Comment on ‘Why Do Some People With Osteoarthritis and Obesity Awaiting Hip or Knee Arthroplasty Achieve Successful Weight Management? A Qualitative Study’

With increasing rates of obesity, more patients face challenges in weight management prior to surgery and preventive weight loss has been shown to reduce postoperative complications. A recent study by Pavlovic et al. examined weight management in obese patients awaiting total knee arthroplasty (TKA) or total hip arthroplasty (THA), with a particular focus on barriers to and facilitators of weight management in culturally diverse settings (Pavlovic et al. 2023). Using qualitative methods, the authors analysed the impact of participants' health beliefs, resilience, understanding of the health care system and sociocultural context on weight management, with the goal of providing clinicians with guidance to optimise weight management. Several shortcomings of this study need to be highlighted for future research. First, due to the limitations of the COVID-19 epidemic, interviews in the study were conducted by telephone rather than face-to-face. This may have limited the researcher's ability to capture participants' nonverbal information (facial expressions, body language, etc.), which may have affected the understanding of participants' emotional states and subtle psychological changes. In addition, telephone interviews may result in a lack of depth and detail in participants' responses, especially when it comes to sensitive topics such as weight management and health habits, which participants may be reluctant to disclose too much information about in a non-face-to-face setting. Second, the study used the Health Literacy Questionnaire and the Patient Activation Scale to measure participants' health literacy and readiness for behaviour change. However, the information provided by the questionnaires is primarily self-reported and may be subject to social desirability bias, that is, participants may be inclined to provide answers that conform to social desirability rather than to their true level of health behaviour and literacy (Dowsey et al. 2022). In addition, these questionnaires do not capture participants' dynamic psychological states or immediate responses to specific interventions. Third, the study had a follow-up period of 6 months, which is adequate to assess the short-term effects of weight management but may be insufficient to assess the effects of long-term weight maintenance. Weight management, especially for obese patients, is often a long-term challenge and short-term weight loss may not translate into long-term health improvement or weight maintenance (Reyes et al. 2016). Therefore, the results of this study may not adequately reflect patients' weight changes over a longer period of time after surgery and their ongoing impact on health. Although this article makes an important contribution to the investigation of weight management in obese patients awaiting TKA or THA surgery, it still suffers from the above-mentioned limitations. Future studies could further improve the comprehensiveness and applicability of the study by expanding the sample, extending the follow-up period, diversifying the intervention strategies and introducing more objective measures. These improvements will help provide more targeted and culturally sensitive clinical guidance for weight management in obese patients. The authors have nothing to report. The authors declare no conflicts of interest. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.