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Feature Article

Toxic waist: practical interventions for metabolic syndrome

Soji Swaraj
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In this opinion piece, GPs are encouraged to recognise metabolic syndrome early as a treatable disease entity in their patients. Practical interventions for metabolic syndrome are described and some tips that GPs can implement themselves even before other multidisciplinary team members have contributed are given.

Key Points

  • Recognise and treat metabolic syndrome with urgency as a disease state in its own right rather than after patients develop diabetes, cardiovascular events, depression, sleep apnoea, osteoarthritis or cancer.
  • Encourage patients to focus on reductions in waist circumference rather than merely focusing on weight in kilograms, and to note rewards such as improved wellbeing, reduction in medication burden, reduction in clothing size, and improved fertility and libido.
  • Adopt the basic principles of the NHMRC guidelines for diet and exercise prescription and consider prescribing a version of the Mediterranean diet with emphasis on vegetables, whole grains and less refined carbohydrates that may help reduce hyperinsulinaemia and adiposity, as well as beneficially alter the lipid profile.
  • Be aware of habitual ‘force-feeding’ patterns (e.g. three meals per day) and consider experimenting with eating only when hungry.
  • Akin to ‘five serves of veg per day’, suggest to patients new normal expectations for exercise, for example: ‘Have you done your six doses a day of 20 repetitions of resistance exercise or 10,000 steps each day?’
  • Consider prescribing drugs such as metformin, liraglutide and the combination of bupropion and naltrexone in patients whose waist circumference measurement is plateauing despite an appropriate lifestyle intervention.
  • Recalibrate the dietary and exercise prescription and motivation levels at each patient visit.

A growing majority of people in ­Australia are overweight and face a future of chronic disease and ­crippled healthcare budgets.1 The Australian health culture is mirroring that in the US, and the level of medical urgency to address metabolic syndrome may be ­inadequate to fight instinctive human sedentarism. Dietary advice pales next to sophisticated marketing of processed food that capitalises on hard-wired urges for carbohydrate, fat and salt. Thus, we might rethink our approach and learn from the same marketing industry to ‘nudge’ (manipulate choice and create a new-normal expectation) and incentivise patients in a leaner, less inflammatory direction.2