OBJECTIVES: To evaluate the longitudinal effects of metabolic and bariatric surgery (MBS) on the prevalence of musculoskeletal and lower extremity (LE) pain, physical function, and healthrelated quality of life. METHODS: The Teen Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected data on 242 adolescents undergoing MBS at 5 centers over a 3-year follow-up. Joint pain and physical function outcomes were assessed by using the Health Assessment Questionnaire Disability Index, Impact of Weight on Quality of Life - Kids, and the Short Form 36 Health Survey. Adolescents with Blount disease (n = 9) were excluded. RESULTS: Prevalent musculoskeletal and LE pain were reduced by 40% within 12 months and persisted over 3 years. Adjusted models revealed a 6% lower odds of having musculoskeletal pain (odds ratio = 0.94, 95% confidence interval: 0.92-0.99) and a 10% lower odds of having LE pain (odds ratio = 0.90, 95% confidence interval: 0.86-0.95) per 10% reduction of BMI. The prevalence of poor physical function (Health Assessment Questionnaire Disability Index score .0) declined from 49% to ,20% at 6 months (P<.05), Physical comfort and the physical component scores, measured by the Impact of Weight on Quality of Life - Kids and the Short Form 36 Health Survey, improved at 6 months postsurgery and beyond (P<.01). Poor physical function predicted persistent joint pain after MBS. CONCLUSIONS: Joint pain, impaired physical function, and impaired health-related quality of life significantly improve after MBS. These benefits in patient-reported outcomes support the use of MBS in adolescents with severe obesity and musculoskeletal pain and suggest that MBS in adolescence may reverse and reduce multiple risk factors for future joint disease.
Bibliographical noteFunding Information:
FINANCIAL DISCLOSURE: Dr Inge serves as a consultant for Standard Bariatrics, UpToDate, and Independent Medical Expert Consulting Services, which are all unrelated to this project. Dr Dixon’s research is supported through a National Health and Medical Research Council research fellowship. Dr Courcoulas received grants from Covidien and Ethicon Johnson & Johnson Health Care Systems; the other authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: Funded by the Rheumatology Research Foundation’s Investigator Award. The Teen Longitudinal Assessment of Bariatric Surgery Consortium was funded by cooperative agreements with the National Institute of Diabetes and Digestive and Kidney Diseases through grants U01DK072493, UM1DK072493, and UM1DK095710 (University of Cincinnati). The study was also supported by grants UL1 TR000077-04 (Cincinnati Children’s Hospital Medical Center), UL1RR025755 (Nationwide Children’s Hospital), M01-RR00188 (Texas Children’s Hospital and Baylor College of Medicine), UL1 RR024153 and UL1TR000005 (University of Pittsburgh), UL1 TR000165 (University of Alabama, Birmingham). Funded by the National Institutes of Health (NIH).
© 2019 by the American Academy of Pediatrics.