Appledore Medical Group - August 21, 2018

Metabolic Syndrome 101
Bernard Benedetto, MD - Bariatric Surgeon

Metabolic syndrome is a combination of risk factors that increase your risk of heart disease, diabetes, and stroke. It is diagnosed when at least three of the following are present:

  • High blood pressure
  • High triglyceride levels
  • Large waistline
  • Low HDL (good) cholesterol
  • High fasting blood sugar

Causes of Metabolic Syndrome

The exact cause of metabolic syndrome is not known, but it is believed to be due to a combination of factors, such as obesity, genetics, lack of physical activity, and poor diet. Metabolic syndrome is more common in people who are Hispanic, Caucasian, or African American.

Risk Factors for Metabolic Syndrome

  • Having, or having a family history, of conditions associated with metabolic disorder like diabetes, hypertension (high blood pressure), cholesterol problems, coronary artery disease, and polycystic ovary syndrome (PCOS)
  • History of gestational diabetes
  • Physical inactivity
  • Poor diet
  • Unhealthy habits, such as smoking
  • Certain medications, such as atypical antipsychotics

Symptoms of Metabolic Syndrome

  • Frequent urination
  • Excessive thirst and hunger due to high blood sugars
  • Dark, velvety skin discoloration seen with obesity


You may be diagnosed with metabolic syndrome if you have a waist measurement—greater than 40 inches in Caucasian men (35 inches in Asian men) or 35 inches in Caucasian women (30 inches in Asian women), or at least two of the following:

  • Fasting glucose level—greater than or equal to 100 mg/dL* (5.55 mmol/L)
  • Triglyceride level—greater than or equal to 150 mg/dL (1.7 mmol/L)
  • HDL cholesterol—less than 40 mg/dL (1.0 mmol/L) in men and less than 50 mg/dL (1.3 mmol/L) in women
  • Blood pressure—greater than or equal to 130/85 millimeters of mercury (mm Hg)

Treatment Options

Bariatric surgery is often an effective treatment for metabolic syndrome. There are several types of bariatric surgery from which patients can choose, and your surgeon can help inform you of the benefits of each procedure for each personal treatment plan.

The non-surgical treatment of metabolic syndrome focuses on treating the underlying causes with lifestyle changes like diet and exercise, as well as treatment of any specific metabolic abnormality. It is important to set modest, attainable goals for yourself. Start by making small changes instead of trying to change everything all at once. You will be more successful and will continue to progress more easily.

Lower Your Weight

  • Find a weight loss program that is right for you. Those with frequent reinforcement are particularly effective. Try to reduce excess weight by at least 10% in the next 6-12 months.
  • Lose weight slowly and steadily. Plan ways to maintain the weight loss.
  • Gastric bypass or other weight loss surgery may be helpful to treat metabolic syndrome if obesity is severe. Talk to your doctor to learn if this is an option for you.

Increase Physical Activity and Reduce Stress

  • Exercise a little each day. Aim for 30-60 minutes of moderate aerobic exercise 4 or more days per week as approved by your doctor.
  • Commit yourself to more physical activity. Join a health club or plan walks with friends. Incorporate increased activity into your daily habits - park further away from your destination, use the stairs rather than the elevator, get up to turn the TV channel rather than using the remote control, and do small exercises, like leg lifts or stomach tucks, while sitting or lying in bed.
  • Control Your Stress Level. Stress can contribute to weight gain and heart disease. Learn relaxation and stress management techniques.

Improve Your Eating Environment and Habits

  • Sit down at the table for your meals.
  • Focus on your food. Do not do other activities, like watching TV, while you are eating.
  • Do not wait until you are completely full before you stop eating.
  • Do not eat because you are bored, tired, stressed, or sad.
  • When eating out, ask for half of your portion to be packed before your meal is served.

Eat a Healthy Diet

  • Eat more fruits and vegetables.
  • Choose lean cuts of meat.
  • Avoid fast foods.
  • Bake, broil, or grill your poultry, fish, or meat. Do not fry your food.
  • Do not add salt to your food.
  • Cut down on saturated fats, many of which are found in animal products. They can raise your cholesterol levels.
  • Choose whole-grain foods like whole wheat bread or brown rice instead of refined or processed foods like white bread or white rice.
  • Eat more fiber-rich foods like beans, fruits, and vegetables.
  • Eat less sugar.
  • Limit or eliminate soda and other sugary drinks including juice.
  • Avoid Excess Alcohol Intake. Drink alcohol in moderation only – 1 drink per day for women and 2 per day for men.

Work with Your Doctor

  • Lower blood pressure to below 130/85 mmHg with diet, exercise, and possibly medication.
  • Improve triglyceride and HDL cholesterol levels through diet, exercise, and sometimes medication.
  • Get regular physical check-ups. You and your doctor should monitor your weight, blood pressure, cholesterol, and blood sugar levels.
  • Stop Smoking. Ask your doctor to suggest programs and/or medications to help you quit smoking. This is extremely important.

In addition to lifestyle changes, your doctor may recommend treatment for a specific metabolic abnormality. Examples include:

  • Insulin resistance—treated with diabetes medications and lifestyle changes.
  • High cholesterol—treated with cholesterol-lowering medications called statins and lifestyle changes.
  • Clotting tendency—treated with low-dose aspirin, especially in those with moderate to high cardiovascular risk.


Many of the same positive lifestyle habits that are used to treat metabolic syndrome also can help reduce your chances of developing it at all. Maintain a healthy weight, eat a wholesome diet, get plenty of exercise, and avoid damaging behaviors like smoking and excessive alcohol consumption.