Osteoarthritis of the Hip: How Weight Loss Can Preserve Your Joint and Reduce Pain

When your hip starts to ache after walking just a few blocks, or when getting out of a chair feels like climbing a hill, it’s not just aging-it’s osteoarthritis. Hip osteoarthritis (OA) is one of the most common causes of mobility loss in adults over 50, and it doesn’t just hurt. It limits everything: walking, sleeping, working, even standing in line at the grocery store. The good news? You don’t have to wait for surgery. One of the most powerful tools you have isn’t a pill or a shot-it’s your own body weight.

Why Losing Weight Matters More Than You Think

People often assume that hip pain is just wear and tear. But here’s the real issue: every extra pound you carry puts three to six times more pressure on your hip joint with each step. That’s not just stress-it’s damage. Over time, that pressure wears down the cartilage that cushions your bones, leading to bone-on-bone friction, inflammation, and chronic pain.

Unlike knee osteoarthritis, where weight loss has been studied for decades and proven to cut pain by 50% or more, hip OA has been trickier to crack. Some studies say weight loss barely helps. Others show dramatic improvements. The truth? It depends on how much weight you lose-and how you do it.

A 2024 study in Nature followed 65-year-olds with hip OA and obesity. Those who lost more than 10% of their body weight saw a 31% improvement in their quality of life. Pain dropped. Movement got easier. Even simple things like putting on socks or climbing stairs became doable again. The biggest gains weren’t in pain scores-they were in daily function. That’s the real win.

The 10% Rule: What Science Actually Says

You’ve probably heard to lose 5% of your weight for arthritis. That’s based on knee OA data. For hips, that’s not enough. The research is clear: if you want real change, aim for at least 10%.

In that same Nature study, people who lost 5-7% saw small improvements. Those who lost 10% or more? Their HOOS scores-the gold-standard measure for hip function-jumped by over 14 points. That’s not just statistically significant. That’s life-changing. One participant, a 68-year-old woman from Perth, lost 13% of her weight over 18 weeks. She went from using a cane to walking unassisted to her local market. She didn’t need surgery. She didn’t take opioids. She just changed how she ate and moved.

And here’s the kicker: losing 20% didn’t give you twice the benefit. The gains plateaued after 10%. That means you don’t need to become a different person-you just need to lose enough to shift the load off your joint.

Why Hip OA Is Different from Knee OA

Here’s where things get confusing. In 2023, NEJM Journal Watch published a blunt headline: “Osteoarthritis of the Hips Is Unaffected by Weight Loss.” That sent shockwaves through clinics. But the study they were referencing had a flaw-it looked at weight loss over just six months. And it compared VLCD (very-low-calorie diet) groups to exercise-only groups. At six months, pain didn’t change much. But at 12 months? The weight-loss group showed clear improvements in pain, function, and overall hip health.

The difference? Time. And biomechanics. Your knee is a hinge. Every step transfers force directly through it. Your hip is a ball-and-socket joint. It’s deeper, more stable, and less directly loaded by each step. That means the impact of weight loss is slower to show up. But it still shows up.

Think of it like this: if you’re carrying a backpack, your knees scream first. Your hip takes the strain later. But if you keep carrying it, your hip starts to break down too. Removing the weight helps-just not as fast.

What Works: The OAHWFL Program and Real Results

One of the most successful programs for hip OA comes from Australia and New Zealand: the Osteoarthritis Healthy Weight For Life (OAHWFL) program. Originally designed for knee OA, it was adapted for hips-and worked.

The program isn’t a fad. It’s structured: 18 weeks of guided weight loss, combining low-carb eating with tailored strength and mobility exercises. Participants didn’t starve. They ate protein-rich meals, vegetables, healthy fats, and cut out sugary drinks and processed snacks. They did 30 minutes of resistance training three times a week-squats, step-ups, and hip bridges-not running or jumping.

In one study, 35 people with hip OA and a BMI over 25 followed this for eight months. Their physical function improved by 32.6%. Pain dropped. Walking speed increased. And here’s the best part: those who stuck with the program kept the weight off for over a year.

