In my opinion, this topic is one of the most relevant issues that can be tackled in any obesity surgery blog since it encompasses a series of diseases that cause a large number of health problems and deaths every year worldwide.
The metabolic syndrome is not a single disease but a series of alterations in the metabolism of the patient. They appear gradually but progressively as the age advances, and obesity is a crucial predisposing factor in this series of problems that also enhance one another regarding the damage they cause to the organism of the person who suffers it.
As the name implies, the metabolic syndrome refers to the metabolism of the body, referring to metabolism by chemical processes that take place in a living organism; Another way of looking at it is like the way our body uses and expends the energy it gets from food.
Metabolic syndrome is also known as "X Syndrome", a concept that was developed from a group of metabolic problems that helped identify people at high risk of heart attack or diabetes.
What is the relationship between weight and metabolic syndrome?
The relationship between overweight and obesity with the metabolic syndrome is something that has been thoroughly studied until being able to verify its close ties of mutual affectation, where the higher the degree of obesity, the higher the risk of suffering from it, although there are also people with a healthy weight who suffer from this syndrome.
The statistics suggest the following:
(* Information from the ADA, American Diabetes Association)
Weight Risk of Metabolic Syndrome
Obesity Class I (IMC 30 a 34.9) 25%
Obesity Class II y III (IMC 35 a 49.9) 52 a 68%
Notice that around 40% of obese patients do not suffer from the metabolic syndrome, while 5% of people with normal weight can suffer from it. Even so, the risk of cardiovascular disease (cardiac or cerebral infarction) is significantly higher in obese patients, regardless of whether or not they suffer from the metabolic syndrome.
A factor that played in favor of the individuals subjected to this research is their cardiorespiratory fitness, where those who despite being obese performed exercise, this decreased their risk of mortality, even when suffering from metabolic syndrome.
How is the metabolic syndrome diagnosed?
Throughout the years, different classifications or parameters have been established in order to determine if a person suffers from metabolic syndrome; by following the guidelines set by the National Heart, Lung, and Blood Institute (NHLBI) and by the National Heart Association of the United States (AHA), the patient is diagnosed with metabolic syndrome when he/she has at least 3 of the following conditions:
- Fasting glucose ≥100 mg/dL (or receiving drug therapy for hyperglycemia)
- Blood pressure ≥130/85 mm Hg (or receiving drug therapy for hypertension)
- Triglycerides ≥150 mg/dL (or receiving drug therapy for hypertriglyceridemia)
- HDL-C <40 mg/dL in men or <50 mg/dL in women (or receiving drug therapy for reduced HDL-C)
- Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women; if Asian American, ≥90 cm (35 in) in men or ≥80 cm (32 in) in women
* An important aspect to highlight is that the person may not have a body mass index that catalogs him/her as obese, but due its body conformation has a fat distribution better known as "apple shaped body ", in which there is too much visceral fat, in other words, a prominent abdomen (waist) or abdominal obesity, this type of complexion alone represents a higher risk for the patient's health.
What are the risk factors of Metabolic Syndrome?
There are risk factors that are not preventable, some related to lifestyle and others that are related to the patient's genetics:
- Age: As the age advances, the risk increases due to changes in the metabolism itself.
- Physical activity: Lack of exercise importantly affects the heart rate and predisposes to the development of these health problems.
- Genetics: Especially with those factors that determine body conformation and where excess calories are being stored in the form of fat.
- Ethnicity: Hispanics, Native Americans, and African-Americans are more at risk of suffering from metabolic syndrome due to their inheritance and lifestyle.
- Food: A diet high in fat leads to intake of foods low in fiber and whole grains, which are what help lower cholesterol levels.
- Medications: It is associated with the intake of antipsychotic drugs as they alter the metabolism.
- Diseases: affecting hormones such as diabetes and polycystic ovarian syndrome
The metabolic syndrome is increasing in its prevalence, in parallel with the epidemic of obesity. In the United States, where almost two-thirds of the population is overweight or obese, more than a quarter of its population meets the diagnostic criteria of the metabolic syndrome.
What is the explanation of the causes of metabolic syndrome?
It is believed that the metabolic syndrome is caused by a dysfunction of adipose tissue (fat) and insulin resistance. The accumulation of body fat causes a proinflammatory state, which causes insulin resistance, a situation considered to be the primary cause or initiator of the metabolic syndrome.
There are several abnormalities which do not make much sense to detail them here, but the end result is an increase in the release of fatty acids in the bloodstream and the progressive accumulation of fat due to insulin’s action. The fat is mainly visceral fat (around and between abdominal organs) since this type of fat is the one associated with the proinflammatory process and the release of harmful substances to the organism that ultimately result in the cascade of events or alterations mentioned in the metabolic syndrome (high blood pressure, high HDL cholesterol, etc).
Treatment and prevention
The cornerstone of the metabolic syndrome treatment is changing the patient's diet and increasing physical activity, although it sounds simple, it is not always the case.
