is tailored for people whose OA is strongly linked to excess body weight.
In short:
GLA:D improves strength and movement, while KNEED improves strength and reduces knee load, leading to faster and more sustainable improvements in pain, mobility, and long-term joint health.
Getting started is easy:
The KNEED program is for adults aged 45–80 with a BMI of 28–41 and a clinical diagnosis of knee osteoarthritis. It is ideal for people who are medically stable, able to participate in a fully remote program, and who may have found traditional diets or physiotherapy alone insufficient.
It is especially suited to those who need a multidisciplinary approach to reduce knee pain, improve mobility, and lower their risk of surgery.
If you are a referring doctor:
Full eligibility criteria and referral guidance can be found on the For Doctors page.
The KNEED program is designed to deliver meaningful improvements in both knee symptoms and overall health. Most participants can expect:
Yes — a GP or specialist referral is required so we can ensure the program is clinically appropriate for you.
A referral does not commit you to joining the program. Once we receive it, the KNEED team will contact you to explain how everything works, answer your questions, and confirm whether you would like to proceed.
Yes. The program is suitable for adults over 65, as long as your referring doctor confirms it is safe for you. Research shows that VLCDs are safe and effective for older adults when properly screened and supervised, and weight loss can significantly reduce knee pain and improve mobility.
Remote physiotherapy is also shown to be safe and effective for older adults. Your physiotherapist will tailor all exercises to your comfort and ability level, using chairs, support surfaces, and modified movements when needed to ensure safety.
Yes. The program is specifically designed for people with moderate to severe knee osteoarthritis, including those already considering knee replacement. Weight loss combined with targeted physiotherapy can:
Physiotherapy can provide short-term relief, but without addressing excess weight — the biggest driver of knee osteoarthritis — symptoms often return. This leads to a cycle of temporary improvement followed by flare-ups, increasing healthcare dependence and raising long-term surgery risk.
The KNEED program combines medical, sustainable weight loss with targeted physiotherapy so you get both immediate improvement and lasting results. This reduces knee load, improves joint function, and supports long-term symptom control.
It’s also an opportunity to improve your overall metabolic health, as weight-related knee osteoarthritis rarely exists in isolation and is often linked with blood pressure, blood sugar, cholesterol, and cardiovascular risk.
No. Any equipment required for the physiotherapy part of the program will be sent directly to your home, and the cost is included in your program fee. You just need a safe space to exercise, comfortable clothing, a reliable internet connection, and a device (phone, tablet, or computer) for your online sessions.
All participants undergo a medical screening before starting the programme. A referring doctor reviews the individual’s medical history and current medications to confirm that the VLCD and physiotherapy pathway are clinically appropriate and safe.
KNEED clinicians — dietitians and physiotherapists — do not adjust medications.
Any medication changes remain the responsibility of the referring doctor.
This mirrors the approach used in the Better Knee, Better Me programme, where medication adjustments during VLCD phases were managed at the doctor’s discretion. Throughout the programme, the dietitian monitors symptoms, hydration, tolerance, and progress, and will advise the participant to seek medical review if anything requires attention.
For doctors who are less familiar with VLCD protocols, the same medication adjustment guidance used in the DROPLET trial — a major UK primary care study demonstrating the safety and effectiveness of this model — can be provided on request.
The full KNEED program lasts 6 months. This includes the 12-week VLCD phase, the transition to a Mediterranean diet, and a structured physiotherapy pathway designed to improve mobility, strength, and pain throughout the entire program.
You will work 1:1 with a physiotherapist experienced in knee osteoarthritis.
They will:
All physiotherapy sessions are delivered online, and any required exercise equipment is sent directly to your home.
At the end of the 6-month program, you will have:
You will also have the option to join one of our post-program pathways, such as continued weight management support or extended physiotherapy, if you want ongoing guidance.
The VLCD is used first because it produces faster early weight loss, which is important for reducing knee pain and improving mobility. Traditional, slower diets can take 6–12 months to create enough symptom relief to feel worthwhile, so patients and doctors often view them as impractical for knee osteoarthritis. This can keep people stuck in a cycle of temporary physio or medication relief and rising surgery risk.
The VLCD helps break this cycle by delivering early results. After this phase, you transition to a Mediterranean diet, which is ideal for long-term healthy eating and weight maintenance.
The VLCD phase lasts 12 weeks and includes:
This phase is medically supervised, designed for safety, and structured to produce early weight loss that helps reduce knee pain and improve mobility before transitioning to long-term healthy eating.
Weight-loss medications (GLP-1 agonists such as semaglutide or tirzepatide) are effective tools for long-term weight management, but they work too slowly for knee osteoarthritis. Because doses must be increased gradually, meaningful weight loss often does not occur until 3–4 months, delaying both pain relief and joint-load reduction.
By contrast, a medically supervised VLCD produces rapid weight loss from Week 1 and is almost twice as fast as GLP-1 medication during the first 12 weeks. This leads to earlier improvements in pain, mobility, and physiotherapy responsiveness — which is crucial in a degenerative, painful condition where delaying symptom relief increases disability and surgery risk.
Weight-loss medications may still play a role later for selected patients, but a VLCD is the best initial approach when early symptom improvement is the clinical priority.
A doctor referral does not require any commitment from you. After we receive your referral, the KNEED team will contact you to explain the program, answer any questions, and confirm whether you would like to proceed.
Payment is only made once you decide to start the program and your clinician has confirmed that KNEED is suitable for you. All payments — whether full or via a payment plan — are completed before your onboarding session.
