Weight loss and the Metabolic Syndrome
Metabolic syndrome is characterised by several abnormalities which include obesity, insulin resistance (the cells stop listening to the message), high blood pressure and raised cholesterol (1). These metabolic abnormalities increase the risk of heart and blood vessel disease (CVD) and type 2 diabetes (T2DM). This syndrome affects 25% of all adults and increases in prevalence with advanced age (2). Weight loss will reduce the risk of adverse outcomes and reverse the process (3). Therefore, it is extremely important that those suffering with metabolic syndrome get good advice and support in losing weight.
How would I know if I have Metabolic Syndrome?
The diagnosis of metabolic syndrome is clinical, meaning based on a series of investigations your doctor will be able to determine your status. There is no one specific test that can clinch the diagnosis. Tests might reveal a raised glucose, cholesterol, body mass index (BMI) and high blood pressure. An ultrasound scan might reveal ‘fatty liver’, a sign that fat is building up in the organs. If fat is in organs this generates lipotoxicity (toxic fat), which leads to metabolic syndrome and insulin resistance.
What can be done to help?
Your doctor should aim treat the conditions above. They might offer dietary and lifestyle changes, or even need to treat the problems with medications. However, the best way to treat and reverse these changes is with a commitment to change the lifestyle that led to the problem in the first instance. A modest fall in weight of just 5% can make a significant difference in fat loss, glucose control and sensitivity to insulin (4).
What are the challenges?
The evidence reveals that changing lifestyle and losing weight is not easy for most people (5). Most people do not even know where to start. Society is filled with high calorie, high sugar, and processed foods. Many sedentary in the office, sedentary in the transport to and from work, then sedentary at home. Over years this will cause a gradual increase in weight, insulin resistance and a route to metabolic syndrome.
Losing weight
There are numerous evidence-based strategies proven to bring about weight loss, a few a mentioned below.
Intermittent fasting is increasingly popular and can be done in various ways, such as alternate day fasting, or fasting on one or two days a week (sometimes known as the 6:1 and 5:2 methods), but the most common is time-restricted eating. Time-restricted eats means that food is eating within a 4 to 12 hour window i.e. 12 to 20 hour daily fast (6).
Mediterranean style diet, rich in fish, olive oil, nuts, fruit and vegetables could be recommended as it is associated with reduced cardiovascular and diabetes complication risk (7).
Meal replacements are proven to help reduce weight however, all have an associate cost. These might be an option, if a lighter diet is preferred to fasting, for example.
Monitoring weight, reducing portion sizes and gain the support of family, will increase the likelihood of losing weight successfully (8).
Exercise is also fundamental in weight loss but can also present difficulties to get started. A brisk walk daily for 15-30 minutes is a good start if you do no exercise at all. Beyond this we should aim for the national guidelines (9):
strengthening activities that work all the major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms) on at least 2 days a week
at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week
spread exercise evenly over 4 to 5 days a week, or every day
reduce time spent sitting or lying down and break up long periods of not moving with some activity
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1. Rochlani Y, Pothineni NV, Kovelamudi S, Mehta JL. Metabolic syndrome: Pathophysiology, management, and modulation by natural compounds. Vol. 11, Therapeutic Advances in Cardiovascular Disease. SAGE Publications Ltd; 2017. p. 215–25.
2. Nolan PB, Carrick-Ranson G, Stinear JW, Reading SA, Dalleck LC. Prevalence of metabolic syndrome and metabolic syndrome components in young adults: A pooled analysis. Preventive Medicine Reports. 2017 Sep 1;7:211–5.
3. Ryan DH, Yockey SR. Weight Loss and Improvement in Comorbidity: Differences at 5%, 10%, 15%, and Over. Vol. 6, Current obesity reports. 2017. p. 187–94.
4. Magkos F, Fraterrigo G, Yoshino J, Luecking C, Kirbach K, Kelly SC, et al. Effects of Moderate and Subsequent Progressive Weight Loss on Metabolic Function and Adipose Tissue Biology in Humans with Obesity. Cell Metabolism. 2016 Apr 12;23(4):591–601.
5. Hall KD, Kahan S. Maintenance of Lost Weight and Long-Term Management of Obesity. Vol. 102, Medical Clinics of North America. W.B. Saunders; 2018. p. 183–97.
6. Albosta M, Bakke J. Intermittent fasting: is there a role in the treatment of diabetes? A review of the literature and guide for primary care physicians. Clinical Diabetes and Endocrinology. 2021 Dec;7(1).
7. Jennings A, Berendsen AM, de Groot LCPGM, Feskens EJM, Brzozowska A, Sicinska E, et al. Mediterranean-style diet improves systolic blood pressure and arterial stiffness in older adults: Results of a 1-year european multi-center trial. Hypertension. 2019 Mar 1;73(3):578–86.
8. Varkevisser RDM, van Stralen MM, Kroeze W, Ket JCF, Steenhuis IHM. Determinants of weight loss maintenance: a systematic review. Vol. 20, Obesity Reviews. Blackwell Publishing Ltd; 2019. p. 171–211.
9. NHS. Exercise [Internet]. NHS. 2021. Available from: https://www.nhs.uk/live-well/exercise/