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Objectives: To evaluate the longitudinal effects of metabolic and bariatric surgery (MBS) on the prevalence of musculoskeletal and lower extremity (LE) pain, physical function, and health-related quality of life., Methods: The Teen Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected data on 242 adolescents undergoing MBS at 5 centers over a 3-year follow-up. Joint pain and physical function outcomes were assessed by using the Health Assessment Questionnaire Disability Index, Impact of Weight on Quality of Life - Kids, and the Short Form 36 Health Survey. Adolescents with Blount disease ( n = 9) were excluded., Results: Prevalent musculoskeletal and LE pain were reduced by 40% within 12 months and persisted over 3 years. Adjusted models revealed a 6% lower odds of having musculoskeletal pain (odds ratio = 0.94, 95% confidence interval: 0.92-0.99) and a 10% lower odds of having LE pain (odds ratio = 0.90, 95% confidence interval: 0.86-0.95) per 10% reduction of BMI. The prevalence of poor physical function (Health Assessment Questionnaire Disability Index score >0) declined from 49% to <20% at 6 months ( P < .05), Physical comfort and the physical component scores, measured by the Impact of Weight on Quality of Life - Kids and the Short Form 36 Health Survey, improved at 6 months postsurgery and beyond ( P < .01). Poor physical function predicted persistent joint pain after MBS., Conclusions: Joint pain, impaired physical function, and impaired health-related quality of life significantly improve after MBS. These benefits in patient-reported outcomes support the use of MBS in adolescents with severe obesity and musculoskeletal pain and suggest that MBS in adolescence may reverse and reduce multiple risk factors for future joint disease., Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Inge received honoraria and stock options from Standard Bariatrics and honoraria from UpToDate and Independent Medical Expert Consulting Services and served as a consultant for Zafgen, Inc, BioMedical Insights, and L&E Research, all outside the submitted work. Dr Harmon served on an advisory panel for Stryker Corporation from 1998 to 2015, unrelated to this project. Dr Dixon consulted for Apollo Endosurgery, Covidien, Bariatric Advantage, Nestle Health Science, Inova, and Novo Nordisk; the other authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)

The associations among lower extremity functional performance and quality of life in obese youth are unknown. The aims of this study were to compare lower extremity strength, lower extremity functional performance, and health related quality of life between obese and healthy-weight youth and evaluate the relationships between lower extremity performance and health related quality of life in obese youth. Twenty obese and 20 age and sex matched healthy-weight youth were recruited. Peak torque of the major lower extremity muscles were measured. Functional performance was measured with single leg hop and single leg balance tests. The Paediatric Quality of Life questionnaire's physical and psychosocial health subscales were used. Paired t-tests and multiple regression analyses were performed. Obese youth demonstrated decreased peak torque in all muscles measured (P < 0.05), poorer functional performance (P < 0.05), and worse physical health related quality of life (P < 0.05) compared to healthy-weight youth. Lower extremity functional performance was associated with aspects of quality of life in the obese group (P = 0.002), but not in the healthy-weight group (P < 0.05). These results may assist in encouraging best practices in the promotion of exercise, physical activity, and quality of life in obese youth.

Importance: Obesity is associated with chronic musculoskeletal pain and is a risk factor for disability and osteoarthritis., Objectives: To describe the prevalence, sites, and intensity of musculoskeletal pain in adolescents with severe obesity; to evaluate associations between musculoskeletal pain and self-reported physical function as well as weight-related quality of life; and to evaluate the association between musculoskeletal pain and high-sensitivity C-reactive protein level., Design, Setting, and Participants: Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a prospective, observational study that collects standardized data on adolescents undergoing weight loss surgery at 5 US centers. We examined baseline data from this cohort between February 28, 2007, and December 30, 2011. We excluded adolescents with Blount disease and slipped capital femoral epiphyses. A total of 233 participants were included in these analyses., Main Outcomes and Measures: We assessed musculoskeletal pain and pain intensity of the lower back, hips, knees, and ankles/feet using the visual analog scale, categorizing musculoskeletal pain into lower back pain, lower extremity (hips, knees, and feet/ankles combined) pain, and no pain. We assessed self-reported physical function status with the Health Assessment Questionnaire Disability Index and assessed weight-related quality of life with the Impact of Weight on Quality of Life-Kids measure. We adjusted for sex, race, age at surgery, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and clinical depressive symptoms in regression analyses., Results: Among the 233 participants, the mean (SD) age at surgery was 17.1 (1.56) years and the median BMI was 50.4. Participants were predominantly female (77%), white (73%), and non-Hispanic (93%). Among the participants, 49% had poor functional status and 76% had musculoskeletal pain. Lower back pain was prevalent (63%), followed by ankle/foot (53%), knee (49%), and hip (31%) pain; 26% had pain at all 4 sites. In adjusted analyses, compared with pain-free participants, those reporting lower extremity pain had greater odds of having poor physical function according to scores on the Health Assessment Questionnaire Disability Index (odds ratio = 2.82; 95% CI, 1.35 to 5.88; P < .01). Compared with pain-free participants, those reporting lower extremity pain had significantly lower Impact of Weight on Quality of Life-Kids total scores (β = -9.42; 95% CI, -14.15 to -4.69; P < .01) and physical comfort scores (β = -17.29; 95% CI, -23.32 to -11.25; P < .01). After adjustment, no significant relationship was observed between musculoskeletal pain and high-sensitivity C-reactive protein level., Conclusions and Relevance: Adolescents with severe obesity have musculoskeletal pain that limits their physical function and quality of life. Longitudinal follow-up will reveal whether weight loss surgery reverses pain and physical functional limitations and improves quality of life.

Background: Childhood obesity is associated with reduced quality of life, physical fitness, and a higher prevalence of lower extremity (LE) pain; however, it is unclear whether and how these factors are related. Questions/purposes: For this study we asked if obese children with LE pain (LE+) had higher BMI-Z scores, lower physical function and psychosocial health, and lower physical fitness compared with obese children without LE pain (LE−). We determined the association of BMI-Z score with physical function, psychosocial health, or physical fitness in obese children. Methods: Medical charts of 183 obese children were reviewed. Recorded data included anthropometrics, demographics, reports of musculoskeletal pain, Pediatric Quality of Life (PedsQL)-Physical Function score, PedsQL-Psychosocial Health score, and physical fitness levels. Data from 175 individuals were included in the analysis, with 51 in the LE+ group and 124 in the LE− group. Statistical analysis included Mann-Whitney U tests and Spearman's rank order correlations. Results: Between the LE+ and LE− groups, BMI-Z and physical fitness scores were not different. The LE+ group scored worse on the PedsQL-Physical Function scale (LE+: 72.4 [17.1], LE−: 79.5 [15.0]) and PedsQL-Psychosocial Health scale (LE+: 70.0 [16.1], LE−: 75.8 [16.3]). BMI-Z scores negatively correlated with PedsQL-Physical Function scores, PedsQL-Psychosocial Health scores, and physical fitness scores. Conclusions: Our findings indicate that LE pain should be considered in the evaluation and management of children who are obese. Level of Evidence: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]