Once payment is received, you’ll be directed to schedule your initial session.
At the moment, the KNEED program is self-funded, and insurance does not currently cover the full program. We hope to secure insurance coverage in the near future as the program develops.
The full 6-month KNEED program normally costs €2,200.
However, as an introductory offer, patients referred before January 2026 qualify for the early-access rate of €1,800 (equivalent to €300 per month). This offer is limited to the first 50 eligible participants.
Yes — payment plans are available, allowing you to spread the cost over monthly instalments at no extra fee. When we contact you after receiving your referral, you’ll be given the option to pay in full or choose a monthly plan.
You can find a full breakdown of what’s included in the program cost on our Pricing page.
Throughout the KNEED program, you will work 1:1 with two specialist clinicians:
Your clinicians work together to provide a seamless, personalised experience from start to finish.
Yes. A VLCD is medically safe when it is clinician-supervised, screened by a doctor before starting, nutritionally complete, and used for a defined short period.
The Better Knee, Better Me research — which KNEED is based on — demonstrated that a VLCD is safe and effective for people with weight-related knee osteoarthritis. VLCDs are also widely used in the NHS Type 2 Diabetes Remission Programme, align with international obesity and osteoarthritis guidelines, and have decades of clinical evidence supporting their safety.
Before entering the programme, a doctor reviews medical suitability. Throughout the diet phase, a dietitian monitors symptoms, hydration, progress, and overall tolerance to ensure the plan remains safe and appropriate.
For referring doctors:
Full safety criteria, screening guidance, and VLCD medication-management reference materials (including the same recommendations used in the DROPLET primary-care trial) are available upon request.
A small amount of water weight often returns after the VLCD — this is completely normal and not a sign of regaining body fat.
During the first 1–2 weeks of a VLCD, some of the weight lost comes from water as glycogen and minerals are used up. When carbohydrates are gradually reintroduced, the body naturally restores this water.
From around week 3 onward, most weight loss comes from fat, and this fat loss does not return simply because the VLCD ends.
The early water loss is still helpful. Even temporary reductions in body weight significantly reduce pressure on the knee, ease pain, and make movement easier — all of which provide an important early advantage for people with knee osteoarthritis.
By the time a small amount of water returns, patients have already achieved:
meaningful fat loss
noticeable pain reduction
improved mobility
increased confidence with movement and activity
These benefits remain, and most people feel more motivated — not less — as they transition into the next phase of the program.
Any weight-loss method can lead to some regain over time because metabolism adapts and hunger hormones increase after losing weight. A VLCD can temporarily amplify these effects compared with slower diets, but it also creates a larger early “buffer” of weight loss, which helps offset this risk.
Long-term studies show that after about two years, total weight loss after a VLCD is similar to traditional diets. The difference is that a VLCD delivers much greater early weight loss, which leads to faster improvements in pain, mobility, and knee load — a major advantage for people with knee osteoarthritis.
A VLCD can lead to a small amount of lean mass loss, but this risk is greatly reduced in a supervised clinical program. In KNEED, this is managed by:
With these safeguards in place, the expected lean mass loss is modest and does not interfere with strength, function, or your ability to benefit from the program.
No. For people with weight-related knee osteoarthritis, rapid weight loss actually helps physiotherapy work more effectively. Reducing body weight lowers knee joint load, decreases inflammation, and makes movement less painful — all of which improve confidence and allow patients to engage more fully in strengthening work.
In the Better Knee, Better Me trial — conducted specifically in adults with knee osteoarthritis and overweight/obesity — the group that completed a VLCD alongside exercise achieved greater improvements in pain, mobility, and function than those doing exercise alone.
Rapid weight loss did not reduce physiotherapy benefits in this population; it enhanced them.
Yes — when medically supervised and based on nutritionally complete VLCD products, an 800-calorie diet is considered safe for short-term use. A VLCD is not the same as eating 800 calories of normal food. It uses high-protein, micronutrient-fortified formula products designed to provide all essential vitamins, minerals, and nutrients despite the lower energy intake.
This is different from the WHO’s ≥1,400-calorie guidance, which applies to food-based diets, not to clinical VLCD formulations.
In the KNEED program, a VLCD is offered only to clinically appropriate patients, following GP approval and screening. Throughout the diet phase, a dietitian monitors symptoms, hydration, progress, and overall tolerance to ensure the approach remains safe and appropriate for you.
No. In the KNEED program, meal replacements are short-term and used in a way that actively supports long-term healthy eating.
Real food from day one:
Phase 1 includes two nutritionally complete products plus one self-prepared meal, so patients immediately practise real-food choices, cooking skills, and portion control.
Structured transition phase:
After the VLCD, patients gradually move into a dietitian-led Mediterranean diet, where long-term habits are built once pain, mobility, and confidence have improved.
Traditional, slower diets are ideal in theory, but they rarely contribute to enough early symptom relief for knee osteoarthritis to make them practical (6-12 months). As a result, patients and doctors most often view them as unrealistic options, keeping people stuck in a cycle of temporary physio or medication relief, rising surgery risk, and ongoing healthcare dependence.
To improve long-term weight-related knee OA outcomes and reduce the risk of persistent pain and surgery, weight loss needs to be faster at the start to break this cycle — which is why a short VLCD phase is used before transitioning to long-term healthy eating.
We’ll talk through your situation, explain how the programme works, and answer your questions.
No obligation. If KNEED isn’t right for you, we’ll tell you.
