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Improvements or Resolution of Comorbidities
Metabolic Syndrome
Metabolic syndrome, which comprises of abdominal obesity, hypertension, atherogenic dyslipidemia, and elevated plasma glucose, is closely linked to both cardiovascular disease and diabetes. The stratifying feature of these diseases is hypothesized to be the release of free fatty acids from abdominal (visceral vs subcutaneous) fat stores.18
There are several side effects of obesity that are also part of the spectrum for diagnosing metabolic syndrome17:
- Elevated triglyceride (TG) levels (≥1.7 mmol/L or drug treatment for elevated TG)
- Elevated waist circumference (men: ≥40 in; Asian-American: ≥35 in; women: ≥35 in; Asian-American: ≥31 in)
- Elevated blood pressure (≥130 mm Hg systolic or ≥85 mm Hg diastolic or drug treatment for hypertension)
- Reduced HDL (< .09 mmol/L)
- Elevated fasting glucose (≥7.0 mmol/L or drug treatment for elevated glucose)
The clinical management of metabolic syndrome, as per the American Heart Association, includes smoking cessation, reducing LDL cholesterol, blood pressure, and glucose levels to their recommended levels, as well as lifestyle interventions, such as:
- Weight loss (BMI less than 25 kg/m2)
- Increased physical activity
- Healthy eating habits
Relevant Links:
Physician Resources—Metabolic SyndromeStandards of Care—Metabolic Syndrome
Resolution of co morbidities References:
1.Obesity in the U.S. American Obesity Assocation.http://www.obesity.org/subs/fastfacts/obesity_US.shtml.
2.Dixon JB, O’Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25:2:358-363.Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547-559.
3.Ahroni JH, et al., Laparoscopic adjustable gastric banding: weight loss, co-morbidities, medication usage and quality of life at one year. Obes Surg. 2005;15:641-647.
4.Spivak H, et al., Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure. Am J Surg. 2005;189:27-32.
5.Frigg A, Peterli R, Peters T, Ackerman C, Tondelli P. Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding. Obes Surg. 2004;14:216-223.
6.Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Management of Obesity in Diabetes, S77-80. Available at: http://www.diabetes.ca/files/cpg2008/cpg-2008.pdf.
7.Centers for Disease Control and Prevention Web site. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2005. Available at: http://www.cdc.gov/diabetes/pubs/factsheet05.htm. Accessed June 20, 2007.
8.Dixon JB, et al., Adjustable Gastric Banding and Conventional Therapy for Diabetes Type 2: A Randomized Controlled Trial, JAMA 2008;299(3):316-323
9.Ponce J, Haynes B, Paynter S, et al. Effect of Lap-Band-induced weight loss on Diabetes Type 2 mellitus and hypertension. Obes Surg. 2004;14:1335-1342.
10.Littner M, Alessi C. Obstructive sleep apnea: asleep in our consciousness no more. Chest. 2002;121: 1729-1730.
11.Fritscher LG, et al., Obesity and obstructive sleep apnea-hypopnea syndrome: the impact of bariatric surgery. Obes Surg. 2007;17:95-99.
12.Morgenthaler TI, et al., Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29:1031-1035.
13.Dixon JB, et al., Sleep disturbance and obesity: changes following surgically induced weight loss. Arch Intern Med. 2001;161:102-106.
14.Ong KL, et al., Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension. 2007;49:69-75.
15.Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med. 2007;175:661-666.
16.Dixon JB, O’Brien PE. Gastroesophageal reflux in obesity: the effect of Lap-Band placement. Obes Surg. 1999;9:527-531.
17.Clearfield MB. The national cholesterol education program adult treatment panel III guidelines. J Am Osteopath Assoc. 2003;103:S1-S5.
18.Gordon C. McCarter GC. Wrestling the beast: obesity, metabolic syndrome, diabetes, and related disorders Medscape. 2006; http://www.medscape.com/viewprogram/5352
19.American Obesity Association Web site. Health effects of obesity. Available at: http://obesity1.tempdomainname.com/subs/fastfacts/Health_Effects.shtml. Accessed April 20, 2007.
20.American Society for Reproductive Medicine Web site. Patient’s fact sheet: weight and fertility. Available at: http://www.asrm.org/Patients/FactSheets/weightfertility.pdf.
Accessed June 20, 2007.
21.Agbaje IM, et al., Insulin dependant diabetes mellitus: implications for male reproductive function. Hum Reprod. 2007;1-7 [epub ahead of print].
22.Sugerman HJ. The pathophysiology of severe obesity and the effects of surgically induced weight loss. Surgery for Obesity and Related Diseases. 2005;109-119.
23.Dixon JB, et al., Pregnancy after Lap-Band surgery: management of the band to achieve healthy weight outcomes. Obes Surg. 2001;11:59-65.
24.The American Urogynecologic Society Web site. Female urinary stress incontinence: overview. Available at http://www.augs.org/i4a/pages/index.cfm?pageid=208. Accessed on May 16, 2007.
25.Carroll JF. Lap Band gastric bypass surgery improves insulin resistance. The American Physiological Society Web site. Available at: http://www.the-aps.org/press/journal/07/29.htm. Accessed June 20, 2007.