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 Researchers followed more than 2,200 obese patients who had weight
loss surgery. After one year, 58 percent of them reported less pain
and 77 percent said they had better physical function.
By three years, the proportion of patients still reporting
improvements in pain and physical function dropped significantly to
49 percent and 70 percent, respectively.
Patients did, however, report consistent improvements in walking
ability at one and three years, and those who started with knee and
hip problems also reported lasting pain reductions and mobility
increases around these joints.
While surgery remains more effective for lasting weight loss than
alternatives such as dieting and exercising, the findings suggest
that not all surgical patients will get the same results, said lead
study author Wendy King, a public health researcher at the
University of Pittsburgh.
The amount of weight lost after the surgery, rather than the type of
surgery, was “consistently related to improvements in pain and
function,” King said by email.
Globally, 1.9 billion adults are overweight or obese, according to
the World Health Organization. Obesity increases the risk of heart
disease, diabetes, joint disorders and certain cancers.
Surgical weight loss has gained traction in recent years, but it is
not risk-free. For example, patients can become malnourished.
In the U.S. alone, roughly 180,000 people get these procedures each
year, according to the American Society for Metabolic and Bariatric
Surgery (ASMBS).
The most common operation, known as a sleeve gastrectomy, reduces
the stomach to the size of a banana. The next most common, known as
Roux-en-Y, creates an even smaller stomach pouch.
King and colleagues focused on people who had Roux-en-Y operations
or procedures known as laparoscopic adjustable gastric banding,
which also reduce the stomach size but can later be reversed.
Most patients were women, and half were at least 47 years old at the
start of the study. They were all severely obese.
Overall, reductions in weight and depressive symptoms were
associated with more improvements in pain and mobility, researchers
report in JAMA.
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Younger patients, men, wealthier and less obese people were also
more likely to have improvements in pain and mobility at one and
three years after surgery.
The study was observational, and it can’t prove weight loss surgery
directly causes reductions in pain or increases in mobility, the
authors note.
Another limitation of the study is the lack of a control group of
people who lost weight without surgery, making it impossible to say
whether the operations might lead to better or worse results than
losing weight through alternative methods such as diet or exercise,
the researchers also point out.
It’s also possible that obese patients would need more than just
surgical weight loss to achieve the best outcomes in pain and
physical function, said Dr. John Morton, chief of bariatric and
minimally invasive surgery at Stanford School of Medicine.
“Clearly patients who have obesity and joint disease are patients
with chronic disease,” Morton, also immediate past president of
ASMBS, said by email.
“These patients likely need to have follow up and access to care for
needed services like physical therapy,” added Morton, who wasn’t
involved in the study.
While it’s possible patients might achieve reductions in pain and
improved mobility if they lost enough weight through diet and
exercise, this often doesn’t happen, noted King.
“Unfortunately, lifestyle interventions that focus on dietary
intake, eating behaviors, exercise, physical activity level, or a
combination of these factors have not been able to achieve a
comparable magnitude of weight loss” as surgery, King said.
SOURCE: http://bit.ly/1ozw2CX JAMA, online April 5, 2016.
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