Musculoskeletal and joint pain were reduced by 40% within 1 year of undergoing bariatric surgery in a group of morbidly obese pediatric patients, according to study results published in Pediatrics. The findings suggest the use of metabolic and bariatric surgery (MBS) in adolescents with severe obesity may reverse joint pain and even prevent future joint disease.
Metabolic and bariatric surgery performed in the pediatric population nearly doubled between 2003 and 2009, leading to improvements in joint pain, physical function, and health-related quality of life (HRQoL). The study researchers wanted to evaluate whether weight-loss surgery performed in adolescents may prevent future osteoarthritis.
To conduct the study, the researchers used the Teen-LABS database (ClinicalTrials.gov identifier, NCT00465829) to identify adolescents aged ≤19 years undergoing MBS in the United States. Adolescents with a body mass index (BMI) >35 kg/m2 and comorbid disease (n=219) were enrolled between February 28, 2007 and December 30, 2011. Data collection occurred at baseline (≤30 days preoperative) and at postoperative assessments (6, 12, 24, and 36 months).
Pain was assessed by a 0- to 10-point visual analog scale (0=no pain; 10=severe pain). Pain was rated at each anatomic site (lower back, hips, knees, ankles, and/or feet); the presence of musculoskeletal pain was defined as pain with a score >0 at any of the sites. The presence of lower extremity (LE) pain was defined as pain with a score >0 at the hips, knees, ankles, and/or feet. Back pain was included with musculoskeletal pain.
Physical function was assessed by using the self-report Health Assessment Questionnaire Disability Index (HAQ-DI). Weight-related QoL was assessed by using the Impact of Weight on Quality of Life—Kids (IWQOL-K), an instrument with 4 subscales (physical comfort, body esteem, social life, family relations) and a total score. Patients also completed the Short Form 36 (SF-36) Health Survey from which the physical summary measures were obtained.
A total of 70% of the patients underwent Roux-en-Y gastric bypass (n=152) and 30% vertical sleeve gastrectomy (n=67). The mean age was 17 years; median BMI was 50 kg/m2. Approximately 66% of patients reported musculoskeletal and LE pain and 50% reported poor physical functions. The percent BMI change at 6 months was –24%; 3 years following surgery, the overall percent BMI change was –27%.
After MBS, both musculoskeletal and LE pain decreased at 6 to 12 months to <30% prevalence. Pain intensity at specific joints was reduced in the first 6 months and maintained. For every 10% reduction in BMI there were 6% lower odds of having musculoskeletal pain and 10% lower odds of having LE pain.
The prevalence of poor physical function declined from 49% to <20% at 6 months. No independent association was found between change in BMI and poor physical function; however, there were 21% greater odds of poor physical function in patients with compared with without LE pain.
Physical comfort, total IWQOL-K scores, and the physical component score on the SF-36 improved by 6 months post-surgery. A total of 30% of patients had persistent joint pain following MBS. Poor physical function predicted greater odds of LE pain. Having clinical-range depressive symptoms or having musculoskeletal or LE pain predicted greater odds of persistent poor physical function.
“Given that adolescents with obesity are at risk for developing osteoarthritis in midlife, our findings suggest that pre-osteoarthritis conditions exist in adolescents with severe obesity, but after MBS, pre-osteoarthritis risk factors and abnormal joint loads may be reversed,” the investigators concluded.
Bout-Tabaku S, Gupta R, Jenkins TM. Musculoskeletal pain, physical function, and quality of life after bariatric surgery. Pediatrics. 2019;144(6):e20191399.