Diabetologists in Chikkajala, Bangalore • Obesity and the metabolic syndrome Obesity (body mass index, or BMI, > 30) is associated with an increased risk of all-cause mortality, largely due to an increase in cardiovascular mortality. Central obesity (waist/hip ratio > 0.9 in men and 0.8 in women) confers most risk, probably because of its association with important risk factors. Risk factors associated with obesity include: 1 increased LDL cholesterol and triglycerides 2 reduced HDL cholesterol 3 hypertension 4 glucose intolerance/insulin resistance. Treatment of obesity The benefits of weight loss should be explained to patients. It is suggested that patients keep a food diary, as this makes them more aware of their food intake, which is always underreported, even by people who are not overweight. Appetite suppressants such as sibutramine, a serotonin and noradrenaline uptake inhibitor, can be useful in selected patients. It is contraindicated for patients with a history of stroke or with uncontrolled hypertension. Patients must have a BMI > 30, or other risk factors and a BMI between 25 and 30. Orlistat, a gastrointestinal lipase inhibitor, causes fat malabsorption and diarrhoea when fat intake exceeds 30% of total dietary intake. There are similar guidelines for its use. Target heart rates Age Target heart rate (based on 60–70% maximal) 30 110–140 40 105–130 50 100–125 60 95–115 1• CORONARY RISK FACTORS 19 There is evidence that gastric banding or bypass can lead to sustained weight loss in very obese patients. The operation can be performed laparoscopically and at much lower risk than for previous open operations. Successful surgery appears to be associated with a reduction in blood pressure, lipid levels and cardiovascular events. The metabolic syndrome Obesity represents part of the definition of this syndrome. It has recently been redefined by the World Health Organisation (WHO) and the US National Cholesterol Education Program (NCEP) Expert Panel.