A study of more than 2,000 people who underwent bariatric surgery to lose weight shows that a majority reported less back and leg pain and said it was easier to walk three years after the procedure.
But those improvements didn’t happen for everyone. The research suggests certain factors could help clinicians identify who is most and least likely to experience improvements in pain and function.
“This data can help patients and clinicians develop realistic expectations regarding the impact of bariatric surgery on pain and disability,” says Wendy King, associate professor in epidemiology at the University of Pittsburgh Graduate School of Public Health and lead author of the study published in the Journal of the American Medical Association.
King and colleagues followed 2,221 patients participating in the Longitudinal Assessment of Bariatric Surgery-2 , a prospective study of patients undergoing weight-loss surgery at one of 10 hospitals across the US. After three years, patients weighed, on average, 28 percent less than prior to surgery.
The majority of the patients received Roux-en-Y gastric bypass, a surgical procedure that significantly reduces the size of the stomach and changes connections with the small intestine.
How to predict who will improve
Through three years of follow-up, 50 to 70 percent of adults with severe obesity who underwent bariatric surgery reported clinically important improvements in bodily pain, physical function, and usual walking speed. About three-quarters of the participants with symptoms indicative of osteoarthritis before surgery experienced improvements in knee and hip pain and function. In addition, more than half of participants who had a mobility deficit prior to surgery did not post-surgery.
Older age, lower income, more depressive symptoms, and pre-existing medical conditions, including cardiovascular disease and diabetes before surgery, were among the factors independently associated with a lower likelihood of improvement in pain and mobility post-surgery, while greater weight loss, greater reduction in depressive symptoms, and remission or improvement in several medical conditions were associated with greater likelihood of improvement.
In the first year following bariatric surgery, 3.7 percent of patients had hip, knee, or ankle surgery; in the second year, 4.9 percent had such surgeries followed by another 4.6 percent in the third year. The majority were knee surgeries. The incidence of back surgeries ranged from 1.5 percent in the first year to 2.3 percent in the third year.
Three years post-surgery, 76.3 percent of patients reported that their leg and back pain interfered with their work “not at all,” up from 54.1 percent pre-surgery. Also, the average physical function score of the participants, which is based on ability to walk various distances, climb stairs, perform vigorous and moderate activities, lift and carry groceries, bathe, dress, bend, and kneel, improved to the point that it was comparable to that of the general US population. Resting heart rate also improved.
“Functional status is an extremely important aspect of health that has not been as well-studied as other conditions that change following bariatric surgery, and this study sheds light on specific factors that may affect improvements in individuals with joint pain who undergo these procedures,” says study coauthor Anita Courcoulas, chief of minimally invasive bariatric and general surgery at the University of Pittsburgh School of Medicine.
Researchers from Weill Cornell Medical College; Pacific University and Oregon Health and Science University; the University of Washington; the Neuropsychiatric Research Institute; East Carolina University; and the National Institute of Diabetes and Digestive and Kidney Disease collaborated on the study.
Source: University of Pittsburgh