New Diagnosis for Overweight

By Rob Stein
Washington Post Staff Writer
Tuesday, February 8, 2005

Germaine Savoy has known for years she needed to lose weight and figured she was in for another lecture when she went to see her doctor last week. She wasn't expecting to hear that she had some strange, ominous-sounding syndrome.

"I've always been petrified about hearing I had diabetes," said Savoy, 50, a civilian employee at Fort Detrick in Frederick who lives on Capitol Hill. "But I never thought about this. I never heard of this."

Savoy has joined the growing number of Americans who are being told they have "metabolic syndrome," a diagnosis that has become alarmingly common, primarily because of the obesity epidemic. A syndrome is a collection of symptoms that make someone prone to disease.

The metabolic syndrome, probably caused by a fundamental malfunctioning of the body's system for storing and burning energy, is defined by having a cluster of risk factors such as elevated blood pressure, poor blood sugar control, high levels of fats in the blood called triglycerides and low HDL, or "good" cholesterol. Individually, each factor may not be highly dangerous, but together they appear to sharply boost the danger of major health problems, notably heart disease, diabetes and, possibly, certain types of cancer.

At least 64 million Americans -- nearly a third of adults age 20 and older -- probably meet the federal government's criteria for the syndrome, and the rate approaches 50 percent among the elderly. Mexican Americans and African American women appear to be especially prone. It also turns up in people who are not obese but have recently put on a lot of weight around their middles, and in an increasing number of overweight children.

"It's a huge medical issue," said Scott M. Grundy of the University of Texas Southwestern Medical Center in Dallas. "And it's just getting worse."

Most of these people have no idea they have the syndrome, and many experts say that unless steps are taken to aggressively identify and treat them, it is likely to spawn future epidemics of heart attacks, strokes, diabetes and other diseases, including sleep apnea, liver disease, and polycystic ovary syndrome, which can cause infertility and other problems.

"The world has moved from infectious disease being the major thing that kills us to this kind of chronic illness," said David M. Nathan of the Harvard Medical School. "It is really the public health issue for the next millennium."

Many aspects of the syndrome remain unclear and controversial. There are several competing definitions, and experts disagree about how dangerous it is and how intensively it should be treated. Some argue that the syndrome arbitrarily lumps together risk factors that doctors already recognize and treat. Combining them into a "syndrome" could prompt doctors to put patients on drugs too quickly or, paradoxically, delay treating patients who need therapy, critics say.

"Conceptually, it's a step backwards," said Gerald M. Reaven of Stanford University, who pioneered an early form of the concept. "And I think it has the real potential to bring about damage clinically."

But most experts consider the approach very useful. They say it is crystallizing thinking about how fat causes illness, motivating patients to lose weight and exercise, pushing doctors to identify and treat patients sooner, galvanizing researchers to decipher the underlying biological defects, and spurring the development of a new generation of more targeted drugs.

"It's emerged as a very important concept," said Daniel Porte Jr. of the University of Washington and the University of California at San Diego. "It's made people think about these problems in a new way."


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