Insulin Resistance Syndrome

Most people with obesity have or will develop metabolic syndrome.¹¹⁷ Excess fat tissue, especially when it accumulates in the abdominal region, increases the likelihood and severity of insulin resistance and is an independent risk factor for cardiovascular disease and diabetes.^118,119 Abdominal obesity is the most common component of metabolic syndrome.¹²⁰ Weight loss, even when modest, has been shown to improve all components of metabolic syndrome, as well as other aspects of health.¹²¹ Therefore, an achievable weight loss goal, such as 5%–10% of body weight, is an important part of metabolic syndrome treatment.

Physical activity is associated with decreased risks of metabolic syndrome, type 2 diabetes, cardiovascular disease, and most other chronic diseases.^122,123 Exercise interventions have been shown to improve metabolic signs such as waist circumference, blood pressure, and HDL-cholesterol levels in people with metabolic syndrome, and physical activity in general improves fitness and positively impacts health outcomes associated with metabolic syndrome.^124,125 Although more research is needed to identify the optimal type, intensity, and duration of exercise necessary for metabolic benefits, an exercise program that includes both aerobic exercise and strength training may have some advantages over aerobic exercise alone.^126,127

Chronic psychological stress has been linked to the development and progression of metabolic syndrome in multiple observational studies.^128,129 Stress-related changes in immune function, insulin sensitivity, glucose metabolism, and eating patterns may all play a role, and may also underlie the observed relationship between metabolic syndrome and major depression.^130,131,132 Mindfulness training interventions have been found to moderate the stress response and improve eating patterns and some metabolic signs in people with metabolic syndrome.^133,134

Although the mechanism is not completely understood, a growing body of research suggests tobacco smoking is independently associated with insulin resistance and abdominal obesity, and may compound the negative impact of metabolic syndrome on vascular health.^135,136 Smoking has also been linked to high blood pressure and high glucose levels.¹³⁷ Smoking cessation has been found to improve blood pressure and levels of triglycerides, glucose, and HDL-cholesterol in the short term in individuals with metabolic syndrome, despite modest weight gain.¹³⁸ The possibility that nicotine replacement therapy, such as using nicotine gums or patches, may contribute to metabolic disturbance needs further exploration.^139,140

Alcohol consumption increases the risk and severity of fatty liver disease in people with obesity and metabolic syndrome.^141,142 Even a low level of alcohol use increases progression of liver fibrosis and risk of liver cancer and other severe liver disease in those with fatty liver.¹⁴³ Although light to moderate drinking, particularly of wine, has been correlated with reduced risks of metabolic syndrome, type 2 diabetes, and some cardiovascular outcomes, abstinence may nonetheless be more beneficial for those with obesity and metabolic syndrome.^{144,145,146,147}