Four hundred fifteen patients with symptomatic knee osteoarthritis and a BMI between 28 and 40 kg/m² were randomized into three groups: a telehealth-delivered exercise program with dietary intervention (n=175), a telehealth-delivered exercise program alone (n=172), or an online education-only control (n=68). The primary outcomes of interest were changes in knee pain (numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index) at 6 months, with follow-up at 12 months. Secondary outcomes included weight loss, physical activity, quality of life, mental health, global change, satisfaction, willingness for surgery, and orthopedic appointments. Overall, both telehealth exercise interventions led to significant improvements in knee pain and function compared to the control group at 6 months, with similar results at 12 months. The diet and exercise group showed additional modest benefits over exercise alone. These findings suggest that telehealth programs incorporating exercise and dietary intervention improve pain, function, and other health-related outcomes in individuals with knee osteoarthritis and overweight or obesity.