Improvements in pain, physical function, and work productivity largely persist for at least seven years after bariatric surgery, despite some regression from the high levels of improvement seen in the years immediately following surgery, epidemiologists report today the University of Pittsburgh at JAMA Network Open.
The findings, which show improvements persisted even as participants aged over the course of the study, can help inform doctors, health insurance providers and patients, many of whom undergo surgery to relieve joint pain and improve mobility.
Adults with severe obesity are much more likely to experience significant joint pain and limitations in their physical abilities. Obesity leads to an earlier need for knee and hip replacement. However, severely obese adults may be denied joint surgery until they lose weight. And, if physical limitations and pain interfere with work performance, weight loss may be necessary to maintain employment.”
Wendy C. King, Ph.D., Associate Professor of Epidemiology, Pitt’s School of Public Health
For seven years, King and colleagues followed 1,491 adults who, between 2006 and 2009, received Roux-en-Y gastric bypass or sleeve gastrectomy, the two most common and effective surgical treatments for ‘severe obesity. At the time of surgery, study participants had a mean age of 47 years and 80% were women.
Participants were enrolled in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective cohort study of US patients undergoing weight loss surgery.
The new research builds on an earlier study by King and colleagues that found that in the three years after bariatric surgery, 50% to 70% of study participants reported clinically significant improvements in pain levels, physical function and usual walking speed.
“At the time, this research provided the largest and longest evaluation of changes in pain and physical function after bariatric procedures today,” King said. “Our new study doubles that time frame, giving patients and doctors a better understanding of how likely bariatric surgery is to produce lasting results.”
In their updated analysis, the researchers found that at seven years after surgery, 43 percent of participants had clinically important improvements in pain, 64 percent in physical function, and 50 percent in 400-minute walk time. meters, all with a drop of between 7 and 11 percentage points. of the triennial evaluation.
Among participants with symptoms suggestive of osteoarthritis before receiving bariatric surgery, at seven years after surgery, 65% reported improvements in hip pain, while 72% reported improvements in knee function, both below 77% three years after surgery.
The small to moderate decreases in pain and improvements in physical function are not surprising, given that the participants also aged over the course of the study to an average of 54 years, King said. Previous research shows that some aspects of physical function, such as balance and strength, begin to decline as people enter their 50s, and others, such as walking speed and aerobic endurance, tend to decline in the sixth decade of life
“On average, participants experienced lasting improvements in walking speed, fitness and almost all pain metrics,” King said.
Additionally, participants reported that pain and health status interfered less with their ability to work after surgery, with 43% of participants reporting impairment at work due to health seven years later of surgery, down from 63% before surgery.
“Combined, our study offers great news about the lasting effects of bariatric surgery,” King said. “But clinicians should look at patients as individuals and consider their full health history, goals and motivations for weight loss when providing preoperative counseling about potential outcomes.”
Additional authors of this research are Amanda S. Hinerman, Ph.D., and Gretchen E. White, Ph.D., both of Pitt.
No funding was provided for this specific analysis, but LABS-2 was funded through a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases.
Source:
Journal reference:
King, WC, et al. (2022) A 7-year study of the durability of improvements in pain, physical function, and work productivity after Roux-en-Y gastric bypass and sleeve gastrectomy. Open JAMA Network. doi.org/10.1001/jamanetworkopen.2022.31593.