Back Surgery Does Not Cure ObesityThursday, April 17, 2008
Immobility, due to pain or otherwise, is certainly a major contributor to weight gain. Pain is indeed often presented by overweight and obese patients as a factor limiting their ability to lose weight.
Given the widely-held (but false!) belief that exercise is the most effective way to lose weight, the general expectation of both patients and health professionals is probably that restoring mobility by relieving pain will enable patients to be more physically active and thereby lose weight.
But is this actually the case?
This issue was recently addressed by Ryan Garcia and colleagues from the Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH in a study just out in the Journal of Bone and Joint Surgery.
Garcia and colleagues examined weight changes in 63 overweight and obese patients with neurogenic claudication who experienced substantial pain relief after lumbar decompression surgery for spinal stenosis. Although Zurich Claudication Questionnaire (ZCQ) Symptom Severity and Physical Function scores significantly improved by a mean of 56.4% and 53.0%, respectively, body weight and BMI significantly increased by 2.48 kg and 0.83 kg/m(2), respectively.
Overall, an average 34 months after surgery, 35% of the patients had actually gained at least 5% of their preoperative body weight while only 6% of the patients weighed at least 5% less than before their operation. The vast majority (59%) remained within 5% of their preoperative body weight.
This study, consistent with several previous studies on joint surgery, nicely documents that increased mobility after pain-alleviating surgery does not necessarily translate into weight loss – in fact, most people will either continue to gain weight or simply stay the same.
Obviously, this should not be an argument against alleviating pain in obese patients – no one deserves to live with pain. It just goes to show that increased mobility alone is not likely to substantially lower body weight – at best, it may prevent further weight gain (difficult enough even at the best of times).
This is probably something patients should be counseled about to not raise any false expectations.
On the other hand, it is important to note that this was not a weight-loss study. This means, that patients were not expressly counseled for weight loss or offered obesity treatments.
The question therefore remains whether or not improving mobility in patients by alleviating pain would improve efficacy of obesity management strategies (which I believe it would).
That is obviously a study that remains to be done.
Friday, April 18, 2008
Very interesting study! I suppose alleviating pain results in the “potential” to be able to lose weight, via better tolerance to exercise. Whether such a “potential” translates into the desired outcome or not, depends on proper counseling, as Dr. Sharma highlighted. I also share in emphasizing the central role of proper eating (portion control, quality control) to reach a healthy weight.