Editors' ChoiceBARIATRIC SURGERY

A dose of exercise to kick-start your gastric bypass

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Science Translational Medicine  23 Sep 2015:
Vol. 7, Issue 306, pp. 306ec162
DOI: 10.1126/scitranslmed.aad3621

Surgical weight loss procedures have been performed for more than 50 years, but the growing obesity epidemic and introduction of laparoscopic technology have spurred a substantial increase in the number of gastric bypass procedures. Now, Coen and colleagues show that exercise performed in the months following surgery enhances the metabolic improvements observed after gastric bypass alone.

The physical transformation that results from the malabsorptive or restrictive bowel anatomy created by gastric bypass surgery is striking, but equally impressive is the rapid resolution of type 2 diabetes and improved sensitivity to the hormone insulin. Improved glycemic control occurs rapidly after surgery, consequent to acute caloric restriction. In contrast, the improvements in insulin sensitivity occur much more slowly and are associated with weight loss over the course of months or years.

In the interest of maximizing the metabolic benefits of bariatric surgery, there has been growing interest in the use of exercise as an adjunctive therapy. In a study of 128 patients, Coen and colleagues found that that when exercise was performed in the months after surgery, insulin sensitivity was restored to a greater extent than with gastric bypass alone. Because this additional improvement with exercise did not result from increased weight loss, the investigators explored the possibility that the therapeutic benefit resulted from favorable adaptations to mitochondria in skeletal muscle. Muscle biopsies were collected from 101 patients who were randomly assigned to either a 6-month moderate exercise program or a health education program (control) after surgery. The enhanced improvements in insulin sensitivity with exercise were associated with increased mitochondrial oxidative capacity and decreased levels of lipid metabolites that are known to interfere with insulin signaling in muscle (for example, sphingolipids and ceramides). These findings demonstrate that exercise can enhance metabolic improvements after bariatric surgery, consistent with the concept that exercise is medicine.

P. M. Coen et al., Exercise and weight loss improve muscle mitochondrial respiration, lipid partitioning and insulin sensitivity following gastric bypass surgery. Diabetes 10.2337/db15-0809 (2015). [Abstract]

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