Enhancing the Metabolic Benefits of Bariatric Surgery: Tipping the Scales With Exercise.

Abstract

The Roux-en-Y gastric bypass (RYGB) procedure is regarded as the gold-standard metabolic surgery in the U.S., rivaling sleeve gastrectomy as the most common bariatric surgery procedure. In addition to considerable weight loss, patients undergoing RYGB exhibit remarkable improvements in multiple metabolic abnormalities, including remission of type 2 diabetes and improvements in insulin sensitivity (1–3). These adaptations can be divided into those that prevail acutely in response to severe energy restriction (e.g., improved glycemia, improved hepatic insulin sensitivity) versus those that occur with more latency, associated with weight loss (e.g., improved peripheral insulin sensitivity) (2,4). In many cases, the long-term improvements in peripheral insulin sensitivity align with the degree of weight lost in the months following the RYGB procedure (5,6). Although the point has been made that peripheral insulin sensitivity remains well below what is observed in lean healthy control subjects in spite of substantial weight loss following RYGB, there is hearty evidence that, if anything, the improvements in peripheral insulin sensitivity following RYGB are greater than would be predicted based on weight loss alone (2,7). For example, Camastra et al. (2) followed morbidly obese RYGB patients with or without diabetes up to 1 year following the procedure, evaluating peripheral insulin sensitivity using the euglycemic-hyperinsulinemic clamp procedure. While it is true that insulin-stimulated glucose disposal 1 year following RYGB (38.5 μmol/min/kg fat-free mass [FFM]) remained well below values measured in lean control subjects (64.0 μmol/min/kg FFM), the values were higher …