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Metabolic Syndrome
What has happened to our waist size?
Dangers of obesity
Abdominal fat is not like other fat: it is especially dangerous.
What is metabolic syndrome?
Where does waist measurement fit in?
Diet and exercise
Medications for obesity
Surgery for obesity and diabetes
What ever happened to our waist size?
Women age 50-59 have twice the rate of obesity as women 20-29.
Men age 50- 59 have 1.6 times as much obesity.
The future looks even worse: the incidence of obesity in children has grown to epidemic proportions. If they start out as obese at age 20-29, where will they be at 50-59?
Dangers of obesity
Obesity affects almost every part of your body:-
Abdominal fat is dangerous
IAA (Intra abdominal adiposity) has in recent years been recognised as a special threat to health. Some researchers even call this fat an organ. Just as the pancreas organ secretes insulin abdominal fat gives out:-
It seems that the fat that forms in the abdomen is particularly bad for these attributes. In contrast the fat that forms on the buttocks/hips especially in women is not associated with heart disease and diabetes. It is long term storage fat, a relic of the times when we had to store fat in times of plenty and burn it in times of famine.
Where does waist size fit in?
Because the fat in the abdomen is particularly bad, a simple indicator of risk for disease is the waist measurement. Previously we measured BMI - body mass index - as an independent factor in heart disease, but that measures all the fat in the body, not just the bad fat. Waist measurement is a more reliable predictor.
A waist measurement over 35" in women and over 40" in men is an independent risk factor.
What is metabolic syndrome?
Metabolic syndrome is a collection of conditions which are very dangerous when present together. People with metabolic syndrome are high risk for heart disease. Through the 1990s and into this century researchers looked for marker conditions that were easy to diagnose using present tests, not requiring esoteric blood tests found only in research lab facilities.
Once identified as having metabolic syndrome the patient is considered at high risk for diabetes and heart disease, increased risk of acute myocardial infarction and sudden death, and requiring immediate medical intervention.
Diet and exercise for metabolic syndrome.
Weight reduction is vital for these patients. The excess fat in the abdomen is actively sending out chemicals that are dangerous to health. Weight reduction is accomplished by a combination of reduced calorie diet and steady gentle exercise.
Diet: the diet reflects the number and severity of the components of metabolic syndrome present in the individual. If diabetes is present and severe, the diet is a diabetic diet combined with insulin or diabetic meds. If the cholesterol and triglycerides is the more prominent feature, a cholesterol diet is indicated. (See "all about cholesterol"). If high blood pressure is prominent, salt reduction is included in the diet.
Exercise is absolutely necessary. Metabolic syndrome patients are usually very unfit so this needs to be supervised by a health professional. The type of exercise needs to be tailored to the individual. If the person is extremely obese then non-weight bearing exercise such as an exercise cycle or cushioned treadmill is preferable to walking or jogging, because of the danger of injury to the knees, ankles, hips and leg muscles.
Medications for obesity in metabolic syndrome.
Orlistat (Xenical) blocks fat digestion and absorption from the bowel.
Sibutramine (Meridia, Reductil ) works on the brain making the patient feel more satisfied, less hungry.
Rimonabant (SR141716, Acomplia, Riobant, Slimona, Rimoslim, and Zimulti) is available in Europe for the treatment of metabolic syndrome)
Surgery for severe obesity and diabetes
A recent study has shown that a high proportion of severely obese diabetics treated with gastric banding (bariatric surgery) lost weight and many reversed their diabetes. See "Gastric Banding".
What has happened to our waist size?
Dangers of obesity
Abdominal fat is not like other fat: it is especially dangerous.
What is metabolic syndrome?
Where does waist measurement fit in?
Diet and exercise
Medications for obesity
Surgery for obesity and diabetes
What ever happened to our waist size?
Women age 50-59 have twice the rate of obesity as women 20-29.
Men age 50- 59 have 1.6 times as much obesity.
The future looks even worse: the incidence of obesity in children has grown to epidemic proportions. If they start out as obese at age 20-29, where will they be at 50-59?
