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The Obesity Epidemic: Prevention and Treatment of the Metabolic Syndrome

  • Authors: Authors: George L. Blackburn, MD, PhD; Laura C. Bevis, MSN, ARNP, FNP-C, ACNP-C
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Target Audience and Goal Statement

This activity is intended for physicians, nurse practitioners, pharmacists, and nurses.

The goal of this activity is to define "state-of-the-art" treatment protocols and clinical strategies for the prevention, diagnosis, and management of the metabolic syndrome.

Upon completion of this activity, participants will be able to:

  1. Define the metabolic syndrome and become familiar with its diagnostic criteria as defined by the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Cholesterol in Adults (ATP III).
  2. Describe the prevalence of weight gain leading to the metabolic syndrome and its impact on type 2 diabetes mellitus and coronary vascular disease (CVD).
  3. Describe the benefits of weight loss and physical activity therapeutic interventions used in the prevention and treatment of metabolic syndrome.
  4. Discuss new interpretations of the lipid profile, impaired glucose tolerance (IGT), inflammation, and vascular coagulopathy in relation to the metabolic syndrome
  5. Use novel patient support tools for the primary care provider in the treatment of metabolic syndrome.


  • Laura C. Bevis, MSN, ARNP, FNP-C, ACNP-C

    Assistant Professor, Department of Nursing; Acute Care and Family Practice Nurse Practitioner, Wichita State University, Wichita, Kansas


     Laura C. Bevis, MSN, ARNP, FNP-C, ACNP-C, has no significant financial interests to disclose.

  • George L. Blackburn, MD, PhD

    S. Daniel Abraham Chair of Nutrition Medicine, Associate Director of Nutrition, Division of Nutrition, Harvard Medical School, Boston, Massachusetts; Director, Center for the Study of Nutrition and Medicine; Chief, Nutritional/Metabolism Laboratory, Beth Israel Deaconess Medical Center, Boston, Massachusetts


    Disclosure:George L. Blackburn, MD, PhD, has disclosed that he has received grants for clinical research from Atkins Foundations, Aventis Pharma, Glaxo-Smith-Kline Inc., Nichimo, Protein Technology International, and R.W. Johnson Pharmaceutical. He has served as an advisor or consultant to Ross, Amgen, Bristol-Myers Squibb Company, Functional Foods LCC, Healthetech, Glaxo-Smith-Kline, Inc., Roche Laboratories, Sanofi-Synthelabo, and Slim-Fast Foods. Dr. Blackburn has served as an ad hoc consultant for education for Ross, Healthetech, Roche Laboratories, and Slim-Fast Foods. He has also disclosed that he is a member of the Speakers Bureau for Ross, Monsanto, and Roche Laboratories and has also received royalties from Abbott (Ross) and Novartis Nutrition, Inc.

Accreditation Statements

    For Physicians

  • Medical Education Collaborative, a nonprofit education organization, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medical Education Collaborative designates this educational activity for a maximum of 1.5 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.
    This CME activity is cosponsored by Medical Education Collaborative and Medscape, also an ACCME-accredited provider.

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    For Nurses

  • 1.8 contact hours of continuing education for RNs, LPNs, LVNs, and NPs. This activity is cosponsored with Medical Education Collaborative, Inc. (MEC) and Medscape. MEC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
    Board of Nursing, Provider Number FBN 2773.
    California Board of Registered Nursing, Provider Number CEP 12990, for 1.8 contact hours.

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    For Pharmacists

  • Medical Education Collaborative, Inc. has assigned 1.5 contact hours (0.15 CEUs) of continuing pharmaceutical education credit. ACPE provider number: 815-999-03-557-H04. Certificate is defined as a record of participation.

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

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There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

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  1. Read the target audience, learning objectives, and author disclosures.
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The Obesity Epidemic: Prevention and Treatment of the Metabolic Syndrome

Authors: Authors: George L. Blackburn, MD, PhD; Laura C. Bevis, MSN, ARNP, FNP-C, ACNP-CFaculty and Disclosures



Obesity is an urgent and growing health problem in the United States. To address it, Health and Human Services (HHS) Secretary Tommy G. Thompson is leading Department initiatives to encourage Americans to make healthy dietary choices and increase exercise. He continues to challenge HHS agencies and the leadership of the public health community to intensify efforts toward those ends. Evidence indicates that metabolic syndrome is a major risk factor that precedes cardiovascular disease (CVD) and diabetes. Changes in diet and exercise that restore or maintain healthy body weight can help patients delay or prevent the onset of disease.

The Office of the US Surgeon General reports that the risks of overweight or obesity may soon cause as much disease and death as cigarette smoking. Current data indicate that 1 in 4 adults in the United States is obese. These conditions, which cost the nation $117 billion in 2000 alone, are responsible for as many as 300,000 premature deaths each year.[1]

An overweight or obese adult is determined by body mass index (BMI), defined as weight in kilograms divided by the square of height in meters or as weight in pounds multiplied by 705 and then divided twice by height in inches. A BMI of between 25 and 29.9 indicates that an individual is overweight, whereas an obese adult has a BMI of 30 or higher. In children and adolescents, overweight is defined as a sex- and age-specific BMI at or above the 95th percentile, based on revised growth charts by the Centers for Disease Control and Prevention (CDC). There is no generally accepted definition of obesity for children and adolescents.

The risk of death, although modest until a BMI of 30 is reached, increases with an increasing BMI. Obese adults have a 50% to 100% increased risk of premature death compared with adults with a BMI of 20-25. However, even moderate weight excess (10-20 lb for a person of average height) increases the risk of death, particularly among adults aged 30-64 years.

In the Western world, growing numbers of people recognize that being overweight and obese is associated with health problems such as heart disease and stroke. People are also becoming increasingly aware that nutrition plays a critical role in maintaining good health. At the same time, most overweight or obese people don't know which foods best meet their nutrition and weight loss needs. All too often, they also underestimate their energy intake and show poor judgment on portion sizes.

Many people have a constellation of major risk factors, life-habit risk factors, and emerging risk factors that constitute a condition called the metabolic syndrome. Factors characteristic of the metabolic syndrome (also known as dysmetabolic syndrome X) are abdominal obesity, atherogenic dyslipidemia (elevated triglyceride [TG] levels, small low-density lipoprotein [LDL] particles, and low high-density lipoprotein cholesterol [HDL-C] levels), raised blood pressure, insulin resistance (with or without glucose intolerance), and prothrombic and proinflammatory states.[2] This clinical update will address the key roles played by weight loss and physical activity in reversing the pathophysiology of the metabolic syndrome (Figure 1).

Figure 1. Metabolic syndrome -- the role of obesity.

Treating metabolic syndrome can prevent or ameliorate cardiovascular disease (CVD) and type 2 diabetes. Figure 1 demonstrates that reductions in glucose tolerance and elevations in lipid constituents and blood pressure, mediated through an increase in free fatty acids (FFAs), culminate in diabetes and CVD.

In the past decade or so, research on and insights into the metabolic syndrome have flourished in the medical literature.[3,4] While much attention has been focused on associated complications,[5,6] new developments for prevention of these disorders, and control and prevention of complications from the manifestations of the syndrome, have also grown binomially.[7,8]