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Bariatric Surgery and Metabolic Syndrome

Metabolic syndrome, also known as Syndrome X, dysmetabolic syndrome, and insulin resistance syndrome, is not a disease but a host of risk factors associated with obesity that make sufferers more susceptible to heart disease, stroke, and diabetes, as well as other illnesses.

According to the American Heart Association, about 47 million adults in the United States have metabolic syndrome. The syndrome is characterized by having excess abdominal fat, resistance to insulin, abnormal levels of fats in the blood, and high blood pressure (AHA 2009).

How do I know if I have metabolic syndrome?

Only a doctor can diagnose metabolic syndrome, but according to the American Heart Association (AHA 2009) and the National Heart, Lung, and Blood Institute (NHLBI), if you have three of the below five metabolic risk factors, most doctors will diagnose you with metabolic syndrome.

  • Large "apple-shaped" waistline: waist equal to or greater than 40 inches in men or equal to or greater than 35 inches in women
  • Lower-than-normal HDL (good) cholesterol: less than 40 mg/dL in men or less than 50 mg/dL in women; or taking medication to control HDL
  • Higher than normal triglycerides: fasting blood levels equal to or greater than 150 mg/dL; or taking medication to control triglycerides
  • Higher than normal blood pressure: greater than or equal to 130/85 mmHg; or taking medication to control blood pressure
  • igher than normal blood sugar: fasting glucose greater than or equal to 100 mg/dL; or taking medication to treat high blood sugar

The more metabolic risk factors that you have, the greater your chances of having a stroke, developing heart disease, diabetes, or other disorders.


These symptoms contribute to metabolic syndrome; the syndrome itself does not have symptoms.


What makes me more susceptible to metabolic syndrome?

Middle-aged men and post-menopausal women tend to store fat around the abdominal area, thus increasing their chances of suffering from metabolic syndrome. The greater the waist circumference, the higher the risk of complications from metabolic syndrome. If you are a man and your waist measures more than 40 inches, or if you are a woman and your waist measures more than 35 inches, then you have a greater risk of developing metabolic syndrome. Patients with the following tendencies have an increased risk for metabolic syndrome:

  • Lack of physical activity; sedentary lifestyle
  • Poor eating habits
  • Socioeconomic status (lower than middle class)
  • Middle age or older
  • Certain ethnicities (Hispanic American, African American, Native American, Asian American, Pacific Islander)
  • Genetic predispositions (for heart disease, diabetes, and so forth)

A person with metabolic syndrome has approximately twice the risk for coronary heart disease and five times the risk for type 2 diabetes than a person without metabolic syndrome. (DeMaria 2007)

Should I consider bariatric surgery for metabolic syndrome?

Only your bariatric team can determine if bariatric surgery is the right path for you to take to control your metabolic syndrome symptoms. Other methods of control include diet, drugs, and exercise.

Medical guidelines for bariatric surgery treatment of metabolic syndrome

Several organizations, including the National Heart, Lung, and Blood Institute, the Institute for Clinical Systems Improvement, the American Society for Bariatric Surgery, the European Association for Endoscopic Surgery, the American Diabetes Association, the European Diabetes Association, and other organizations, have recommended that bariatric surgery be considered as a treatment plan for patients with a BMI of 35 or more with coexisting medical conditions. The American College of Physicians recommends that bariatric surgery be considered for patients with a BMI of 40 or more with coexisting conditions. These organizations generally agree that patients have already attempted to lose weight through other means without success, have medical and psychological profiles indicating a good probability of surgical success, and have a team of bariatric specialists from multiple specialties caring for them before, during, and after surgery. (DeMaria 2007)

Metabolic syndrome statistics after bariatric surgery

Severely obese patients who have had bariatric surgery generally experience significant reductions in weight and in weight-related illnesses associated with metabolic syndrome one year after surgery. According to one study, patients with metabolic syndrome lost an average of 31.9% of body weight one year after surgery. Their blood pressure, glucose, triglycerides, and cholesterol levels were reduced, resulting in a 95.6% resolution of metabolic syndrome.

Ninety-five percent of patients who had gastric banding surgery reported that their metabolic syndrome was resolved. Over 98% of patients who had gastric bypass surgery reported that their metabolic syndrome was resolved after their gastric bypass. (Lee 2004)

A 1990 - 2003 study by the Mayo Clinic of 180 patients with metabolic syndrome who underwent Roux-en-Y surgery showed that 87% of the patients had a decrease in their metabolic syndrome symptoms. (Batsis 2008)

What are my other options for treatment of metabolic syndrome?

Doctors often advise their patients that lifestyle changes along with medication can dramatically improve health. Diet, exercise, and possibly medications, especially for patients with diabetes or high blood sugar levels, are recommended and used for the treatment of metabolic syndrome. Patients who smoke should quit smoking because of the many complications from tobacco use.

Metabolic syndrome can often be controlled by making positive lifestyle changes, including eating a healthy, low-calorie diet, exercising regularly, and possibly taking medications to control your blood sugar, cholesterol, triglycerides, blood pressure, or a combination of these ailments. Being overweight, a lack of physical activity and eating a poor diet can contribute to insulin resistance and metabolic syndrome. Changes in eating habits, exercise, behavioral techniques, and drugs can be used to help patients lose weight and control metabolic syndrome.

The bottom line

You must consult with your doctor to see if bariatric surgery is right for you. Surgery of this magnitude should not be considered as an easy way out. Avoiding obesity in the first place is the best way to reduce your risk of developing metabolic syndrome.

Find out more about bariatric surgery

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Find out if you are a candidate for bariatric surgery.

References

American Heart Association. 2009. Metabolic Syndrome. February 16. http://www.americanheart.org/presenter.jhtml?identifier=3063528 (accessed July 11, 2009).

Batsis, J., et. al. 2008. Effect of Bariatric Surgery on the Metabolic Syndrome: A Population-Based, Long-term Controlled Study. Mayo Clinic Proceedings. August. 83(8):897-906. Consumer Health Complete. EBSCOhost. University of Houston-Downtown (accessed July 11, 2009).

DeMaria, E. 2007. Bariatric Surgery for Morbid Obesity. The New England Journal of Medicine. May 24. 356(21):2176-83. http://content.nejm.org/cgi/content/full/356/21/2176 (accessed July 21, 2009).

Lee, W., Huang, M., Wang, W., Lin, C., Chen, T., Lai, I. 2004. Effects of Obesity Surgery on the Metabolic Syndrome. Archives of Surgery. 139(10):1088-92. http://archsurg.ama-assn.org/cgi/reprint/139/10/1088 (accessed July 30, 2009).

National Heart, Lung, and Blood Institute (NHLBI). Overweight and Obesity Podcast Transcript. National Institutes of Health. U.S. Department of Health and Human Services. http://www.nhlbi.nih.gov/health/dci/pods/trans_obesity.html (accessed July 11, 2009).

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2007. Do You Know the Health Risks of Being Overweight? National Institutes of Health. U.S. Department of Health and Human Services. December. http://win.niddk.nih.gov/publications/health_risks.htm (accessed July 11, 2009).

Scholten, A. 2009. Metabolic Syndrome: Syndrome X; Insulin Resistance Syndrome; Deadly Quartet. Conditions & Procedures, InBrief. February, 1. Consumer Health Complete. EBSCOhost. University of Houston-Downtown (accessed July, 11 2009).

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