April 5, 2020 - Sunday

Obesity and Metabolic Syndrome

By Suheil Khuri M.D.

Obesity3Metabolic syndrome also called Syndrome X, is a disorder composed of a combination of medical problems that strongly predispose the person to cardiovascular disease. There are five risk factors that are related to metabolic syndrome:
1. Central (visceral, abdominal) Obesity.
2. Elevated Blood Pressure (hypertension)
3. Elevated blood sugar (glucose) (diabetes mellitus).
Metabolic syndrome is associated with insulin resistance (decreased sensitivity to insulin) and can be a major contributor to this syndrome.
4. Elevated Triglycerides (fats)
5. Decreased HDL, the good type of cholesterol.

In metabolic syndrome one typically has an apple-shaped body configuration (much larger waist with a lot of fat above the waist) as compared to those who have a pear-shaped body configuration (narrower waist with more fat around their hips and below the waist). This apple shaped body puts one at a higher risk of developing heart disease, diabetes and the other complications of metabolic syndrome.

The diagnosis is made if one has “Central Obesity” plus any two of the other 4 risk factors, or has any 3 of the 5 risk factors.

Central Obesity is defined as excessive abdominal fat in a person with BMI (Body Mass Index, a measure of obesity) over 30 in both males and females, or a waist circumference over 40 inches in men and over 35 inches in women.

This is an important syndrome to check for since it carries a significant cardiovascular and diabetic risk. There is a significantly increased chance of developing a coronary artery (heart) disease and
heart failure (1.5 – 2 times), cerebrovascular (stroke) episodes (2 to 2.4 times) as well as diabetes in patients with metabolic syndrome even if one does not have a previous cardiovascular disease or diabetes.

It is estimated that ~34% of adults in the USA may have metabolic syndrome and the prevalance is on the increase.

The principal finding in most patients with metabolic syndrome is: Central Obesity. This is accumulation of fat around the waist which indicates increased fat in the inner organs of the body referred to as visceral fat.
Treatment of metabolic syndrome involves:
1. Lifestyle changes. This is the first line of treatment which includes:
a. A low calorie diet. Research and randomized trials have shown that carbohydrate restricted diets improve all features of metabolic syndrome. Following a low carbohydrate diet will result in: reduced glucose and triglyceride levels, imropved HDL cholesterol and insulin sensitivity as well as more weight loss.
b. A regular exercise program. Lack of physical activity is a known predictor of cardiovascular events and related mortality. Many components of metabolic syndrome are related to a sedentary lifestyle. This includes increased centrally concentrated adipose tissue, decreased HDL cholesterol; and a trend toward increased blood pressure, triglycerides and glucose in those that have a genetic predisposition.

One needs to exercise at least 30 minutes 3-4 times weekly but it is much better to work out gradually till you reach one hour of daily exercise.Studies have shown that watching television, videos and staying in front of a computer more than four hours daily carries a two fold increased risk of metabolic syndrome when compared with those who did this for only one hour or less daily.

c. Behavior and habit changes. This includes:
– Accountability. This is critical for success.
– Self-monitoring : is important since we underestimate our calories intake by 1/3rd and over estimate our physical activities by ½.
– Portion and stimulus control.
– Managing stress.
– Preparing for events and not missing any meals.

It takes a long time to learn a new habit, and one needs to work hard to learn those new habits by repetition and concentration.

“Changing a habit talkes 4 weeks to install and 1-2 years to make permanent.”
d. If the metabolic risk factors (hypertension, diabetes, increased triglycerides,) are severe then medication is used at this stage as well.

If this first line of treatment does not prove to be adequate or efficient then drug treatment is frequently required. This involves treatimg the metabolic diseases associated with metabolic syndrome as well as the obesity.

2.    Medication therapy:
a. The individual disorders that compose the metabolic syndrome that are present, need to be evaluated and each one treated separately:
– Hypertension
– Cholesterol drugs may be used to lower triglycerides and LDL (bad cholesterol)
– Address diabetes and insulin resistance with medications
b. Weight loss medications may be needed as well.

You need to remember that:

A simple 5% – 10% weightloss can result in significant improvement in all components of metabolic syndrome.

Call us now at Dr. G’s WeightLoss and Wellness of Jupiter at: 561-427-2232 for a free consult.

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