Dangers of obesity
Obesity affects almost every part of your body:-
- skeleton: osteoarthritis from wear and tear: fat also gives out a chemical that increases inflammation! Double whammy!
- liver: fatty infiltration of the liver, gall stones, cholecystitis
- lungs: sleep apnoea - can be fatal: hypoventilation - your tissues do not receive enough oxygen: poor mental function etc..
- OB/GYN irregular periods, infertility, increased problems with prolapse following childbirth.
- brain: strokes, TIAs.
- Endocrine: diabetes, lipid disorders
- cardiovascular: high blood pressure, coronary artery disease, peripheral artery disease, aneurysms, vein problems.
- cancer: oesophagus, pancreas, colon, kidney and prostate, breast, uterus and cervix
- and many more.
Abdominal fat is dangerous
IAA (Intra abdominal adiposity) has in recent years been recognised as a special threat to health. Some researchers even call this fat an organ. Just as the pancreas organ secretes insulin abdominal fat gives out:-
- free fatty acids (including triglycerides),
- increased adipokines (inflammatory substances that corrode your artery walls and let cholesterol be deposited there):
- and decreased adiponectin (substances that help with fat and sugar metabolism.)
It seems that the fat that forms in the abdomen is particularly bad for these attributes. In contrast the fat that forms on the buttocks/hips especially in women is not associated with heart disease and diabetes. It is long term storage fat, a relic of the times when we had to store fat in times of plenty and burn it in times of famine.
Where does waist size fit in?
Because the fat in the abdomen is particularly bad, a simple indicator of risk for disease is the waist measurement. Previously we measured BMI - body mass index - as an independent factor in heart disease, but that measures all the fat in the body, not just the bad fat. Waist measurement is a more reliable predictor.
A waist measurement over 35" in women and over 40" in men is an independent risk factor.
What is metabolic syndrome?
Metabolic syndrome is a collection of conditions which are very dangerous when present together. People with metabolic syndrome are high risk for heart disease. Through the 1990s and into this century researchers looked for marker conditions that were easy to diagnose using present tests, not requiring esoteric blood tests found only in research lab facilities.
- obesity especially as measured by waist size.
- diabetes or pre-diabetes: as measures by fasting glucose: if very high this is diagnostic of diabetes: if borderline repeat 2 hours after eating.
- high blood pressure
- high triglycerides
- some researchers include increased LDL-C (low density cholesterol)
Once identified as having metabolic syndrome the patient is considered at high risk for diabetes and heart disease, increased risk of acute myocardial infarction and sudden death, and requiring immediate medical intervention.
Diet and exercise for metabolic syndrome.
Weight reduction is vital for these patients. The excess fat in the abdomen is actively sending out chemicals that are dangerous to health. Weight reduction is accomplished by a combination of reduced calorie diet and steady gentle exercise.
Diet: the diet reflects the number and severity of the components of metabolic syndrome present in the individual. If diabetes is present and severe, the diet is a diabetic diet combined with insulin or diabetic meds. If the cholesterol and triglycerides is the more prominent feature, a cholesterol diet is indicated. (See "all about cholesterol"). If high blood pressure is prominent, salt reduction is included in the diet.
Exercise is absolutely necessary. Metabolic syndrome patients are usually very unfit so this needs to be supervised by a health professional. The type of exercise needs to be tailored to the individual. If the person is extremely obese then non-weight bearing exercise such as an exercise cycle or cushioned treadmill is preferable to walking or jogging, because of the danger of injury to the knees, ankles, hips and leg muscles.
Medications for obesity in metabolic syndrome.
Orlistat (Xenical) blocks fat digestion and absorption from the bowel.
Sibutramine (Meridia, Reductil ) works on the brain making the patient feel more satisfied, less hungry.
Rimonabant (SR141716, Acomplia, Riobant, Slimona, Rimoslim, and Zimulti) is available in Europe for the treatment of metabolic syndrome)
Surgery for severe obesity and diabetes
A recent study has shown that a high proportion of severely obese diabetics treated with gastric banding (bariatric surgery) lost weight and many reversed their diabetes. See "Gastric Banding".
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