A Battle Against Metabolic Syndrome

In primary care almost daily, I face counseling overweight or obese patients on a healthy lifestyle. “Follow the Mediterranean diet!” or “Try to allow at least 150 minutes weekly of moderate physical activity into your routine.” More than likely these patients also have features of the dreaded metabolic syndrome: waist circumference ≥40 inches in men or ≥35 inches in women, triglycerides ≥150 mg/dL, high-density lipoprotein cholesterol ≤40 mg/dL in men and ≤50 mg/dL in women, fasting blood glucose ≥100 mg/dL or hemoglobin A_1c (HbA_1c) ≥5.7%, and systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥85 mm Hg (1). Yet more often than not when I introduce the term “metabolic syndrome,” patients tend to look at me bewildered. Most undoubtedly reply, “What did you say?” 

Metabolic syndrome affects more than one third of the U.S. population and contributes to a progressive pathophysiologic change to the health of the human body (2). Potential changes include the development of diabetes mellitus type 2, hepatic steatosis, obstructive sleep apnea, cardiovascular disease, and even chronic inflammation (1). This proinflammatory state can be associated with insulin resistance and endothelial dysfunction leading to vascular impairments (3). This prompts me to highlight the importance of educating patients on this multifaceted condition. 

I am always searching for more tools to implement in practice regarding weight management. A randomized controlled trial on time-restricted eating (TRE) published in Annals of Internal Medicine provides enlightening information (2). Adults with metabolic syndrome were randomly assigned to receive 3 months of TRE with the standard of care (i.e., nutrition counseling and pharmacotherapy) versus standard of care only. TRE was limited to an eating window period of 8 to 10 hours, with the overall goal of reducing the participant’s original eating period by at least 4 hours. The study showed improvement in HbA_1c by 0.10%, as well as reduced glycemic variability, body mass index, and trunk fat. The article additionally mentions that the Diabetes Prevention Program found that a decrease in HbA_1c by 0.10% will help reduce the risk for diabetes mellitus type 2 (2). Although one limitation of this trial is its duration of only 3 months, the study is relevant for presenting a nonpharmaceutical and cost-effective option available to patients. 

The call to focus on chronic disease prevention is crucial, particularly in a time of growing rates of overweight and obesity. It is predicted that one third of the global population of children and adolescents will be overweight or obese by 2050 (4). Of note, these habits can be followed into adulthood and lead to features of metabolic syndrome and chronic disease development. Indeed, there have been significant advancements in pharmacologic options for patients with obesity, notably glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists. More research is currently under way for indications such as fatty liver disease, chronic kidney disease, obstructive sleep apnea, and Alzheimer disease. However, I still commonly meet patients who do not want to start medication treatment, and lifestyle adjustments continue to be paramount in preventing chronic disease. 

Incorporating lifestyle adjustments is one part of this complex subject, with TRE remaining an encouraging intervention. As a primary care physician, I look forward to utilizing another method of combating metabolic syndrome. 

References 

1. Dobrowolski P, Prejbisz A, Kuryłowicz A, et al. Metabolic syndrome - a new definition and management guidelines. A joint position paper by the Polish Society of Hypertension, Polish Society for the Treatment of Obesity, Polish Lipid Association, Polish Association for Study of Liver, Polish Society of Family Medicine, Polish Society of Lifestyle Medicine, Division of Prevention and Epidemiology Polish Cardiac Society, "Club 30" Polish Cardiac Society, and Division of Metabolic and Bariatric Surgery Society of Polish Surgeons. Arch Med Sci. 2022;18:1133-1156. [PMID: 36160355] doi:10.5114/aoms/152921 
2. Manoogian ENC, Wilkinson MJ, O'Neal M, et al. Time-restricted eating in adults with metabolic syndrome. A randomized controlled trial. Ann Intern Med. 2024;177:1462-1470. [PMID: 39348690] doi:10.7326/M24-0859
3. Esposito K, Giugliano D. The metabolic syndrome and inflammation: association or causation? [Editorial]. Nutr Metab Cardiovasc Dis. 2004;14:228-32. [PMID: 15673055]
4. GBD 2021 Adolescent BMI Collaborators. Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet. 2025;405:785-812. [PMID: 40049185] doi:10.1016/S0140-6736(25)00397-6 

Athena Failla, MD, MPH

Athena Failla is an internal medicine physician with Florida Medical Clinic Orlando Health. She completed her medical degree at Florida International University and her internal medicine residency at Wake Forest University in North Carolina. Prior to her medical training, she completed a Master of Public Health in epidemiology at the University of South Florida. She is passionate about preventative health and providing collaborative and patient-centered care.