Adolescent bariatric surgery associated with improved mobility and reduced musculoskeletal pain

1. In this multi-center, prospective cohort study, adolescent patients undergoing bariatric surgery demonstrated improved functional mobility and reduced subjective musculoskeletal pain post-operatively at 6, 12, and 24 months.

2. The longer term effects of these changes, however, are not well characterized at this point, given the predisposition for weight gain years later in the bariatric surgery population.

Evidence Rating Level: 2 (Good)

Study Rundown: Childhood obesity is linked to many adverse health outcomes including declined cardiovascular health, and increased prevalence of debilitating musculoskeletal pain and declined mobility. Bariatric surgery in teenage patients has been shown to have significant weight loss, but data on improvements in functional outcomes such as mobility and subjective improvements in pain have not been investigated. This study followed teenage patients after either roux-en-Y gastric bypass or sleeve gastrectomy for up to 2 years measuring functional mobility through a timed 400m walk with subjective musculoskeletal pain scores.

Compared with baseline assessment, patients 6-months post-operative were found to have significantly reduced time for 400m walk and reduced resting and peak heart rates. Subjective musculoskeletal pain concerns were also reduced following bariatric surgery. Improvements in both functional mobility and pain were durable up to two years after surgery. Strengths of the study included the two-year follow-up period and the relatively large size of the cohort. The weaknesses of the study included lack of assessment of weight loss and its correlation with the studied parameters. Additionally, the cohort was predominantly female and Caucasian, which limits generalizability.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Factors Related to Improvement In Joint Pain and Physical Function Following Bariatric Surgery

In-Depth [prospective cohort]: The described study included 206 patients aged 19 or under who underwent either Roux-en-Y gastric bypass or sleeve gastrectomy as part of the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Patients underwent mobility assessments at baseline and then at 6-, 12-, and 24-months. Functional mobility was evaluated with timed 400-meter walk and assessment of resting, posttest, and 2-minute posttest heart rate. Musculoskeletal pain concerns were reported if there was pain in any of the knee, calf, foot, or back.

At 6 months, there was significant improvement in time of walk completion (mean 376 seconds vs. 347 seconds, P<0.01), resting heart rate (mean 84 bpm to 74 bpm, P<0.01), posttest heart rate (mean 128 bpm to 113 bpm, P<0.01), and two-minute heart rate recovery. Musculoskeletal pain also decreased from baseline to RR=0.76 (P<0.01) at the 6-month time point and continued to demonstrate similar effect up to 2-years post-operatively.

Image: PD

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