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Bariatric surgery in teens may reduce musculoskeletal pain and improve mobility

By Nicole MacKee
Bariatric surgery reduces musculoskeletal pain and improves functional mobility in adolescents with severe obesity, US researchers have reported.

In a multicentre observational study, published in JAMA Pediatrics, the researchers evaluated the impact of bariatric surgery on musculoskeletal pain and mobility in 206 adolescents with a body mass index (BMI) range of 33.9 to 80.4 kg/m2.

The adolescents, who were aged between 13 and 20 years at the time of surgery, underwent Roux-en-Y gastric bypass (67.5%), sleeve gastrectomy (27.2%) and laparoscopic adjustable gastric band surgery (5.3%). They completed a 400 metre walk before surgery (n=206), and at six months (n=195), 12 months (n=176) and 24 months (n=149) after surgery.

After adjusting for age, sex, ethnicity, baseline BMI and surgical centre, the researchers found that the relative risk (RR) of musculoskeletal pain concerns from baseline was reduced at six months (RR, 0.76), 12 months (RR, 0.62) and 24 months (RR, 0.47). However, improvements in pain were not associated with a percentage change in BMI.

They also found time to completion of the 400 metre walk, resting heart rate and heart rate difference were improved compared with baseline at all time points.

Dr Shirley Alexander, Consultant Paediatrician at The Children’s Hospital at Westmead, Sydney, said musculoskeletal pain can be a significant barrier [to physical activity] for many adolescents with obesity, and can contribute to a vicious cycle of ever increasing weight gain.

‘Adolescents with obesity tend to be less active and so less likely to have good fundamental movement skills, more likely to have falls and flat feet, and have more pain, which means they don’t want to engage in physical activity. They then put on weight and the whole cycle repeats,’ said Dr Alexander, who specialises in child and young adult obesity. Bariatric surgery could have a role in reversing this cycle, she said, and could be life-changing for more severely affected adolescents, but the availability of such surgery was still limited in the Australian public health system. She also noted that the long-term consequences of bariatric surgery in younger people were still unknown.

Dr Malcolm Hogg, Head of Pain Services, Melbourne Health, and Clinical Associate Professor at the University of Melbourne, noted methodology regarding reporting pain concerns made it difficult to determine the extent and process of reported improvements in pain, and how this related to functional improvements. Significant loss to final follow up and how these outcomes were assessed was also unclear, he added.

Dr Hogg said the authors reported no association between change in BMI and change in pain report, such that the reduced pain reported in the study could reflect the general attitudinal changes of teenagers who were more engaged in physical activity.

‘That fits with our view of pain in that there is more to it than just the structural, mechanical aspect; there is a neurological aspect to the pain experience as well,’ he said.

Dr Alexander agreed that the positive psychological effect of exercise could contribute to pain reduction. 

‘Exercise makes you feel better, it makes you feel more confident, more competent, and that positive psychological effect is often very helpful in dealing with pain.’