Why You Should Care About Obesity - The Metabolic Syndrome

by Jeffrey Heit, M.D. Health Professional

There certainly has been a lot of talk over the past few years regarding the so called "obesity epidemic" in the United States. Over two thirds of Americans are considered overweight with a BMI of over 25 and a third are considered frankly obese with BMIs of 30 or higher. What does obesity mean in terms of your health and the health of our nation?

A lot. Individuals who are obese have a much higher chance of developing a condition known as "insulin resistance" or the "metabolic syndrome." This condition is basically a derangement of your body's own ability to regulate glucose levels with the insulin it produces. Obese individuals tend to have a decreased response to the insulin their bodies produce. It means that over time, they will need to produce more insulin for a given glucose load than one who is not obese. After a while, even the increased insulin levels are not enough to bring the blood glucose levels to the normal range, and the individual now has "glucose intolerance."

A fasting blood sugar test will show a slightly elevated glucose in the 100-115 range. This condition can frequently lead to overt diabetes, where fasting blood sugar is frequently much higher than 120 and complications of diabetes itself can occur. The insulin resistance is also thought to produce derangements of two other entities- serum triglycerides and blood pressure. It is believed that increased fasting insulin levels increase serum triglyceride levels. Triglycerides, which are similar to cholesterol but not exactly the same, have been linked to coronary artery and peripheral vascular disease.

Moreover, elevated triglycerides usually go hand in hand with low HDL levels. HDL is the so called "good cholesterol" that helps keep your arteries clear of LDL or bad cholesterol and plaque build up. Finally, elevated circulating insulin levels have been linked to elevated blood pressure. The exact nature of this relationship has not been well established, but individuals with insulin resistance and glucose intolerance that also may have hypertriglyceridemia and low HDL have a higher incidence of hypertension or high blood pressure.

Furthermore, one need not develop these three entities in the order I presented here. One who is obese can easily develop high blood pressure first, followed by glucose intolerance and high triglycerides or some combination of these in a different order and timing. The order of the development is not the important point. The take home message is that obesity increases the likelihood of developing the metabolic syndrome. The metabolic syndrome is as much of an epidemic in the US as is obesity and it is now easy to see why.

Obesity sets the stage for the metabolic syndrome which then itself increases one's chances of diabetes, heart disease, stroke and other maladies. Therefore, not only should we be concerned about obesity for our own individual health, but as a society, we need to be concerned with the burgeoning obesity epidemic and what it will mean for the nation's overall health and healthcare expenditures in the coming years.

Jeffrey Heit, M.D.
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Jeffrey Heit, M.D.

Jeffrey Heit is an internist in Burlington, Massachusetts and is affiliated with Philadelphia Veterans Affairs Medical Center. He wrote for HealthCentral as a health professional for Obesity.