Treatment of the Metabolic Syndrome with Weight Loss, Exercise, Hormones, and Surgery

Abstract

Weight reduction improves all components of the metabolic syndrome. This is seen with calorie-reduced diets as well as weight-loss Mediterranean-type diets. Exercise is also an effective strategy, but less so than diets usually because the weight loss is less. Sibutramine, xenical, and rimonabant are effective strategies to lower body weight and improve the metabolic syndrome. Surgery is more effective than the other strategies for reducing body weight and has significant effects on the components of the metabolic syndrome. Simply removing fat, however, is not enough to improve the features of the metabolic syndrome. Removal of subcutaneous fat by liposuction does not improve lipids or blood pressure, whereas removal of visceral fat by lipectomy does. Central adiposity can be attenuated independently of total body fat. Growth hormone, testosterone, cortisol, and dehydroepiandrosterone all have independent effects on visceral adipose tissue.