Metabolic syndrome and obesity

Below is an excerpt from "Products, Technologies and Markets Worldwide for the Clinical Management of Obesity, 2011-2019" (Report #S835, MedMarket Diligence, LLC).

Metabolic syndrome (MetS) is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes. It affects one in five people, and prevalence increases with age. Some studies estimate the prevalence in the USA to be up to 25% of the population. MetS is composed of an array of factors including insulin resistance, obesity, dyslipidemia, hypertension, and greater risk for diabetes, heart disease and stroke. These are all related to obesity, although recent research indicates that these may be related to the body’s attempts to protect organs from excess fat.

In a review in the March 9th, 2010 issue of Trends in Endocrinology and Metabolism, Roger Unger, MD, University of Texas Southwestern at Dallas, suggested that obesity may not be all bad: it may be the body’s way of storing lipids in a less harmful manner, i.e. in fat tissue, in order to protect the body’s organs from the toxic effects of excess lipids. When the lipids become too numerous for the fat tissue to handle, then those fats spill over into places where they can produce toxic effects. These effects trigger the cascade of symptoms known as metabolic syndrome.

The body’s resistance to leptin, known for its appetite-suppressing abilities, is at the center of the shift from protective obesity to metabolic syndrome. Leptin is also responsible for partitioning fat in the body; but as fat stores grow, this partitioning can only go so far before resistance sets in, and the fat starts being stored in and harming other organs. The researchers found that most humans develop leptin resistance as they pass their reproductive years, meaning that everyone needs to watch their diet and exercise, or start on the path to MetS.

Definitions of MetS differ. There are no well-accepted criteria for diagnosing the metabolic syndrome. The WHO criteria (1999) require the presence of diabetes mellitus, impaired glucose tolerance, and impaired fasting glucose or insulin resistance, in addition to at least two of the following:

  • Blood pressure: ≥ 140/90 mmHg
  • Dyslipidemia: triglycerides (TG): ≥ 1.695 mmol/L and high-density lipoprotein cholesterol (HDL-C) ≤ 0.9 mmol/L (male), ≤ 1.0 mmol/L (female)
  • Central obesity: waist:hip ratio > 0.90 (male); > 0.85 (female), or body mass index > 30 kg/m2
  • Microalbuminuria: urinary albumin excretion ratio ≥ 20 µg/min or an albumin:creatinine ratio ≥ 30 mg/g

The criteria proposed by the American Heart Association’s National Cholesterol Education Program (NCEP) are widely used. The American Heart Association and the National Heart, Lung, and Blood Institute recommend that the metabolic syndrome be identified as the presence of three or more of these components:

  • Elevated waist circumference:
    • Men — Equal to or greater than 40 inches (102 cm)
    • Women — Equal to or greater than 35 inches (88 cm)
  • Elevated triglycerides: Equal to or greater than 150 mg/dL (1.7 mmol/L)
  • Reduced HDL (“good”) cholesterol:
    • Men — Less than 40 mg/dL (1.03 mmol/L)
    • Women — Less than 50 mg/dL (1.29 mmol/L)
  • Elevated blood pressure: Equal to or greater than 130/85 mm Hg or use of medication for hypertension
  • Elevated fasting glucose: Equal to or greater than 100 mg/dL (5.6 mmol/L) or use of medication for hyperglycemia

Report #S835 on the worldwide market for obesity drugs and devices is described below and a link:

This report is a detailed market and technology assessment and forecast of the products and technologies in the clinical management of obesity (bariatrics). The report describes the current and projected patient population in obesity, detailing their incidence worldwide, with available incidence by country for the U.S., major European countries, major countries in Asia/Pacific (including Japan, China, India and Australia), the clinical practices in their management to encompass surgical approaches, medical supervised severely restricted diets, drug therapies, OTC treatments, biopharmaceuticals, non-pharmacologic approaches and weight maintenance approaches. The report describes clinical trends in the management of the obese. The report details the products on the market and the status of those in development for bariatric surgery, drug therapy, gastric stimulation devices, brain stimulation devices, combination therapies and genetic therapy and other therapies under development, and will provide current and worldwide market forecasts (2009-2019) separately for pharmaceuticals (with separate segment forecast data for satiety, malabsorption, appetite suppression and combination drugs) and devices (with separate segment forecast data for stomach restriction artificial fullness, malabsorption, gastric emptying and appetite suppression), with current (2009) market shares of the leading competitors in each segment. (The report addresses the challenges to obesity drug approval, such as the FDA's February 2011 rejection of Orexigen's Contrave, and considers the realistic prospects for obesity drugs and their changing opportunities to succeed in the U.S. and international markets.) The report profiles the 45 leading competitors, detailing current and potential position in the market, their products and their market strengths and likelihood of future success.

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