Hope for the Middle Aged Pleasingly Plump
Competency # 3 Understanding the Metabolic Syndrome
Reference: Archives Internal Medicine August 5th, 2008 (168) 1617-1624 Wildman et al
Two articles this week in the same journal on the same topic. What is your risk for a heart attack by being just a wee bit overweight? The rising rate of obesity worldwide has correlated with a rising rate of diabetes and heart attack. We have asked the question, again and again, does being overweight cause diabetes or is it associated with diabetes? Those are two very different questions. Causing it means you have to get skinny, otherwise you are toast. Being associated means you may be. Some of us can live just fine being a “comfortable” weight.
From Tubingen Germany, Dr. Stefan et al found that overweight Germans are not universally at “metabolic” risk. Half of the obese Germans had normal insulin sensitivity, and normal lipids. (At least half of Germans: we are pretty sure different ethnic groups have different risk profiles. South Asians are much more at risk with obesity, for example.) This suggests that being obese is NOT always the cause of diabetes and heart disease. The second study, from Albert Einstein Medical Center in New York looking at the American population found the same thing. Half of obese folks are metabolically in trouble with elevated fats and insulin resistance. But half were not. Even more interesting to me is that a quarter of folks from the normal weight group had a profile of resistance to insulin and out of whack blood fats.
These two studies will be quoted for years in many venues. It means that we must rethink the way we look at metabolic syndrome, the constellation of abnormalities that constitute risk for heart disease, in a new way. In America, we have put primary emphasis on your waist size and your body mass index as being the beginning of all difficulties. We have suggested that getting overweight was going to do you in as sure as the sun would come up tomorrow. These studies clearly demonstrate a different point. Being overweight puts you at higher RISK of diabetes, as the obese folks were at 50%, the overweight folks (BMI from 25-30) were at 30% risk, and the normal weight folks were at 25% risk. But taken the other way, 50% of obese folks had normal insulin sensitivity and blood fats, 70 % of overweight folks were okay, and 75 % of normal weight folks were okay. Conclusion: The primary problem with cardio-metabolic risk is NOT obesity; it is INSULIN resistance. That crosses all lines. To catch things early while lifestyle changes will still work means we can’t let even the normal weight folks go without an occasional review to see if they are internally still safe.
WHO (The World Health Organization) has argued that insulin resistance is primary to metabolic syndrome. The Europeans have tended to go along. These studies might just convince the American medical crowd to start singing in the same choir.
And just what might be the difference? The factors the authors studied to call someone normal were BP, white blood count, EKGs, blood lipids, fibrinogen (clotting protein or a way of looking at “inflammation”,). That’s a pretty easy combination of tests to get from your doctor. I think the difference comes down to the genes you inherit, the daily exercise you do, and the foods you choose.
WWW: What will work for me? If I’m going to catch medical problems early, this study suggests that getting skinny isn’t the whole story. Insulin sensitivity is, and that, you are either born with or without. If you have a tendency to be insulin resistant, which I personally do, then you and I have to adopt those life style parameters that keep us as healthy and insulin sensitive as we can. As best as I can tell, that means daily exercise (which keeps you more insulin sensitive for 18 hours at a time), avoiding heavy meals and having smaller frequent meals, and avoiding high doses of sugar. Let’s see, today I get a C (only walked 10 minutes), a B, (4 small snack meals) and D, (half a milk shake at Kopp’s – fell off the wagon). Time to get the annual physical and see what my sugars are doing… maybe next week, after I walk a bit more.