Linda
02-16-2004, 10:16 AM
Doctor fears 'metabolic syndrome' epidemic is shadowing obesity rate
Estimated 25 percent of Americans have condition that is cluster of heart disease risks.
By DAVID RUMBACH
Tribune Staff Writer
There's no doubt that bariatric surgery helps people whose obesity has reached the point where weight itself causes diseases.
But it won't solve America's growing weight problem. Instead, the rapid growth of bariatric surgery reflects how bad the obesity epidemic has become.
"It's scorched-earth policy,'' Dr. Paul Howard, a cardiologist in South Bend, said of the operation. "A lot of damage has already been done" by the time people qualify for the surgery.
Howard said people's arteries suffer damage for years before obesity causes high blood sugar and results in a diagnosis of Type II diabetes, a very common "co-morbidity'' for people undergoing bariatric surgery.
He believes that a second dangerous epidemic -- of a condition called the "metabolic syndrome'' -- is occurring in concert with the surge in obesity now being seen in industrialized countries around the world. In the United States, it's estimated that 131 million residents are overweight or obese.
Metabolic syndrome, sometimes called "syndrome X,'' consists of a complex cluster of risk factors for heart disease. Bad enough by themselves, they're even worse when they occur together, Howard said.
They include:
High triglycerides and low LDL cholesterol (good cholesterol).
Elevated blood pressure of 130/85 or higher.
A fat midsection, defined as a waistline of at least 40 inches in men and 35 in women.
Insulin resistance.
Elevated levels of certain tell-tale molecules in the blood, such as C-reactive protein and fibrinogen.
Howard said it's estimated that 25 percent of adults in the United States have metabolic syndrome, including almost all severely obese people who are candidates for weight-loss surgery.
"This is the epidemic of the 21st century,'' he said.
Howard believes the disease is driven by one of the same factors that is driving the obesity epidemic: the preponderance of refined carbohydrates in the American diet.
Refined carbohydrates, according to this theory, are metabolized so quickly that they cause a rapid increase, or spike, in blood sugar.
The body reacts to elevated sugar by releasing an excess of insulin into the bloodstream. Eventually, the body's cells become resistant to the insulin and blood sugar rises to the unsafe levels seen in diabetes.
But before that happens, years of excess insulin already have caused inflammatory damage to the arteries, Howard said. It does the damage by way of all those risk factors that define the metabolic syndrome.
Avoiding carbohydrates, of course, is the name of the game for the popular Atkins diet, which Howard and other doctors consider to be unhealthful.
Howard said only certain kinds of carbohydrates are bad and need to be avoided: namely, the refined or simple carbohydrates found in processed foods and especially the high fructose corn syrup used ubiquitously as a sweetener.
Complex carbohydrates, such as those found in black beans, whole wheat, green vegetables and lots of other foods, don't lead to insulin resistance, he said.
Dr. Michael Tachman said the controversy over low-carb dieting has left many people confused, and rightly so.
"It's kind of a muddle right now,'' said Tachman, an endocrinologist and the medical director of Memorial Hospital's new Bariatric Surgery and Weight Loss Center. "No one knows what the right answer is.''
One role of the center will be to provide medical supervision for people who are dieting in preparation for weight-loss surgery.
Some surgery candidates need to lose weight to make surgery safer, while others may need to try dieting to qualify for insurance coverage of their operation.
Tachman said patients who wish to try a diet of their own choosing will be allowed to, as long as it's reasonably safe and only temporary.
"Beyond six months on a fad diet is not good,'' he said. "Hopefully people can make a transition to a balanced diet.''
Ultimately, Tachman said, it's the total calories consumed and not the source of calories that determines whether someone gains weight, loses it or stays the same.
"If you find a well-balanced diet with the right amount of calories and stick to it you'll lose weight,'' he said.
