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Pediatrics

Physical activity impacts insulin sensitivity post metabolic bariatric surgery in adolescents with severe obesity

International Journal of Obesity volume 44, pages 1479–1486 (2020)Cite this article

Subjects

Abstract

Background/objectives

We hypothesized that physical activity (PA) improves insulin sensitivity in adolescents with severe obesity beyond that attributable to metabolic bariatric surgery (MBS).

Subjects/methods

StepWatchTM monitors objectively measured PA in 88 participants in the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Primary outcomes included absolute change in fasting insulin, HOMA-IR, and fasting glucose from pre-surgery (baseline) to 6, 12, 24, and 36 months post-MBS. SAS PROC TRAJ generated activity trajectories based on probability and individual participant step count trajectories. Linear regression models were used, adjusted for baseline value, visit, surgical procedure, sex, and percent change in BMI. Additional models adjusted for percent change in iliac waist circumference (IWC) or percent body fat (BF), measured by bio-impedance.

Results

Two activity trajectories were identified: more active (MA, n = 13) and less active (LA, n = 75). MA baseline mean daily step count was >6000, increasing to >9000 at 2 years. LA mean daily step count remained at ~4000. Few participants recorded moderate step activity (cadence >80 steps/minute). Still, fasting insulin and HOMA-IR differed in association with activity trajectoy. MA was associated with a greater absolute decrease in fasting insulin (−7.8 μU/ml [95% CI: (−11.8, −3.7)], p ≤ 0.001) and a greater decrease in HOMA-IR (−1.9 [95% CI: (−3.0, −0.7)], p = 0.001), when adjusted for percent change in BMI. The significant independent effect of MA remained when adjusted for percent change in IWC or percent BF. Clinically, 100% of MA trajectory participants normalized fasting insulin, HOMA-IR, and fasting glucose by 6 months and normalization remained throughout the 36 months follow up. In contrast, 76.3 and 65.8% of LA trajectory participants normalized fasting insulin and HOMA-IR, respectively, by 12 months with 28.6% of both remaining normalized at 36 months.

Conclusions

PA is independently associated with improved insulin sensitivity beyond that attributable to MBS in adolescents with severe obesity.

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Fig. 1: MA and LA Trajectories.
Fig. 2: HOMA-IR and fasting insulin trajectories.

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Funding

The Teen-LABS consortium is funded by cooperative agreements with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), through grants UM1DK072493 (PI, Dr Thomas Inge, University of Colorado, Denver, CO), and UM1DK095710 (PI, Dr Changchun Xie, University of Cincinnati). Dr Paula Holland Price was supported by the National Heart, Lung and Blood Institute (NHLBI): 5T32HL116276-05.

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Author notes

  1. These authors contributed equally: Thomas H. Inge, Robert H. Eckel

Authors and Affiliations

  1. Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

    Paula Holland Price

  2. Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA

    Alexander M. Kaizer

  3. Pediatric Surgery, Children’s Hospital Colorado, Aurora, CO, USA

    Thomas H. Inge

  4. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Thomas H. Inge

  5. Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Robert H. Eckel

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Correspondence to Paula Holland Price.

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Price, P.H., Kaizer, A.M., Inge, T.H. et al. Physical activity impacts insulin sensitivity post metabolic bariatric surgery in adolescents with severe obesity. Int J Obes 44, 1479–1486 (2020). https://doi.org/10.1038/s41366-020-0585-8

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