However it is the first thing that you should focus on since weight loss and the increase in physical activity with regular exercise of at least 30 minutes 3 times a week, can help to improve insulin levels significantly and blood pressure, even with a loss of only 5 to 10% of excess weight.
It is also recommended the use of medications to control lipids levels (fats) in the blood to reduce the risk of atherosclerosis (calcification) of the arteries, coronary (cardiac) arterial and cerebrovascular disease. However, for most patients with moderate to severe type 2 diabetes and obesity, intensive medical treatment does not provide enough reduction in blood glucose levels to reverse or prevent the harmful effects of diabetes.
The main problem with this medical measure as we all know is that the vast majority of patients suffering from obesity and metabolic syndrome have entered a vicious cycle in which their own body is programmed not to lose too much weight. This self-regulation system is still under study, in which the patient with a certain degree of obesity (BMI of 35 or higher) can lose weight with much effort but at the moment when that effort stops weight comes back again. In this situation is where the great tool that weight loss surgery represents in the resolution of diseases that includes the metabolic syndrome.
Effects of weight loss surgery on the metabolic syndrome
The relationship between weight loss and metabolic syndrome improvement is so close and favorable that weight loss surgery is currently considered a definitive treatment line for this disease since several of its parameters alone, are indicative factors for being a candidate for bariatric surgery.
Now, with greater justification when it is not only one of them but some or all of the parameters involved in the metabolic syndrome. The effect of obesity surgery on the metabolic syndrome is so positive that it is sometimes called metabolic surgery where not only those patients who are obese are considered as candidates but also those who suffer from the syndrome and have a normal weight. Throughout the last two decades, many studies have been conducted in non-obese ill people undergoing obesity surgery with very encouraging results!
The metabolic syndrome, present in 52% of morbidly obese patients who underwent a weight loss surgery program showed a significant reduction of their weight one year after surgery, as well as a marked improvement of all the factors involved in the syndrome, indicating a cure rate of up to 95.6%!
Speaking specifically about gastric sleeve surgery and gastric bypass (the two most current bariatric procedures worldwide), it has also been proven in various studies to improve or even cure several or all of the components involved in the metabolic syndrome. There is a well-recognized study by the guild known as STAMPEDE, conducted at the Cleveland Clinic, led by Dr. P. Schauer in which it was found that gastric bypass or gastric sleeve achieved an average weight loss of 29.4 and 25.2 kg respectively, unlike only 5.4 kg in patients under intensive medical treatment.
Concerning diabetes, the success rate in the reduction of glycosylated hemoglobin levels HbA1c to 6% (adequate or acceptable level) twelve months later was three times higher in patients undergoing gastric sleeve or gastric bypass compared to the ones who only received medical treatment. (42%, 37% versus 12%, respectively).
The previous resulted in a lower need for medications for diabetes, hypertension, and hyperlipidemia. The long-term follow-up of patients with gastric sleeve showed a remission or improvement of diabetes in 77%, even after 6 to 8 years of surgery.
In an analysis of several studies involving almost four thousand patients undergoing gastric sleeve, a reduction of arterial hypertension was shown in 75% of the cases, with a resolution of the disease in 58% of them, in a follow-up of 1 year and a half. There were also significant reductions in HDL cholesterol and triglyceride levels one year after surgery.
The burden of having to take medications on a daily basis for life is not easy for any patient to assimilate and the simple fact of being able to take fewer drugs or even getting rid of them is a joy for most.
In another retrospective study of morbidly obese patients undergoing gastric sleeve surgery, a 79% loss of excess weight was reported two years after surgery, and 83% of these patients with type 2 diabetes were able to quit their medications only one month after surgery. They also stopped requiring antihypertensive medications at 6 months and lipid-lowering drugs 3 months after surgery. This is because the levels of glucose, triglycerides, and blood pressure dropped to normal ranges for at least a period of two years after surgery.
It is very evident then that the results obtained in patients with metabolic syndrome who undergo weight loss surgery, either gastric sleeve or gastric bypass, benefit tremendously and well above the possible benefit that is achieved with non-surgical measures (medications, diet and exercise), mainly due to the problem of weight regain or insufficient weight loss with these medical measures.
Due to the high prevalence of obesity and overweight mainly in North America (more than 65% of its population) and the close relationship of this with the metabolic syndrome, it can be concluded that when relatively “less expensive” measures such as medication, diet, and exercise have failed, metabolic surgery or weight loss surgery is the indicated solution in the vast majority of cases.
If you suffer from metabolic syndrome or you believe you could have it, we invite you to contact us, and we will gladly guide you and help you determine what measures would be most appropriate for your case.
Written by: Gabriel Rosales
Dr. Gabriel Rosales is a highly skilled, board certified surgeon in constant pursuit of learning the latest innovations in the weight loss surgery field to give his patients the best care possible.