Partnering with Your Patient: Metabolic Syndrome
In this video, Karlijn Burridge, PA-C, provides the take-home messages from her session at our Practical Updates in Primary Care 2023 Virtual Series. Ms Burridge talks about how metabolic syndrome is defined, the recommended treatments for metabolic syndrome, and how physicians can collaborate with and motivate their patients to live a healthier lifestyle.
Karlijn Burridge, PA-C, is an obesity medicine specialist at Enara Health (Glen Ellyn, Illinois).
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Karlijn Burridge, PA-C: Hey everyone, just in case you missed our session, opportunities to improve metabolic syndrome with your patient, which was presented by myself, Karlijn Burridge, I'm a PA-C and an obesity specialist and Dr Michael Bloch. So just to recap some of what we talked about, we talked about first and foremost about what is metabolic syndrome. So metabolic syndrome is defined as having three or more of the following factors. So one, either abdominal obesity defined as a waist circumference greater than or equal to 40 inches in men or greater than or equal to 35 inches in women. Two triglycerides greater than or equal to 150, HDL less than 40 in men or less than 50 in women. Blood pressure of greater than or equal to 130 over 85 or being on a blood pressure lowering medication. And lastly, having fasting glucose over 100. So if your patient has three or more of these risk factors, that is considered metabolic syndrome.
And the reason why we care about metabolic syndrome is because it significantly increases cardiovascular mortality. And it is incredibly common in the United States and worldwide, especially if we think about the fact that over 42% of US adults currently have obesity, and many of them are developing a lot of these metabolic complications even before they develop or reach the point of having obesity. So some of the current recommendations for the treatment of metabolic syndrome is to treat that atherogenic dyslipidemia. So making sure that we're treating LDL and HDL, making sure that we're treating hypertension, making sure that we're treating or preventing diabetes. And so if somebody does have diabetes, to make sure to get that hemoglobin A1C under seven. And also to make sure that our patients are on aspirin for prothrombotic states. But most importantly, the best way that we can help our patients is through weight loss and increased physical activity. That should be our absolute highest priority.
And we know from the diabetes prevention study that subjects with prediabetes reduce the risk of developing diabetes by 58% with a 7% loss in body weight. So this is incredibly powerful and this is really where we should be focusing our attention with our patients. So the question is, how do we help our patients do this in terms of nutrition? What can we recommend for our patients? So we know that there is no one size fits all, but when we look at the physiology of insulin and its effect on lipolysis and lipogenesis, it's clear that chronically elevated levels of insulin, as we see with insulin resistance drives hunger and weight gain. So a nutrition plan that lowers insulin is going to be beneficial. And when we look at some of the trials like the A TO Z trial where they compare four popular diets, we did see that there was almost twice as much weight loss in the very low carbohydrate or the Atkins plan compared to some of the other plans, at least at six months.
But also important was that people can gain weight or lose weight on any of these plans, and that adherence is really, really important. So we can talk about things that our patients can do to optimize their health, such as making sure that they're eating whole foods and eating the right proportion of healthy carbohydrates, healthy fats and proteins, making sure that they are limiting or eliminating sugar, high fructose corn syrup and those refined starches, making sure that they're eating real food, drinking water, making sure they're getting physical activity every day and getting plenty of sleep.
So these all sound like great recommendations, but how can we help our patients make these difficult behavioral changes? So this is where we really dive into motivational interviewing in the presentation and using the 5 A's model to help patients with behavior change. So motivational interviewing is a collaborative conversation style to strengthen a person's own motivation and commitment to change. So we talk about important concepts of motivational interviewing, such as asking open-ended questions, using affirmations, reflections, and summaries with our patients, and making sure that we're taking an empathetic approach and really partnering with our patients when we're talking about making a lot of these complex behavior changes. So if you want to know more about all of this, make sure you check out our session, and thank you so much for being with us today.