Metabolic Syndrome

What is metabolic syndrome?

Metabolic syndrome is a serious health condition. It is a group of five conditions — increased blood pressure, high blood sugar, high cholesterol or triglyceride levels and excess abdominal fat — that occur together. Metabolic syndrome increases your risk of having heart disease, stroke and diabetes, as opposed to having only one of the above conditions.

Having just one of these conditions doesn’t mean you have metabolic syndrome. However, any of these conditions increase your risk of serious disease. Having more than one of these might increase your risk even more.

If you have metabolic syndrome or any of its conditions, big lifestyle changes are required to delay or even prevent the development of serious health problems.

Why is metabolic syndrome a cause for concern?

Metabolic syndrome greatly increases your risk of having cardiovascular diseases. High cholesterol and high blood pressure can lead to the blockage in your arteries. These plaques narrow and harden your arteries and can lead to a stroke or heart attack.

Metabolic syndrome can also lead to diabetes. This is because it is linked to insulin resistance in diabetics, where cells do not respond normally to insulin and glucose is not broken down as easily, thus glucose levels in the blood remain high.

What causes metabolic syndrome?

Metabolic syndrome is a serious health condition that affects around one-fifths of adults. The underlying causes of metabolic syndrome include a sedentary lifestyle, being overweight or obese and physical inactivity.

How is metabolic syndrome diagnosed?

During a consultation session with your doctor, metabolic syndrome is diagnosed against a criteria if you have at least three of the following:

  • Central obesity (defined as waist circumference of more than 40 inches in men, and more than 35 inches in women)
  • High triglyceride level of 150 milligrams per deciliter of blood (mg/dL) or more, or being on medications for high triglycerides
  • Low HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women, or being on low HDL cholesterol medications
  • Elevated blood pressure of 130/85 mm Hg or higher, or being on medications for high blood pressure
  • Fasting glucose of 100 mg/dL or greater, or being on medication for high blood glucose

Why should I undergo surgery for metabolic syndrome?

Although metabolic syndrome is a serious health condition, you can reduce your risks significantly by losing some weight. This means increasing your physical activity; eating a healthy and balanced diet that’s rich in whole grains, fruits, vegetables and fish.

However, for severely overweight individuals who have repeatedly been on diets or exercised without much success, metabolic bariatric surgery is recommended. It has a high success rate, with over 8o per cent of patients losing and maintaining their initial weight loss. It has proven to dramatically improve or cure diabetes, lower insulin levels within a few days of surgery and normalise blood glucose levels and such that therapy or medications are no longer necessary. Another key indicator of the success of bariatric surgery is the low risks and complications associated with the procedure.

It has to be noted that while the success of bariatric surgery depends most importantly on choosing an experienced surgeon, you will have to play a part in changing your diet and exercise routines to maintain weight loss.

Why bariatric surgery for metabolic syndrome?

Weight loss is recommended as the first-line management of metabolic syndrome, as it offers numerous incredible benefits in one’s health status. However, many patients with metabolic syndrome fail to achieve significant and sustained weight loss through lifestyle changes. These include consuming a healthful, reduced-calorie diet and engaging in regular physical activity. In fact, few medical treatments have been effective in severely overweight patients in the long run.Currently, only bariatric surgery, also known as metabolic surgery, results in sustained weight loss in patients who are severely obese. Substantial and sustained weight loss has been proven to
have astonishing effects on resolving or improving metabolic syndrome. Laparoscopic roux en y gastric bypass and laparoscopic sleeve gastrectomy have proven to be effective and safe medical procedures.

Sustained weight loss

For severely obese individuals with metabolic syndrome, bariatric surgery plays a major role in helping them lose a significant amount of weight and sustain the weight loss in the long run. Research has shown that in patients with metabolic syndrome, the average weight loss one year after surgery is 30 per cent of the initial body weight and eventually 60 per cent. Furthermore, patients do maintain their weight loss. More than 50 per cent excess weight loss was maintained for Laparoscopic roux en y gastric bypass and Laparoscopic sleeve gastrectomy at 8, 10 and 14 years and 8 years after the procedure respectively.

Reduced components of metabolic syndrome

As a result of substantial weight loss, bariatric surgery has been shown to significant reduce the components of metabolic syndrome one year after surgery. Weight loss surgery helps to greatly lower blood pressure, triglycerides and total cholesterol levels, leading to a 95 per cent resolution or improvement of metabolic syndrome a year after surgery. This is especially significant in reducing the risk of stroke and heart disease, where HDL and triglycerides are key indicators in these conditions.

Reduced risk of obesity-related medical conditions

Many patients also resolve or improve Type II Diabetes, hyperlipidemia, hypertension and obstructive sleep apnea after bariatric surgery. Type II Diabetes resolved in around 80 per cent, hyperlipidemia in more than 70 per cent, hypertension in 60 per cent and sleep apnea in 85 per cent of patients. As diabetes, hyperlipidemia and hypertension form the triad of metabolic components, this resulted in a 95 per cent resolution or improvement rate in metabolic syndrome for severely obese patients one year following surgery.

Is bariatric surgery suitable for me?

Bariatric surgery is performed to help the severely overweight or moderately overweight who suffer significant complications from their excess weight. This is especially so if an individual has been unable to lose weight through conventional methods such as diet, exercise or medicine. According
to health guidelines, you may be recommended to undergo weight loss surgery if you have a Body Mass Index (BMI) of:

  • 40 kg/m2 or higher
  • 35 kg/m2 or higher with diabetes or metabolic syndrome

How does bariatric surgery work?

Weight loss surgery works in several ways, and are all either malabsorptive, restrictive (Laparoscopic sleeve gastrectomy), or a combination of both (Laparoscopic roux en y gastric bypass). Malabsorptive procedures alters the way your digestive system works. Restrictive procedures greatly reduce the size of your stomach.

More specifically,
Laparoscopic roux en y gastric bypass is a surgery to change your gastrointestinal tract. It causes the food you consume to bypass most of the stomach and the upper part of your small intestine.This procedure helps you lose weight in two ways: you will feel full more quickly and consume
smaller amounts of food with the reduced space in your stomach and restricted food it can hold (restrictive) and curbs your body’s absorption of calories and nutrients (malabsorptive). This surgery improves metabolic syndrome by helping you achieve rapid and significant weight loss.

Laparoscopic sleeve gastrectomy is a surgery which removes a large portion of your stomach. In doing so, this helps you lose weight rapidly. With a narrow remaining stomach, there is much less space for food. You will only be able to consume smaller amounts of food after the surgery. Laparoscopic sleeve gastrectomy may also cause your appetite to decrease as it removes the upper part of your stomach called the fundus. The fundus is a part of your stomach that produces ghreline, amongst others. Ghrelin is known as your ‘hunger hormone’ and is involved in appetite control. By reducing the levels of ‘hunger’ hormone produced by your stomach, this procedure helps you lose weight following the surgery.