Changes in Functional Mobility and Musculoskeletal Pain After Bariatric Surgery in Teens With Severe Obesity

Abstract

IMPORTANCE Severe obesity is associated with mobility limitations and higher incidence of multijoint musculoskeletal pain. It is unknown whether substantial weight loss improves these important outcomes in adolescents with severe obesity.OBJECTIVE To examine the association of bariatric surgery with functional mobility and musculoskeletal pain in adolescents with severe obesity up to 2 years after surgery. DESIGN, SETTING, AND PARTICIPANTSThe Teen-Longitudinal Assessment of Bariatric Surgery Study is a prospective, multicenter, observational study, which enrolled 242 adolescents (Յ19 years of age) who were undergoing bariatric surgery from March 2007 through February 2012 at 5 US adolescent bariatric surgery centers. This analysis was conducted in November 2015.INTERVENTIONS Roux-en-Y gastric bypass (n = 161), sleeve gastrectomy (n = 67), or laparoscopic adjustable gastric band (n = 14). MAIN OUTCOMES AND MEASURESParticipants completed a 400-m walk test prior to bariatric surgery (n = 206) and at 6 months (n = 195), 12 months (n = 176), and 24 months (n = 149) after surgery. Time to completion, resting heart rate (HR), immediate posttest HR, and HR difference (resting HR minus posttest HR) were measured and musculoskeletal pain concerns, during and after the test, were documented. Data were adjusted for age, sex, race/ethnicity, baseline body mass index (calculated as weight in kilograms divided by height in meters squared), and surgical center (posttest HR and HR difference were further adjusted for changes in time to completion). RESULTSOf the 206 adolescents with severe obesity included in the study, 156 were female (75.7%), the mean (SD) age was 17.1 (1.6) years, and the mean (SD) body mass index was 51.7 (8.5). Compared with baseline, significant improvements were observed at 6 months for the walk test time to completion (mean, 376 seconds; 95% CI, 365-388 to 347 seconds; 95% CI, 340-358; P < .01), resting HR (mean, 84 beats per minute [bpm]; 95% CI, 82-86 to 74 bpm; 95% CI, 72-76), posttest HR (mean, 128 bpm; 95% CI, 125-131 to 113 bpm; 95% CI, 110-116), and HR difference (mean, 40 bpm; 95% CI, 36-42 to 34 bpm; 95% CI, 31-37). These changes in time to completion, resting HR, and HR difference persisted at 12 months and 24 months. Posttest HR further improved from 6 months to 12 months (mean, 113 bpm; 95% CI, 110-116 to 108 bpm; 95% CI, 105-111). There were statistically significant reductions in musculoskeletal pain concerns at all points.CONCLUSIONS AND RELEVANCE These data provide evidence that bariatric surgery in adolescents with severe obesity is associated with significant improvement in functional mobility and in the reduction of walking-related musculoskeletal pain up to 2 years after surgery.

Treatment Options for Severe Obesity in the Pediatric Population: Current Limitations and Future Opportunities

“…From a comorbidity standpoint, studies have noted an 85% to 95% remission in T2D, a 64% to 73% resolution of dyslipidemia, and a 75% remission in hypertension . Importantly, bariatric surgery improves functional mobility and reduces musculoskeletal pain , favorably alters levels of adipokines and cytokines , improves insulin sensitivity and beta‐cell function , improves kidney function and albuminuria , reduces nonalcoholic hepatic steatohepatitis , and improves weight‐related quality of life . Moreover, a high proportion of youth are able to sustain weight loss long term, which should be an expectation given the risks and invasive nature of the procedure .…”

Weight Loss Surgery in Adolescents

“…Teen‐LABS participants demonstrated improved measures of the 400‐m walk test, which occurred after 6 months and persisted at 12 and 24 months. They also reported reductions in musculoskeletal pain at 24 months 72 . A smaller cohort in the Adolescent Morbid Obesity Study demonstrated improvements in cardiorespiratory fitness measured by VO 2 max/kg of body mass and walking distance at 2 years postprocedure.…”

Thirty‐Year Risk of Cardiovascular Disease Events in Adolescents with Severe Obesity

“…The Framingham Heart Study has developed a 30-year CVD event risk estimate (validated in 20-to 59-year-olds) that offers the opportunity to prospectively evaluate CVD event risk over the long term (10). Given the preponderance of evidence suggesting childhood obesity is a risk factor for early CVD morbidity and mortality (3,4,6,7,11), coupled with the elevated CVD risk profile exhibited among youths with severe obesity (12)(13)(14)(15)(16)(17)(18), it is probable that the risk of CVD events later in life is high among youths with severe obesity.…”

“…Currently, the only intervention with high rates of clinically meaningful and sustained weight loss among youths with severe obesity is metabolic and bariatric surgery (MBS) (12)(13)(14)(16)(17)(18)(19)(20). Data in adults undergoing MBS have demonstrated a significant reduction in CVD events and mortality compared with nonsurgical controls (21)(22)(23).Whether these findings translate to pediatric populations cannot be determined without long-term follow-up.…”