A Long View of Weight-Loss Surgery

The value of weight-loss or bariatric surgery goes beyond losing weight. The procedure can make a difference in a person’s health and quality of life. It can ease joint pain and help patients remain mobile. It can help them avoid joint replacement and qualify for joint replacement if necessary. And, as a study by researchers at the University of Pittsburgh finds, weight-loss surgery can improve a person's economic security by making it possible for them to remain at their jobs.

“Adults with severe obesity are much more likely to experience significant joint pain and limits to their physical abilities,” researcher, Wendy C. King, associate professor of epidemiology in Pitt’s School of Public Health, said in a statement. “Obesity leads to an earlier need for knee and hip replacement. However, adults with severe obesity may be denied joint surgery until they lose weight. And, if physical limitations and pain interfere with job performance, losing weight could be necessary to maintain employment.”

Nearly 1500 adults who had had either Roux-en-Y gastric bypass or sleeve gastrectomy between 2006 and 2009 were followed for seven years. The median age of participants was 47 years old at the time of their surgeries; 80 percent were female; and all were part of a National Institutes of Health-funded study of U.S. patients undergoing weight-loss surgery.

“On average, participants experienced durable improvements in walking speed, fitness and almost all metrics of pain.”

What they found was that the improvements seen after three years persisted over seven — even with participants aging over the course of the study. Seven years post-surgery, 64 percent of the participants had improved physical function, and 43 percent had clinically important improvements in pain. Participants’ walking speed over 400 meters also improved by 50 percent.

There was a small to moderate drop of 7 to 11 percentage points between the results after three years and those after seven, however, but participants had aged to a median age of 54 years over the course of the study. Balance and strength are known to start to decline when people enter their 50s. “On average, participants experienced durable improvements in walking speed, fitness and almost all metrics of pain,” King explained.

When asked about their work lives, participants reported that pain and health status interfered less with their ability to work post-surgery. Before surgery, 63 percent of the participants reported their work was impaired by their health. Seven years after surgery, only 43 percent so reported.

The findings should help doctors counsel patients about the kinds of improvements bariatric surgery can provide, and help patients consider long-term benefits they may not have thought of before. “Our new study…[gives] patients and doctors a better understanding of the likelihood that bariatric surgery will yield lasting results.” Every patient is different, however, and King cautions that doctors — and patients — should consider the candidate's health history, goals and motivations when discussing surgical interventions for weight-loss.

The study is published in JAMA Network Open.