Source: http://www.southbendtribune.com/stories/2004/02/16/local.20040216-sbt-MICH-A2-Doctor_fears__metabo.sto
Estimated 25 percent of Americans have condition that is cluster of heart disease risks.
By DAVID RUMBACH
Tribune Staff Writer
There's no doubt that bariatric surgery helps people whose obesity has reached the point where weight itself causes diseases.
But it won't solve America's growing weight problem. Instead, the rapid growth of bariatric surgery reflects how bad the obesity epidemic has become.
"It's scorched-earth policy,'' Dr. Paul Howard, a cardiologist in South Bend, said of the operation. "A lot of damage has already been done" by the time people qualify for the surgery.
Howard said people's arteries suffer damage for years before obesity causes high blood sugar and results in a diagnosis of Type II diabetes, a very common "co-morbidity'' for people undergoing bariatric surgery.
He believes that a second dangerous epidemic -- of a condition called the "metabolic syndrome'' -- is occurring in concert with the surge in obesity now being seen in industrialized countries around the world. In the United States, it's estimated that 131 million residents are overweight or obese.
Metabolic syndrome, sometimes called "syndrome X,'' consists of a complex cluster of risk factors for heart disease. Bad enough by themselves, they're even worse when they occur together, Howard said.
They include:
High triglycerides and low LDL cholesterol (good cholesterol).
Elevated blood pressure of 130/85 or higher.
A fat midsection, defined as a waistline of at least 40 inches in men and 35 in women.
Insulin resistance.
Elevated levels of certain tell-tale molecules in the blood, such as C-reactive protein and fibrinogen.
Howard said it's estimated that 25 percent of adults in the United States have metabolic syndrome, including almost all severely obese people who are candidates for weight-loss surgery.
"This is the epidemic of the 21st century,'' he said.
Howard believes the disease is driven by one of the same factors that is driving the obesity epidemic: the preponderance of refined carbohydrates in the American diet.
Refined carbohydrates, according to this theory, are metabolized so quickly that they cause a rapid increase, or spike, in blood sugar.
The body reacts to elevated sugar by releasing an excess of insulin into the bloodstream. Eventually, the body's cells become resistant to the insulin and blood sugar rises to the unsafe levels seen in diabetes.
But before that happens, years of excess insulin already have caused inflammatory damage to the arteries, Howard said. It does the damage by way of all those risk factors that define the metabolic syndrome.
Avoiding carbohydrates, of course, is the name of the game for the popular Atkins diet, which Howard and other doctors consider to be unhealthful.
Howard said only certain kinds of carbohydrates are bad and need to be avoided: namely, the refined or simple carbohydrates found in processed foods and especially the high fructose corn syrup used ubiquitously as a sweetener.
Complex carbohydrates, such as those found in black beans, whole wheat, green vegetables and lots of other foods, don't lead to insulin resistance, he said.
Dr. Michael Tachman said the controversy over low-carb dieting has left many people confused, and rightly so.
"It's kind of a muddle right now,'' said Tachman, an endocrinologist and the medical director of Memorial Hospital's new Bariatric Surgery and Weight Loss Center. "No one knows what the right answer is.''
One role of the center will be to provide medical supervision for people who are dieting in preparation for weight-loss surgery.
Some surgery candidates need to lose weight to make surgery safer, while others may need to try dieting to qualify for insurance coverage of their operation.
Tachman said patients who wish to try a diet of their own choosing will be allowed to, as long as it's reasonably safe and only temporary.
"Beyond six months on a fad diet is not good,'' he said. "Hopefully people can make a transition to a balanced diet.''
Ultimately, Tachman said, it's the total calories consumed and not the source of calories that determines whether someone gains weight, loses it or stays the same.
"If you find a well-balanced diet with the right amount of calories and stick to it you'll lose weight,'' he said.
Source: http://www.southbendtribune.com/stories/2004/02/16/local.20040216-sbt-MICH-A2-Doctor_fears__metabo.sto