Diabetes

04 February 2010

Obesity and the metabolic syndrome

One in every two South Africans suffers from obesity, which increases the individual's risk to develop metabolic syndrome. Dr Ingrid van Heerden takes a look at possible solutions.

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One in every two South Africans suffers from obesity, which increases the individual's risk to develop metabolic syndrome. In fact, it is estimated that one in every four South Africans already suffer from the syndrome.

This article places an interesting paper on The Role of Xenical in the Patient with Metabolic Syndrome, as delivered by Prof Luc van Graal at the first Regional Congress on Obesity, in sharp focus.

Van Graal is the Head of the Department of Diabetology, Metabolism and Clinical Nutrition at the University Hospital in Antwerp, Belgium.

The metabolic syndrome

Van Graal started his lecture by defining the metabolic syndrome. Patients with this syndrome have three or more of the following symptoms:

  • obesity, particularly so-called visceral obesity
  • insulin resistance
  • glucose intolerance (characterised by raised blood glucose levels)
  • hyperinsulinaemia (raised insulin levels in the blood)
  • hypertriglyceridaemia (raised blood levels of certain fats called triglycerides)
  • low HDL-cholesterol (i.e. low blood levels of ‘good’ cholesterol that protects against heart disease)
  • hypertension (high blood pressure)
  • coronary heart disease

Some patients only have one or two of these symptoms, while others may have all the above-mentioned symptoms.

Van Graal emphasised that the most central factor in this type of syndrome is visceral obesity – in other words accumulation of fat in the lower abdomen.

He also cautioned that metabolic syndrome is usually associated with type 2 diabetes and that individuals who develop visceral fat depots are particularly prone to this type of diabetes.

Solutions

The good news is that by losing just a modest amount of weight, patients with metabolic syndrome can improve their symptoms. For example, if a patient with metabolic syndrome reduces his weight by as little as 4 kg, he can expect an improvement in diabetic symptoms and it may be possible for the individual to stop taking diabetic medication.

Van Graal said that the maintenance of body weight, especially during the woman's menopause, is a goal that needs to be achieved. Once menstruation stops, weight gain is inevitable unless women make adjustments to their food intake and exercise levels.

To prevent metabolic syndrome, it is essential to prevent childhood, adolescent and adult obesity. By preventing one problem, namely obesity, you can also put a stop to the multi-faceted metabolic syndrome and all its symptoms. The problem is, however, how individuals and populations should prevent weight gain and the development of obesity.

The role of Xenical

Van Graal discussed one slimming aid that can potentially prevent obesity and assist obese patients to lose appreciable amounts of weight, namely Orlistat or Xenical, as it is known in South Africa. This medication is a so-called lipase inhibitor. Lipases are enzymes our bodies use to digest fat so that it can be absorbed into the system and then deposited in the fat stores. If the lipase enzymes are inactivated, no fat will be absorbed out of the digestive tract, no fat will be deposited in the fat stores, and the patient will start losing weight.

Research has shown that obese patients are capable of losing 10-11% of their weight over a period of six months if they use Xenical together with a very-low-fat diet.

The obese patients in one study, who had lost 10-11% of their weight (e.g. a 70-kg individual would have lost 7-8 kg), experienced dramatic improvements in metabolic syndrome symptoms. Their visceral fat decreased, their BMIs decreased, markers of diabetes decreased, their levels of free fatty acids decreased, and the way they metabolised glucose improved significantly.

Free fatty acids are produced when lipase enzymes digest fat. This is also the form in which fat is transported to the storage areas, such as the hips, thighs and tummy.

The improvement in glucose metabolism in patients using Xenical was so good that researchers have suggested that this medication has a separate glucose-improving effect in addition to the advantage gained from losing weight. Any improvement in glucose metabolism will of course improve the symptoms of diabetes.

Up to 75% of all patients participating in these studies lost significant amounts of weight when using Xenical and cutting out fat in their diets. For each kilogram of body weight that was lost, the patients reduced their abdominal fat layer by 1 cm and the amount of visceral fat stored in the stomach area by 25%.

These are exciting results that indicate that every kilogram an obese patient with metabolic syndrome loses will result in significant reductions in abdominal fat and other negative symptoms of this syndrome.

Practical considerations

Xenical is available in South Africa. It does, however, have to be obtained on prescription via your medical doctor.

One complaint that many people have is that Xenical is expensive. This may be true as a month’s supply can cost in excess of R500. However, the good news is that patients who have some practically fat-free meals every day don’t have to use as many tablets as patients who eat fat at each meal.

For example, if the patient eats cereal (Special K) or cooked maize meal or oats porridge with fat-free milk, fruit, wholewheat toast and jam for breakfast, it would not be necessary to take a tablet for such a meal and the patient would save money.

If patients also consider that they would be saving the money they would have spent on other slimming pills and products (which can also be expensive and may not cause significant weight loss), and that they are certain of achieving significant weight loss with all the accompanying improvements in their health, then the price of a month’s supply of Xenical becomes a great deal more acceptable.

So if you suffer from obesity and metabolic syndrome with all its negative symptoms (high blood pressure, insulin resistance or diabetes, raised blood fat levels and heart disease), then do consult your doctor about Xenical. It could just be the solution to your problems. – (Dr Ingrid van Heerden, DietDoc, November 2004)

Any questions? Ask DietDoc

 

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