For Doctors
For Doctors
Empowering your patients with a proven, clinician-led digital pathway combining medical weight management and physiotherapy for knee osteoarthritis.
Evidence-based1. CORU-registered clinicians. Aligned with NICE obesity and osteoarthritis guidance2,3.
What is the KNEED Program
KNEED is a six-month digital physiotherapy and medical weight management program for adults with knee osteoarthritis linked to excess weight.
It combines targeted physiotherapy, a medically supervised VLCD for rapid early weight loss, and a Mediterranean-style long-term plan — all delivered virtually by CORU-registered clinicians. The program is available by doctor referral only to ensure medical safety and suitability.Core Clinical Components
Pillar 1: Dietetic Care & Digital Nutrition Support
Focused on safe rapid weight loss, behaviour change, and long-term maintenance.
Key Components- Initial dietetic assessment
- VLCD preparation and education
- 12-week medically supervised VLCD
- Behaviour change support (motivational interviewing, behavioural therapy, SMART goals)
- 2-week transition to Mediterranean eating pattern
- Mediterranean long-term plan
- Structured outcome reviews (start, midpoint, final)
- Weight and food logging
- Resource sharing
- Secure messaging
Pillar 2: Physiotherapy Care & Digital MSK Support
Built around progressive osteoarthritis rehabilitation and long-term self-management.
Key Components- Osteoarthritis education (pain, load, flare management)
- Knee OA strengthening program
- Exercise demonstration videos
- Automated exercise reminders
- Resource sharing
- Secure messaging
Expected Clinical Outcomes
- Clinically meaningful reductions in knee pain and improved function1 → Greater independence, improved ability to work, and enhanced quality of life
- 9–15 kg weight loss in the first 6 weeks4,5 (depending on starting weight) → Equivalent 36–60 kg reduction in knee joint load (1 kg ≈ 4 kg reduced pressure6)
- 10–20% total body weight loss across the full program1,7 → Equivalent 20–40% reduction in long-term knee replacement risk (1% loss ≈ 2% reduced risk8)
- Improved metabolic markers (BP, HbA1c, lipids)
- Lower healthcare utilisation (fewer medications, imaging, and clinician visits)
Eligibility Criteria for the KNEED Program
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Inclusion
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Exclusion
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Ideal Candidates
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Age: Clinician discretion |
Unstable cardiac/hepatic/renal disease, recent (≤6 months) cardiac event or stroke |
Tried physiotherapy with limited success |
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BMI: ≥27 kg/m² |
Active eating disorder, severe cognitive/psychiatric impairment, pregnancy or breastfeeding |
Motivated but have struggled with traditional diets |
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Clinical diagnosis of knee OA. Suitable for all severities of knee OA. |
Any condition where rapid weight loss is not advisable (e.g. hypotension, untreated osteoporosis, hypoglycaemia, or clinically significant sarcopenia/frailty where further loss of lean mass would be unsafe) |
Patients requiring first-line multidisciplinary care to reduce knee pain, improve function, enhance quality of life, and reduce surgical risk |
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Medically stable or GP-cleared for VLCD and physiotherapy |
Recurrent falls (>1 in past 12 months) or housebound due to mobility issues — GP discretion advised |
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Able & willing to take part in a fully remote program |
Any unexplained or clinically concerning symptoms suggesting underlying disease |
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Referral & Onboarding Pathway
Referral Submitted by GP
- GP confirms age (45–80), clinical OA diagnosis, and BMI ≥ 28
- Checks suitability (excludes contraindications)
- Reviews relevant medications
- Completes short referral form
Step 01
Onboarding & screening
- KNEED team contacts the patient shortly after referral
- Payment is only required once the patient confirms their place
- Program introduction call scheduled
- Medical onboarding and suitability confirmed
- Initial dietitian and physiotherapy sessions arranged
Step 02
Program begins
- ✔️ Weight management and physiotherapy care delivered by KNEED clinicians
- ✔️ Ongoing digital tracking, communication, and support
- ✔️ Referrer updated at onboarding, midpoint, and completion
Step 03
Medically Supervised Very-Low-Calorie Diet (VLCD): Clinical Rationale
Why We Use a VLCD in KNEED
KNEED follows the evidence-based model of the University of Melbourne’s Better Knee, Better Me program1, which integrates rapid, supervised weight loss with physiotherapy for clinically meaningful improvements in knee osteoarthritis.
A 12-week medically supervised VLCD, followed by transition to a Mediterranean diet, provides a safe, structured, and clinically validated start to treatment.
This model is nationally implemented in the NHS Diabetes Remission Programme9, and NICE supports VLCD use in people with obesity at higher clinical risk2.
What Is a VLCD?
A VLCD provides ~800 kcal/day using nutritionally complete, high-protein, micronutrient-fortified products10.
This differs fundamentally from low-calorie food-based diets:
- WHO’s ≥1,400 kcal guideline applies to standard food diets
- VLCD products are nutritionally complete and safe when used short-term under supervision
VLCDs are offered only to clinically appropriate patients based on GP judgement and KNEED eligibility criteria, with dietitian-led monitoring throughout.
What It Looks Like in Practice
KNEED uses a partial meal-replacement model:
- 4 VLCD products per day
- 1 self-prepared real-food meal in the evening
Chosen because it provides:
- Better flexibility and adherence
- Real-food practice from Day 1
- Strong early results
- Alignment with the Better Knee, Better Me trial structure
Why VLCD Works Specifically for Knee OA
For most health conditions, the speed of weight loss isn’t crucial. But for knee osteoarthritis, speed determines whether weight loss can make a clinical difference.
