Is Bariatric Surgery a Way of Doping for Obese Subjects?

Abstract

Abstract Physical fitness and overweight are generally considered incompatible, while weight-loss is easily associated with health and fitness. Indeed, aerobic exercise capacity (best reflected by the maximal oxygen consumption, VO2peak) is recognized as a strong fitness indicator and a powerful predictor of mortality in different populations. VO2peak and exercise efficiency are known to be reduced in sedentary obese subjects. Associated to the mechanical difficulty of exercising with excessive body weight, dyspnea and fatigue are the current symptoms reported by obese subjects. Weight loss therefore seems like a solution to overcome exercising difficulties in order to achieve a more active and healthier lifestyle. As a radical and effective intervention, bariatric surgery allows a dramatic reduction in body weight and is also known to be associated to an improvement of daily activity levels and quality of life. However not all patients reach their therapeutic target, especially regarding physical fitness, and most still complain of asthenia. The present review therefore aims to explore the question of the link between a dramatic weight reduction, typically observed after bariatric surgery, and the VO2peak. While weight-bearing efforts, often present in daily life, are obviously easier when fat mass reduction occurs after bariatric surgery, an excessive reduction in muscle mass loss would lead to a functional deficit and/or affect absolute VO2peak or the dyspnea threshold. Current expert opinion therefore recommend to include the bariatric surgery patients in a hematologic and nutrition follow-up associated to adequate exercise training, starting before and lasting after bariatric surgery. Keywords Bariatric surgery; Exercise capacity; Obesity, Oxygen uptake, VO2max