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Bariatric Surgery

Obesity management strategies should cut fat, not muscle

International Journal of Obesity (2024)Cite this article

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The field of obesity management has seen rapid advances in the past decade. Until recently, the only guideline-endorsed options for obesity management were lifestyle intervention and bariatric surgery. The emergence of pharmacological interventions, in particular glucagon-like peptide-1 (GLP-1) agonists, has radically changed the obesity management landscape [1]. In this perspective, we wish to highlight one clinically important aspect that is generally neglected in obesity management research: the importance of maintenance of muscle mass.

In virtually all existing obesity management trials, the effectiveness of the intervention is evaluated only through assessment of absolute and relative losses of total body weight [1]. To some extent, this focus is appropriate because loss of body weight is generally desirable and can drastically reduce morbidity and mortality in individuals with obesity. However, in addition to the kilograms lost, it is important to pay attention to the origin of the lost kilograms. It needs to be taken into account whether losses of body weight are attributable to loss of fat mass alone, fat and muscle mass, or even muscle mass alone.

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References

  1. Elmaleh-Sachs A, Schwartz JL, Bramante CT, Nicklas JM, Gudzune KA, Jay M. Obesity management in adults: a review. JAMA. 2023;330:2000–15.

    Article  CAS  PubMed  Google Scholar 

  2. Argilés JM, Campos N, Lopez-Pedrosa JM, Rueda R, Rodriguez-Mañas L. Skeletal muscle regulates metabolism via interorgan crosstalk: roles in health and disease. J Am Med Dir Assoc. 2016;17:789–96.

    Article  PubMed  Google Scholar 

  3. Taylor R, Price TB, Katz LD, Shulman RG, Shulman GI. Direct measurement of change in muscle glycogen concentration after a mixed meal in normal subjects. Am J Physiol. 1993;265:E224–9. https://doi.org/10.1152/AJPENDO.1993.265.2.E224

    Article  CAS  PubMed  Google Scholar 

  4. Hood DA, Memme JM, Oliveira AN, Triolo M. Maintenance of skeletal muscle mitochondria in health, exercise, and aging. Annu Rev Physiol. 2019;81:19–41.

    Article  CAS  PubMed  Google Scholar 

  5. Prado CMM, Wells JCK, Smith SR, Stephan BCM, Siervo M. Sarcopenic obesity: a critical appraisal of the current evidence. Clin Nutr. 2012;31:583–601.

    Article  CAS  PubMed  Google Scholar 

  6. Sizoo D, Stam SP, de Heide LJM, Emous M, van Zutphen T, van Dijk PR, et al. The association of low muscle mass with prevalence and incidence of Type 2 diabetes in different BMI classes. Diabetes Res Clin Pract. 2023;195:110197. https://doi.org/10.1016/J.DIABRES.2022.110197

    Article  PubMed  Google Scholar 

  7. Nuijten MAH, Eijsvogels TMH, Monpellier VM, Janssen IMC, Hazebroek EJ, Hopman MTE. The magnitude and progress of lean body mass, fat‐free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta‐analysis. Obes Rev. 2022;23:e13370. https://doi.org/10.1111/OBR.13370

    Article  PubMed  Google Scholar 

  8. McCrimmon RJ, Catarig AM, Frias JP, Lausvig NL, le Roux CW, Thielke D, et al. Effects of once-weekly semaglutide vs once-daily canagliflozin on body composition in type 2 diabetes: a substudy of the SUSTAIN 8 randomised controlled clinical trial. Diabetologia. 2020;63:473–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Aronne LJ, Sattar N, Horn DB, Bays HE, Wharton S, Lin W-Y, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA. 2024;331:38–48.

    Article  CAS  PubMed  Google Scholar 

  10. Sizoo D, de Heide LJM, Emous M, van Zutphen T, Navis G, van Beek AP. Measuring muscle mass and strength in obesity: a review of various methods. Obes Surg. 2020;31:384–93.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Grevendonk L, Connell NJ, McCrum C, Fealy CE, Bilet L, Bruls YMH, et al. Impact of aging and exercise on skeletal muscle mitochondrial capacity, energy metabolism, and physical function. Nat Commun. 2021;12:4773.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  12. Longland TM, Oikawa SY, Mitchell CJ, DeVries MC, Phillips SM. Higher compared with lower dietary protein during an energy deficit combined with intense exercise promotes greater lean mass gain and fat mass loss: a randomized trial. Am J Clin Nutr. 2016;103:738–46.

    Article  CAS  PubMed  Google Scholar 

  13. Nunn E, Jaiswal N, Gavin M, Uehara K, Stefkovich M, Drareni K, et al. Antibody blockade of activin Type II receptors preserves skeletal muscle mass and enhances fat loss during GLP-1 receptor agonism. Mol Metab. 2024;80:101880.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, The Netherlands

    Daan Kremer & Stephan J. L. Bakker

  2. Department of Sustainable Health, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands

    Dionne Sizoo

  3. Center Obesity Northern Netherlands (CON), Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands

    Dionne Sizoo

  4. University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Endocrinology, Groningen, The Netherlands

    André P. van Beek

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  1. Daan Kremer
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  2. Dionne Sizoo
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  3. Stephan J. L. Bakker
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  4. André P. van Beek
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Contributions

DK conceptualized and wrote the first manuscript draft. DS helped with the manuscript writing and revisions. SJLB and APB helped with the conceptualization and provided supervision.

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Correspondence to Daan Kremer.

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Kremer, D., Sizoo, D., Bakker, S.J.L. et al. Obesity management strategies should cut fat, not muscle. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01502-w

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