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Bariatric Surgery for Obesity Improves Symptoms of Arthritis

August 17, 2017
Bariatric surgery is recognized for improving obesity-related comorbidities such as diabetes, hypertension, sleep apnea, and cardiovascular disease. Weight loss following bariatric surgery also improves arthritis symptoms and mobility, new study finds.

Evidence suggests that as body mass index (BMI) increases, the chance of developing osteoarthritis increases as well. Weight loss is among the initial non-pharmacological recommendations for several painful arthritic diseases, particularly knee osteoarthritis.1-3 However, maintaining weight loss over the long term is challenging, especially if patients have pain and their movement is limited.

In a new study of positive outcomes following bariatric surgery, arthritis was one of the comorbidities that improved with weight loss following surgery. In this study, patients who had a BMI of 40 kg/m2 or less before surgery were more likely to reduce their weight to a BMI of 30 kg/m2 or less 1 year later and to experience remission of their comorbid conditions.4

Bariatric surgery can help relieve many health-related effects of obesity, including osteoarthritis.

The study reviewed the records of 27,320 adults undergoing bariatric surgery in hospitals within the Michigan collaborative between June 2006 and May 2015. One year after surgery, patients’ mean BMI was reduced from 48 kg/m2 preoperatively, to 33 kg/m2. Arthritis was among the comorbidities that showed improvement following bariatric surgery, indicating that weight loss has a positive effect.

“The effects of weight loss on arthritis were not evaluated specifically in this study; however, there are clear benefits to weight loss among patients with arthritis pain,” Oliver A. Varban, MD, lead author of the study, told Practical Pain Management. “Our study demonstrates that offering bariatric surgery as a first-line treatment of obesity is more likely to generate the best results and allow patients to achieve a BMI of 30 kg/m2 or less. This in turn allows for the maximal benefit for weight-related comorbid conditions, which may include arthritis.”

A subset of 9,713 patients (36%) achieved a BMI of less than 30 kg/m2 at 1 year, and their mean preoperative BMI was 42.7 kg/m2. These patients were significantly more likely to discontinue medications for hyperlipidemia, diabetes, and hypertension and to experience sleep apnea remission.

Weight Loss of 10% Reduces Arthritis Symptoms

Bariatric procedures included laparoscopic or open Roux-en-Y gastric bypass (RYGB) in 44%, laparoscopic sleeve gastrectomy (LSG) in 38%, laparoscopic adjustable gastric banding (LAGB) in 16%, and biliopancreatic diversion with duodenal switch (BPD/DS) in 1%. Patients who underwent the metabolic procedures LSG, RYGB, and BPD/DS were more likely to achieve BMI < 30 kg/m2 compared with those who had LAGB, a purely restrictive procedure. Among this group, 57% received RYGB.  

“Not only do patients find that the physical burden of obesity is relieved with weight loss, but there have been other studies to show that weight loss lowers the markers for inflammation, which are a part of arthritis pain,” said Dr. Varban. A recent study, showed that a weight loss of 10% of body weight in obese patients (BMI ≥30) with knee osteoarthritis that could be maintained over 3 years could maintain weight-loss induced benefits on osteoarthritis symptoms.5

In this study, weight loss was maintained through the controlled use of meal replacements in 1 of 2 protocols.5 Maintaining such a regimen is challenging, and patients received dietary and behavioral support. Similarly, in the bariatric surgery study,4 authors recommend that patients be counseled appropriately with respect to weight loss expectations after bariatric surgery. This is especially significant, as only 8.5% of patients with a pre-surgery BMI of 50 kg/m2 or greater achieved a BMI of < 30 kg/m2 after bariatric surgery.

"Bariatric surgery is optimal in patients with a BMI of less than 40," Dr. Varban and colleagues wrote. "Policies and practice patterns that delay bariatric surgery until the BMI is 50 or greater can result in significantly inferior outcomes.”

While guidelines recommend bariatric surgery for patients with a BMI or at least either 35 kg/m2 or 40 kg/m2, surgery is often considered only after other interventions have failed and patients are at high risk for morbidity and mortality from weight-related comorbidities, or after they are truly debilitated. Insurance carriers often require a trial of weight loss before surgery. “Our data suggest that these practices may have a detrimental effect on outcomes,” wrote Dr. Varban.

“One important point to be noted among patients suffering from joint pain and obesity,” Dr. Varban told Practical Pain Management. “Patients who undergo gastric bypass surgery cannot take NSAIDs after surgery because they increase the risk of ulcers, which are painful and may result in stricture, bleeding, and even perforation. Among patients dependent on NSAIDs, sleeve gastrectomy is a better choice.”

If intensified intervention for obesity at an earlier stage proves to become more accepted by the medical and insurance industries, another, nonsurgical option is available. The Obalon Balloon System, approved in September 2016, uses gastric balloons to occupy space in the stomach. Indicated for adults with obesity who have a BMI of 30 to 40 kg/m2 and have been unable to lose weight through diet and exercise, the system is intended to be used for 6 months while participating in a moderate-intensity diet and exercise program.

The FDA based its approval on clinical data showing that patients who swallowed the capsule containing an inflatable balloon lost just about twice as much weight as those receiving just a capsule with no balloon (14.4 lbs. vs 7.4 lbs.) 

 

Last updated on: August 17, 2017
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