Only 1 in 5 patients receive full first-line OA care11, largely because traditional diets require 6–12 months to reach the weight loss level needed for symptom improvement12,13.
- Slow weight loss provides no immediate pain relief → patients don’t see value in starting
- Clinicians view slow methods as impractical for a degenerative, painful condition
- Care defaults to medication & intermittent physio → temporary relief only
- The cycle continues: persistent pain, higher healthcare use, rising surgery risk
Unlike hypertension or diabetes, knee OA directly affects daily pain, mobility, work, and independence. When future surgery is a concern, timely improvement becomes essential — and slow weight-loss methods cannot deliver this.
How a VLCD Breaks This Barrier
- VLCDs typically achieve 9–15 kg weight loss in 6 weeks4,5 → every 1 kg lost reduces ~4 kg knee load6
- Creates clinically meaningful symptom improvement within weeks
- Over a full programme, patients commonly achieve 10–20% total weight loss1,7 → 20–40% reduction in knee replacement risk
Why a VLCD Instead of Weight-Loss Medication?
Weight-loss medications (GLP-1 agonists such as semaglutide or tirzepatide) are effective for long-term weight management, but they work too slowly for knee osteoarthritis. Because doses must be titrated gradually, meaningful weight loss often does not occur until 3–4 months, delaying pain relief and joint-load reduction.
In contrast, a medically supervised VLCD produces rapid weight loss from Week 1 and is nearly twice as fast as GLP-1 medications during the first 12 weeks14,15. This creates earlier improvements in pain, mobility, and physiotherapy responsiveness — crucial in a degenerative 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 most effective evidence-based first-line strategy when early symptom improvement is the priority.
Bottom Line
- A VLCD delivers early, clinically meaningful symptom relief—almost twice as fast as weight-loss medications during the first 12 weeks.
- Reduced pain and joint load enhance physiotherapy effectiveness.
- Early success builds engagement for long-term Mediterranean-diet adherence.
Common VLCD Concerns
- Lean mass loss minimized by screening, high-protein formulas, and strengthening physio.
- “Isn’t 800 kcal too low?” VLCD products are nutritionally complete — unlike food-based diets at 800 kcal.
- Rapid weight loss enhances physio outcomes.
- Mediterranean transition supports long-term habits.
- Weight regain risk comparable to all structured diets.
- Safe for eligible older adults; more fat than muscle is typically lost.
- Delivered under structured medical and dietetic supervision.
Key Evidence & References
1. Bennell et al., 2021
Comparing telehealth-delivered exercise and weight loss programs with online education for knee osteoarthritis. Annals of Internal Medicine, 175(2), 198–209.
2. NICE, 2025
Physical activity and diet guidance for overweight and obesity management. https://www.nice.org.uk/guidance/ng246/
3. NICE, 2022
Osteoarthritis in over 16s: diagnosis and management. https://www.nice.org.uk/guidance/ng226/
4. Cifuentes et al., 2023
Weight regain after total meal replacement VLCD programs with/without anti-obesity medications. Obesity Science & Practice, 10(1), e722.
5. Ardavani et al., 2020
Effects of VLCDs and LED + exercise training on skeletal muscle mass. Advances in Therapy, 38(1), 149–163.
6. Messier et al., 2005
Weight loss reduces knee-joint loads in overweight/obese older adults with knee OA. Arthritis & Rheumatism, 52(7), 2026–2032.
7. Cifuentes et al., 2023b
Additional publication on weight regain after VLCD with/without medications. Obesity Science & Practice, 10(1), e722.
8. Salis et al., 2022
Weight loss associated with reduced risk of knee/hip replacement. International Journal of Obesity, 46(4), 874–884.
9. NHS England, n.d.
NHS Type 2 Diabetes Path to Remission Programme. https://www.england.nhs.uk/diabetes/treatment-care/diabetes-remission/
10. Edwards-Hampton & Ard, 2024
Latest clinical guidelines for meal replacements in VLCD and LCD obesity treatment. Diabetes Obesity and Metabolism, 26(S4), 28–38.
11. Mazzei et al., 2022
Use of guideline-consistent treatments after orthopaedic non-surgical recommendations. Osteoarthritis & Cartilage Open, 4(2), 100256.
12. Contreras et al., 2024
Health benefits beyond the scale during weight loss programs. Nutrients, 16(21), 3585.
13. Dantas et al., 2020
Knee osteoarthritis treatments and implications for physiotherapy. Brazilian Journal of Physical Therapy, 25(2), 135–146.
14. Anyiam et al., 2024
Metabolic effects of VLCD, Semaglutide, or combination therapy in T2DM. Clinical Nutrition, 43(8), 1907–1913.
15. Rodriguez et al., 2024
Semaglutide vs Tirzepatide for weight loss in adults with overweight or obesity. JAMA Internal Medicine, 184(9), 1056.
Common Clinical Questions
Find fast answers to common questions about KNEED, our digital care model, safety, and patient eligibility.
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.
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.
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.
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.
Give your patient the digital KNEED Patient Information Leaflet
This digital leaflet explains in clear, patient-friendly language how the programme works, who it’s suitable for, pricing and value, and how to get started safely with a clinician referral.
Once opened, you can share the link directly with patients or print a copy from the file to give them in person.