Newswise — After weight-loss surgery, 57 percent of patients with significant mobility issues before surgery no longer had them and about 70 percent of those with severe knee and hip pain or disability, experienced improvements in joint specific pain and function, according to new study, funded by the National Institutes of Health (NIH), that followed patients for three years.
The findings were presented here at ObesityWeek 2015, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The weeklong conference is hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).
“Our study found that clinically meaningful improvements in bodily pain, specific joint pain, and both perceived and objectively measured physical function are common following bariatric surgery. In particular, walking is easier, which impacts patients’ ability to adopt a more physically active lifestyle. However, some patients continue to have significant pain and disability,” said Wendy King, PhD, Associate Professor of Epidemiology at the University of Pittsburgh Graduate School of Public Health. “In addition to weight loss, we identified several factors related to patients’ likelihood of improvement.”
Researchers analyzed 2,221 patients (79% female) for joint and bodily pain, related medication use and physical function pre- and annually post-surgery. The median body mass index (BMI) was 46 kg/m² and the average age was 47 years. The majority (70%) underwent Roux-en-Y gastric bypass, a quarter (25%) laparoscopic adjustable gastric band, and 5 percent had other procedures.
Other variables analyzed included: age, sex, race, household income, BMI, smoking status, depressive symptoms, comorbid conditions such as diabetes, and percent weight change. All patient data was obtained from the Longitudinal Assessment of Bariatric Surgery (LABS) 2 study, an observational study of bariatric surgery patients from 10 hospitals across the country.
Despite significant improvements in several measures of pain and function for most people, after three years approximately one-in-six patients reported narcotic pain medication use, 26 percent still had a mobility deficit, and there was large variation in several measures of pain, disability and physical function.
Predictors of Improvements in Pain and Function
Younger age, male sex, higher household income, lower BMI, and fewer depressive symptoms before surgery, predicted a higher likelihood of improvement in several pain and function outcomes. Greater weight loss and improvement in depressive symptoms following surgery were also independently associated with improvements in pain and function after surgery.
A history of stroke, cardiovascular disease, diabetes, and venous edema with ulceration post-surgery had a negative impact on outcomes. Greater pain pre-surgery was associated with a higher likelihood of improvement in pain following surgery, but a lower likelihood of improvement in physical function and specifically, mobility.
"Obesity can affect the knees and hips and cause bodily pain because of all the added stress it puts on the joints. As a result, musculoskeletal problems are quite common among bariatric patients,” said John M. Morton, MD, MPH, president of the ASMBS and Chief, Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, who was not involved in the study. “Bariatric surgery can help reduce or reverse that pain and improve function, but the longer one lives with obesity, the less improvement one may have. In certain cases, some damage to the joints may be irreversible.”
In addition to Dr. King, study authors of the abstract entitled, “Factors Related to Improvements in Joint Pain and Physical Function Following Bariatric Surgery,” include Jia-Yuh Chen and Steven H. Belle, University of Pittsburgh Graduate School of Public Health; Anita P. Courcoulas, MD, University of Pittsburgh Medical Center; Gregory F. Dakin, MD, Weill Cornell Medical College, NY; Katherine A. Elder, School of Professional Psychology, Pacific University, OR; David R. Flum, MD, MPH, University of Washington, Seattle; William F. Gourash, CRNP, MSN, University of Pittsburgh Medical Center; Marcelo W. Hinojosa, MD, University of Washington, Seattle; James E. Mitchell, MD, Neuropsychiatric Research Institute, Fargo, ND; Bruce M. Wolfe, MD, Oregon Health Sciences University, Portland; and Susan Z. Yanovski, MD, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MD.
About Obesity and Metabolic and Bariatric Surgery
According to the Centers of Disease Control and Prevention (CDC), more than 78 million adults were obese in 2011–2012.i The ASMBS estimates about 24 million people have severe or morbid obesity. Individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including type 2 diabetes, heart disease and cancer.ii,iii
Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions and results in significant weight loss. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques.iv The risk of death is about 0.1 percentv and the overall likelihood of major complications is about 4 percent.vi
About the ASMBS
The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in obesity, while maintaining a steady exchange of experiences and ideas that may lead to improved outcomes for morbidly obese patients. For more information, visit www.asmbs.org.
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*FACTORS RELATED TO IMPROVEMENT IN JOINT PAIN AND PHYSICAL FUNCTION FOLLOWING BARIATRIC SURGERY -- Wendy King, PhD; Jia-Yuh Chen, MS; Steven Belle, PhD, MScHyg; Anita Courcoulas, MD, MPH; Gregory Dakin, MD; Katherine Elder, PhD; David Flum, MD, MPH, FACS; William Gourash, MSN, CRNP;
Marcelo Hinojosa, MD; James Mitchell, MD; Bruce Wolfe, MD; Susan Yanovski, MD; Presented November 4, 2015
iPrevalence of Obesity Among Adults: United States, 2011–2012. Center for Disease Control and Prevention. (October 2013). Access October 2013 from http://www.cdc.gov/nchs/data/databriefs/db131.htm
iiOffice of the Surgeon General – U.S. Department of Health and Human Services. Overweight and obesity: health consequences. Accessed March 2012 from http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.html
iiiKaplan, L. M. (2003). Body weight regulation and obesity. Journal of Gastrointestinal Surgery. 7(4) pp. 443-51. Doi:10.1016/S1091-255X(03)00047-7.
ivPoirier, P., Cornier, M. A., Mazzone, T., et al. (2011). Bariatric surgery and cardiovascular risk factors. Circulation: Journal of the American Heart Association. 123 pp. 1-19. Accessed March 2012 from http://circ.ahajournals.org/content/123/15/1683.full.pdf
vAgency for Healthcare Research and Quality (AHRQ). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Jan 2007
viFlum, D. R. et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed June 2012 from http://content.nejm.org/cgi/content/full/361/5/445
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