Sunday, August 30, 2015

Bariatric Surgery Can Treat Metabolic Syndrome

Bariatric surgery has been shown to be an effective weight loss approach. The surgery is not only an effective weight loss tool, it is also a tool for resolving type II diabetes in many cases. Now, studies are showing that bariatric surgery can reduce the health risks associated with a collection of metabolic conditions comprising what is called the metabolic syndrome.

An agreed-to definition of the metabolic syndrome does not exist. But most definitions consist of similar elements. For example, the National Heart, Lung and Blood Institute (NHLBI) chooses from five key metabolic conditions to establish the syndrome.

The NHLBI considers a person to be suffering from metabolic syndrome if the person is diagnosed with any three of the following five conditions: 1. Abdominal obesity, 2. "a high triglyceride level (or [the person is] on medicine to treat high triglycerides)," 3. a low HDL cholesterol level (or [the person is] on medicine to treat low HDL cholesterol)," 4. high blood pressure (or [the person is] on medicine to treat high blood pressure)," and 5. high fasting blood sugar (or [the person is] on medicine to treat high blood sugar)."

If a person has metabolic syndrome, that person's risk of diabetes, heart attack, or stroke is increased. Two studies have shown that bariatric surgery can reduce the severity of conditions commonly associated with the syndrome. In one study consisting of 258 patients, where half of the patients underwent gastric bypass surgery and half of the patients were treated non-surgically, gastric bypass surgery decreased "the prevalence of metabolic syndrome" to a greater degree than did the nonsurgical treatment.

And in another investigation, which was an "observational study from 1992-2009, of 40 consecutive elderly age persons greater than 60 years… with class II-III obesity," bariatric surgery decreased the prevalence of metabolic syndrome in a large percentage of the patients.

So bariatric surgery can effectively treat metabolic syndrome in some cases. This treatment option adds to the usefulness of the surgery. The possibility that bariatric surgery may be an effective treatment for metabolic syndrome should be of interest to bariatric surgeons and non-surgical weight loss service providers.

Wednesday, August 19, 2015

BMI vs. Waist-To-Height Ratio in Determining Cardiometabolic Risk

BMI is probably the most commonly used obesity related measurement. However, BMI is not necessarily the best measurement for all types of obesity. Indeed, it is not the most accurate measurement for abdominal obesity which is often associated with cardiometabolic risks. Anthropomorphic measurements involving waist are better indicators of these risks in most cases. These measurements include waist, waist-to hip ratio, and waist-to-height ratio (WHtR), which may be one of the best.

Two reasons why BMI is the measurement used most often for obesity is its ease of calculation (Weight in Kilograms/(Height in Meters2) and the U.S. government's recommendation that the measurement be used by physicians. The "government guidelines urge physicians to screen all adult patients for obesity, and offer health and lifestyle counseling for those with a high body mass index (BMI)."

Still, studies show that WHtR is a better measurement for predicting cardiometabolic risks. According to a study published in 2013, "WHtR appears to be superior to BMI in detecting several outcomes, including incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality." It should be noted that the investigators did find that WHtR was a more useful measurement in Asians than in non-Asians. But the investigators indicated that their study results supported "the use of WHtR in identifying adults at increased cardiometabolic risk."

Investigators conducting another more recent study also concluded that "WHtR measurements were .. good markers for ... cardiometabolic risk." Let us note here that unlike some who say that BMI should be thrown out completely, we do not advocate this. Investigators have used BMI for some time in many studies, and BMI has proven to be useful.

But physicians and other healthcare providers might want to consider using WHtR as well as BMI. Including WHtR in their set of patient assessment tools could give providers more insight into unhealthy cardiometabolic conditions.  Using this measurement could help the providers deliver better care to their patients.

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