The prevalence of overweight and obesity in the western world is growing, and with it there is a growing number of patients with osteoarthritis, a condition that leads to pain and disability. The association between body weight and osteoarthritis is mediated by both mechanical and humeral factors such as growth factors, hormones and mediators of the immune system. This review will present the mechanisms which lead to osteoarthritis, and will discuss available treatments which are suitable for the overweight and obese population, along with promising emerging new treatments.