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In battling obesity and prediabetes, combining exercise with weight loss is key

Insulin sensitivity improved twofold when exercise paired with 10% weight loss

by Jim DrydenJune 27, 2023

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Researchers at Washington University School of Medicine in St. Louis have found that combining regular exercise with a 10% loss of body weight more than doubles sensitivity to insulin, compared with a 10% weight loss without exercise. Enhanced sensitivity to insulin has important health benefits and likely decreases the risk of Type 2 diabetes and coronary heart disease.

The researchers at the university’s Center for Human Nutrition knew that losing moderate amounts of weight could make people more sensitive to insulin and that exercise alone is not very effective in helping those with obesity and prediabetes lose weight. What they didn’t know was that combining a regular exercise program with a 10% loss of body weight could have such a profound effect on the body’s sensitivity to insulin.

The findings are published June 26 in the journal Nature Metabolism.

“Obesity makes the body resistant to insulin’s ability to decrease glucose production by the liver and increase glucose uptake by skeletal muscle tissue, leading to an increase in blood glucose concentrations,” said senior investigator Samuel Klein, MD, director of the Center for Human Nutrition. “Insulin resistance is a major factor that causes Type 2 diabetes, nonalcoholic fatty liver disease and abnormal blood lipids in people with obesity. We’ve shown that combining exercise with weight loss causes a marked improvement in whole-body insulin sensitivity, thereby lowering the risk of developing diabetes and treating obesity-related metabolic diseases to a much greater degree than is possible with weight loss alone.”

Study volunteers each had a body mass index (BMI) of 30 to 49; 30 is considered obese. Each participant also had prediabetes, with medical evidence of insulin resistance.

A total of 16 people completed the study. Eight were in a diet-only group in which the participants lost 10% of their body weight. The other eight also dieted and lost 10% of their body weight but also were part of a supervised exercise program several days each week.

“The data from most studies show that exercise has very little effect on body weight in people with obesity,” explained Klein, who also is the William H. Danforth Professor of Medicine and Nutritional Science and director of the university’s Division of Geriatrics & Nutritional Science. “Our study involved detailed analyses of metabolic changes in muscle and body fat before and after a 10% weight loss in people who lost weight with diet therapy alone and in those who lost the same amount of weight with diet therapy plus supervised exercise training. The results demonstrate that the benefits of combining exercise with weight loss are considerable.”

More than 37 million people in the U.S. have diabetes, and more than 40% have obesity, which is linked to as many as half of all diabetes diagnoses. It is believed that 96 million people in the United States, about one in three adults, have prediabetes.

“The metabolic benefits we found in this study demonstrate the profound reasons why exercise should always be included in weight-management therapy,” Klein said.

Beals JW, Kayser BD, Smith GI, Schweitzer GG, Kirbach K, Kearney ML, Yoshino J, Rahman G, Knight R, Paterson BW, Klein S. Diet-induced weight loss improvements in metabolic function are enhanced by exercise in people with obesity and prediabetes. Nature Metabolism, June 26, 2023.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute and the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). Grant numbers P30 DK056341, P30 DK020579, T32 HL130357, T32 DK007120 and UL1 TR000448.

About Washington University School of Medicine

WashU Medicine is a global leader in academic medicine, including biomedical research, patient care and educational programs with 2,800 faculty. Its National Institutes of Health (NIH) research funding portfolio is the third largest among U.S. medical schools, has grown 52% in the last six years, and, together with institutional investment, WashU Medicine commits well over $1 billion annually to basic and clinical research innovation and training. Its faculty practice is consistently within the top five in the country, with more than 1,800 faculty physicians practicing at 65 locations and who are also the medical staffs of Barnes-Jewish and St. Louis Children’s hospitals of BJC HealthCare. WashU Medicine has a storied history in MD/PhD training, recently dedicated $100 million to scholarships and curriculum renewal for its medical students, and is home to top-notch training programs in every medical subspecialty as well as physical therapy, occupational therapy, and audiology and communications sciences.

Jim retired from WashU Medicine Marketing & Communications in 2023. While at WashU Medicine, Jim covered psychiatry and neuroscience, pain and opioid research, orthopedics, diabetes, obesity, nutrition and aging. He formerly worked at KWMU (now St. Louis Public Radio) as a reporter and anchor, and his stories from the Midwest also were broadcast on NPR. Jim hosted the School of Medicine's Show Me the Science podcast, which highlights the outstanding research, education and clinical care underway at the School of Medicine. He has a bachelor's degree in English literature from the University of Missouri-St. Louis.