The key? Support. Telehealth coaching, weekly check-ins, and personalized plans made the difference. People didn’t just lose weight-they learned how to live differently.

Exercise Isn’t Optional-It’s Essential

Losing weight without exercise is like trying to fix a leaky roof by mopping the floor. You’ll get wet. And you’ll still be wet tomorrow.

Exercise doesn’t just burn calories. It rebuilds the muscles around your hip. Strong glutes, quads, and core muscles act like natural shock absorbers. They take pressure off the joint. They stabilize your pelvis. They help you move without pain.

Forget running. Forget high-impact aerobics. Focus on:

1. Resistance training: Bodyweight squats, seated leg presses, resistance band hip abductions
2. Low-impact cardio: Swimming, cycling, elliptical
3. Mobility work: Gentle hip circles, seated forward folds, yoga for hips

Do this three times a week. Even 20 minutes a session adds up. A 2023 trial showed that people who combined diet and exercise lost more weight-and kept it off-than those who only dieted.

When Weight Loss Isn’t Enough

Let’s be honest: not everyone can lose 10% of their body weight. Some have mobility limits. Others have metabolic conditions. Some just can’t stick with it.

That doesn’t mean you’re out of options. The American College of Rheumatology says weight loss is a conditional recommendation for hip OA-meaning it helps most people, but not all. If you’re struggling, talk to your doctor about:

• Physical therapy: Custom exercise plans that protect your joint
• Assistive devices: Canes or walkers to reduce load
• Medications: NSAIDs for flare-ups, but only short-term
• Weight-loss medications: Only if your BMI is over 30 and you’ve tried lifestyle changes for six months

Surgery-like hip replacement-is still the last resort. But if you can delay it by even two years with weight loss and exercise, you’ll have a better outcome when you do go under the knife. Younger, leaner patients heal faster and have implants that last longer.

What to Eat (And What to Avoid)

You don’t need a fancy diet. You need consistency.

Focus on:

• Lean proteins: Chicken, fish, tofu, eggs
• Non-starchy vegetables: Spinach, broccoli, zucchini, peppers
• Healthy fats: Avocado, olive oil, nuts, seeds
• Whole grains: Oats, quinoa, brown rice (in moderation)

Avoid:

• Sugary drinks: Soda, juice, sweetened coffee
• Refined carbs: White bread, pastries, pasta
• Ultra-processed foods: Chips, frozen meals, packaged snacks
• Excess alcohol: It fuels inflammation and slows fat loss

One study in the Journal of Metabolic Health found that low-carb diets led to better joint outcomes than low-fat diets for people with OA. Why? Less insulin spikes. Less inflammation. Less fat storage around the joint.

Real People, Real Results

Meet James, 62, from Fremantle. He weighed 112 kg. His hip hurt to walk to the mailbox. He tried painkillers. They made him dizzy. He tried injections. They helped for two weeks. Then he joined a local weight-loss group focused on OA. He lost 12% of his weight in six months. Now he walks his dog every morning. He plays with his grandkids. He didn’t get surgery. He didn’t need it.

Or Maria, 58, from Subiaco. She had hip OA for seven years. She was told she’d need a replacement by 65. She started the OAHWFL program. She lost 14 kg. Her HOOS score improved by 18 points. Her doctor said, “You’ve bought yourself five years.” She’s planning a trip to Bali next year. No cane. No pain.

These aren’t outliers. They’re proof.

What’s Next?

The science is shifting. We’re moving away from “weight loss helps knees, not hips” to “weight loss helps hips-if you do it right.” The goal isn’t perfection. It’s progress. Even 5% helps. But 10%? That’s where the real joint preservation kicks in.

You don’t need to run marathons. You don’t need to eat kale every day. You just need to move more, eat better, and stick with it long enough to let your body heal.

Your hip isn’t broken. It’s overloaded. Take the weight off-and it might just surprise you.