BMS delivers functional, CVD and musculoskeletal improvements in adolescents out to six years

Adolescents with severe obesity who underwent BMS were seen to have improved functional mobility, cardiovascular parameters and musculoskeletal outcomes, which were sustained or continued to improve until six years of follow-up, US researchers have reported.

The researchers used data from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort study, to investigate the functional mobility and probability of walking-related musculoskeletal pain, as well as the relationship between these outcomes and weight regain, for up to up years after MBS among adolescents with severe obesity.

They routinely administered 400-m walk tests at baseline, six months one year and annually for up to six years. Time to completion, resting heart rate (HR), immediate post-test HR, HR difference, HR recovery and the risk of walking-related musculoskeletal pain were assessed over the course of scheduled follow-up research visits. They hypothesised that the improvements in functional mobility, cardiovascular parameters, and musculoskeletal pain observed postoperatively would be sustained at six years, even in the setting of weight regain, and that there would be a significant weight-independent contribution to these outcomes.

In total, 205 patients were included in this analysis, consisting of 146 (71.2%) who underwent RYGB and 59 (28.8%) who underwent vertical sleeve gastrectomy. There was a moderate amount of incomplete data, with 185 (90.2%) participants at six months, 168 (82.0%) participants at one year, 143 (69.8%) participants at two years, 122 (59.5%) participants at three years, 125 (61.0%) participants at four years, 126 (61.5%) participants at five years and 119 (58.0%) participants at six years who completed 400-m walk tests. At baseline, the median age of the cohort was 17.1 years (IQR: 15.9–18.2 years) with a median body fat percentage of 53.2% (IQR: 50.2%–56.1%).

Prior to BMS, the mean BMI was 53.0 (95% CI: 51.9–54.4), which decreased to 36.7 (p<0.001, 95% CI: 35.6–37.8) at one year, representing a 30.8% decrease in BMI. The mean BMI of the cohort then increased to 39.9 (p<0.001, 95% CI: 38.2–41.6) at year six, with 66 (32.2%) participants experiencing clinically significant weight regain (>20%).

At baseline, the estimated average walk time for the cohort was 383 s (95% CI: 368–399), which decreased to 344 s (p < 0.001, 95% CI: 330–357) at one year and 351 s (p = 0.038, 95% CI: 330–372) at six years. Resting HR decreased from 90 bpm (95% CI: 87–93) to 78 bpm (p < 0.001, 95% CI: 74–81) at year one and was equal to 80 bpm (p = 0.003, 95% CI: 76–84) at year six.

Immediate post-test HR decreased from 128 bpm (95% CI: 123–133) at baseline to 108 bpm (p < 0.001, 95% CI: 103–113) at one year and 100 bpm (p<0.001, 95% CI: 94–107) at six years. Similarly, the HR difference between the immediate post-test HR and the resting HR also decreased from 38 bpm (95% CI: 33–42) at baseline to 31 bpm (p=0.003, 95% CI: 26–35) at one year and 20 bpm (p<0.001, 95% CI: 15–25) at six years. HR recovery decreased from baseline at 30 bpm (95% CI: 26–34) to 25 bpm (p = 0.015, 95% CI: 21–29) at one year and 17 bpm (p=0.001, 95% CI: 12–22) at six years.

The prevalence of musculoskeletal pain decreased from the baseline visit at 37.2% (95% CI: 25.5%–48.9%) to 14.1% (p=0.003, 95% CI: 5.4%–22.8%) at one year and 11.0% (p=0.014, 95% CI: 4.3%–17.6%) by six years.

“Our findings suggest that the effects of MBS on functional mobility and musculoskeletal pain are durable for up to six years. Improvements in walk time and resting HR were sustained to a similar level between six months and up to six years after surgery,” the authors write. “Steady improvements in immediate post-test HR, HR difference, and HR recovery occurred over time, suggesting that, although the initial improvements in these parameters may be due to surgical intervention, other factors such as decreased inflammatory stress and metabolic adaptations may be contributing to sustained improvement in these proxies for cardiovascular fitness.”

The findings were reported in the paper, ‘Functional mobility and pain are improved for 6 years after adolescent bariatric surgery’, published in the journal Obesity. To access this paper, please click here