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Original Investigation |

Changes in Functional Mobility and Musculoskeletal Pain After Bariatric Surgery in Teens With Severe Obesity Teen–Longitudinal Assessment of Bariatric Surgery (LABS) Study

Justin R. Ryder, PhD1; Nicholas M. Edwards, MD, MPH2; Resmi Gupta, MS, MA2; Jane Khoury, PhD2; Todd M. Jenkins, PhD2; Sharon Bout-Tabaku, MD, MSCE3; Marc P. Michalsky, MD3; Carroll M. Harmon, MD, PhD4; Thomas H. Inge, MD, PhD2; Aaron S. Kelly, PhD1
[+] Author Affiliations
1University of Minnesota Medical School, Minneapolis
2Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
3Nationwide Children’s Hospital, Columbus, Ohio
4Women and Children’s Hospital of Buffalo, Buffalo, New York
JAMA Pediatr. 2016;170(9):871-877. doi:10.1001/jamapediatrics.2016.1196.
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Importance  Severe obesity is associated with mobility limitations and higher incidence of multijoint musculoskeletal pain. It is unknown whether substantial weight loss improves these important outcomes in adolescents with severe obesity.

Objective  To examine the association of bariatric surgery with functional mobility and musculoskeletal pain in adolescents with severe obesity up to 2 years after surgery.

Design, Setting, and Participants  The TeenLongitudinal Assessment of Bariatric Surgery Study is a prospective, multicenter, observational study, which enrolled 242 adolescents (≤19 years of age) who were undergoing bariatric surgery from March 2007 through February 2012 at 5 US adolescent bariatric surgery centers. This analysis was conducted in November 2015.

Interventions  Roux-en-Y gastric bypass (n = 161), sleeve gastrectomy (n = 67), or laparoscopic adjustable gastric band (n = 14).

Main Outcomes and Measures  Participants completed a 400-m walk test prior to bariatric surgery (n = 206) and at 6 months (n = 195), 12 months (n = 176), and 24 months (n = 149) after surgery. Time to completion, resting heart rate (HR), immediate posttest HR, and HR difference (resting HR minus posttest HR) were measured and musculoskeletal pain concerns, during and after the test, were documented. Data were adjusted for age, sex, race/ethnicity, baseline body mass index (calculated as weight in kilograms divided by height in meters squared), and surgical center (posttest HR and HR difference were further adjusted for changes in time to completion).

Results  Of the 206 adolescents with severe obesity included in the study, 156 were female (75.7%), the mean (SD) age was 17.1 (1.6) years, and the mean (SD) body mass index was 51.7 (8.5). Compared with baseline, significant improvements were observed at 6 months for the walk test time to completion (mean, 376 seconds; 95% CI, 365-388 to 347 seconds; 95% CI, 340-358; P < .01), resting HR (mean, 84 beats per minute [bpm]; 95% CI, 82-86 to 74 bpm; 95% CI, 72-76), posttest HR (mean, 128 bpm; 95% CI, 125-131 to 113 bpm; 95% CI, 110-116), and HR difference (mean, 40 bpm; 95% CI, 36-42 to 34 bpm; 95% CI, 31-37). These changes in time to completion, resting HR, and HR difference persisted at 12 months and 24 months. Posttest HR further improved from 6 months to 12 months (mean, 113 bpm; 95% CI, 110-116 to 108 bpm; 95% CI, 105-111). There were statistically significant reductions in musculoskeletal pain concerns at all points.

Conclusions and Relevance  These data provide evidence that bariatric surgery in adolescents with severe obesity is associated with significant improvement in functional mobility and in the reduction of walking-related musculoskeletal pain up to 2 years after surgery.

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Figure 1.
Changes in Time to Completion for the 400-m Walk Test and Resting Heart Rate Prior to Testing From Baseline to 6 Months, 12 Months, and 24 Months

Data are adjusted for age, sex, race/ethnicity, baseline body mass index, and surgical center. The error bars represent 95% CIs. bpm indicates beats per minute.

aP < .01 from baseline.

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Figure 2.
Changes in Posttest Heart Rate, Heart Rate Difference, and 2-Minute Heart Rate Recovery From Baseline to 6 Months, 12 Months, and 24 Months

Data are adjusted for age, sex, race/ethnicity, baseline body mass index, surgical center, and change in time to completion. The 2-minute heart rate recovery is calculated by posttest heart rate minus 2-minute postcompletion heart rate. The error bars represent 95% CIs. bpm indicates beats per minute.

aP < .01 from baseline.

bP = .01 from 6 months.

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Figure 3.
Patients With and Without Musculoskeletal Pain Concerns During or After the 400-m Walk Test at Baseline (Preoperative) and 6-Month, 12-Month, and 24-Month Follow-up

Relative risk (RR) of having musculoskeletal pain concerns from baseline, with 95% CIs listed below. The P values indicate the difference from baseline.

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