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KMID : 1033120130020010001
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대한비만대사외과학회지
2013 Volume.2 No. 1 p.1 ~ p.9
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Insulin Resistance with Severe Obesity in Skeletal Muscle: Role of Bariatric Surgery and Exercise
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Kwak Hyo-Bum
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Abstract
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The prevalence of obesity throughout the world has reached epidemic proportions. In modern society, obesity induced by high fat/calorie diet and reduced physical activity results in a serious health threat because of the increased risk of developing chronic diseases such as cardiovascular disease and diabetes, which are associated with insulin resistance. Skeletal muscle in our body plays an important role in regulating whole-body homeostasis; a) skeletal muscle is responsible for ∼80% of the post-prandial clearance of glucose, b) skeletal muscle fatty acid oxidation comprises approximately ∼90% of energy requirements in the rested state. Severe obesity is associated with multiple defects in skeletal muscle which contributes to insulin resistance and a reduction in fatty acid oxidation in skeletal muscle. However, so far it is not clear what specific mechanisms are responsible for obesity-induced insulin resistance. Bariatric surgery offers the most effective therapy for weight loss and type II diabetes mellitus (T2DM) with full and durable remission of the disease in severe obesity. However, depressed fatty acid oxidation in severe obesity is not altered with gastric bypass surgery/weight loss. Exercise training can improve fatty acid oxidation and insulin action in skeletal muscle, suggesting that exercise training should be considered as an adjunct to bariatric surgery as an intervention to severe obesity. In this review, I will briefly summarize the potential mechanisms by which severe obesity contributes to the development of insulin resistance in skeletal muscle. Also, I will discuss the effects of bariatric surgery and exercise training on weight loss and remission of T2DM including the exercise guidelines for morbidly obese and diabetic patients.
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KEYWORD
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Severe obesity, Insulin resistance, Skeletal muscle, Gastric bypass, Exercise
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