Metabolic Syndrome: A Public Health Concern Among US Population

Introduction

Metabolic Syndrome was first introduced during a conference by physician, Gerald M. Reaven at the American Diabetes Association in the year 1980 (Jimenez & Vidal, 2016, pg. 3), and defined the condition as having three or more of the five risk factors, a “cluster” that could potentially increase the risk of a person developing cardiovascular disease or diabetes. This condition classified as a cluster of risk factors consists of: fasting glucose higher than 100 mg/dL, elevated blood pressure 130/85 (mmHg), Triglycerides 150 and greater (mg/dL), HDL Women less than 50 Men less than 40 mg/dL, and waist circumference being greater than 40 inches for Men and 35 inches or greater for Women (American Heart Association, 2016). As Reaven stated, having a higher fasting number indicates the person is experiencing insulin resistance and for this reason is why other comorbidities come into place, such as increased waist circumference and elevated blood pressure. Briefly introducing the concept of how social determinants of health influences one’s life, it will be emphasized on occupational exposures (such as solvents, metals, pesticides, etc) and analyze the effect they have on cellular respiration and how that contributes to the increased rate of blood pressure and heart disease.

The interruption to the cells activity can affect the pancreas (islets), endocrine system, “mitochondrial defects, endothelial dysfunction, and oxidative stress”, which can be translated to the functioning of the body. It could also be focused on why the heart is working twice as hard to deliver appropriate oxygenated blood to all the other organs, and is becoming impaired by the chemical and cellular changes in the body. Inflammation also takes place in the cellular level, due to the pressure and high triglycerides in the blood stream that are not filtered (digested by HDL) (Bulka et al. , 2017)This is currently a Public Health issue and struggle because now we are hearing more about children being overweight, mothers developing gestational diabetes (2%-10% cases per year in the US) (CDC, 2017), and others having high blood pressure, or high triglycerides. Since the 1980’s almost 40 years ago obese rates have increased from 15% to 23. 2% to 30. 9% in age group 20-74, which automatically classified the United Sates of one - third of its population being obese (Lewis & Basu 2016, pp. 16) (Heiss, 2014). Indicating that 1 in 20 Americans in the U. S are classified as extreme obese. Obesity is well known to be the most common yet preventable risk factor for many chronic diseases.

Obesity is seen and interpreted differently among socioeconomic status and among demographic groups. The increase rates of obesity that has taken place since 1980’s has been recorded to have an impact on children and adults, and a difference in incidence rates among Men and Women. From the 1970’s body mass index in Men was 25. 3% compared to 27. 6% from 1990’s-2000’s, for Women 24. 4% compared to 28. 2% in the 2000’s. Having highlighted the importance and understanding of the increase of body mass index which is correlated to waist circumference, it helps to understand why having greater than 40 inches for Men and 35 inches or greater for Women, ultimately increases the risk of developing MetS. Even before and after the years 2011-2012 obesity rates has increased dramatically among African Americans and Mexican – Americans (Lewis & Basu 2016, pp. 16-19)

Now that we have examined the foundation and history of MetS, we will shift the focus to the current data released by the CDC on MetS. Current obesity prevalence in the US is about 39. 8% (affecting about 93. 3 million people) within the years 2015-2016, which of as presented increases the risk of many preventable chronic diseases. 47% of Hispanics are currently living with obesity and 46. 8% of African Americans are affected (CDC, 2018). There are differences of incidence rates among diverse Hispanics. The diversity of Latino background such as, “Cuban, Dominican, Mexican, Puerto Rican, Central and South America”, all demonstrated a difference of prevalence of risk factors which put each of them at different levels of risk (Heiss et al, 2014). This is important to be able to identify who is more at risk, and considering that everyone is different and cannot generalize all Hispanics/Latinos under one category. It does make a difference in numbers among each other, considering culture. 33. 9% of US individuals are currently living with prediabetes, this consists of 84. 1 million adults (18 years of age and older) that are diagnosed with prediabetes (CDC, 2018). This means that individuals with obesity and prediabetes are at higher risk of developing metabolic syndrome.

Since MetS is underlined by someone being obese or being insulin resistant, these numbers support the evidence that MetS is still relevant, and could indicated that doctors should be assessing patients as whole, and addressing all the risk factors as whole, not individually (CDC, 2018). Social determinants of health (SDH) are also contributed to the increase of MetS, for instance where one lives and works (environmental) (occupational), socioeconomic, education levels, demographic groups, and access to health care. These factors all intertwine with the ability to carry on and maintain a healthy lifestyle, yet also prevent disease and reduce health disparities. (classroom textbook). In “Metabolic Syndrome: A Comprehensive Textbook”, has highlighted the interconnection of SDH, and how it influences one to be more at risk on developing MetS, explained as follows: “manifestation of the interaction between poverty and place” (Lewis & Basu, 2016, pp. 13-14). About 47. 9 million of the US citizen population are classified as uninsured (without health insurance), about 90% of that number is estimated to live at 38% below the poverty line or 400%, below the poverty line which makes one eligible for Medicaid. This means those that are not covered by health insurance are placed in situations where they are at higher risk of not receiving preventive care and additional focus in chronic disease care. So, imagine a domino effect, if the person is covered by Medicaid, which is eligible because the of their low income, live in an area where poverty exists, and maybe even violence, it could potentially lead to the decrease of physical activity, because of safety and access to resources, which can later be justified as to why blood pressure and obesity are still prevalent in communities or in populations that are covered by Medicaid or are underserved (Staiano et al, 2016).

Consequently, it can be translated to the importance of understanding this current trend, and the providing supporting evidence of the continuous decrease of physical activity and increase intake of calories and portions. Food portions in the U. S has increased almost to its max, which promotes bigger meals for your “buck”, a cheap short term deal, that many do not for see the future effects on their health. The importance of interpretation of this data is to identify the increasing rate of obesity and the increase of MetS, also to understand who is being affected, to be able to determine how to prevent it and/or delay the onset of many preventable diseases. Keeping in mind that all these risk factors are preventable, what has the US delivered in attention of MetS? (Unnatural Causes, 2008).

Current Public Health Approaches and Interventions

Now, we will be evaluating the past and present successful interventions and treatment for prevention of Metabolic Syndrome. Diabetes Prevention Program (DPP), as called by the CDC, is a prevention program for individual currently diagnosed, or is currently living with pre-diabetes, that of course are at risk, and that many have many of the risk factors stated (in other words, MetS). The purpose of this program is to deliver an evidence based program to communities where individuals are provided with essential skills and tools to adapt a new lifestyle, with significant changes and improvement in their health. Many of which addresses and tackles MetS, the “clusters”, and helps individuals maintain consistency in their care for health. The biggest focus is on losing weight and keeping those pounds off (to lower waist circumference), to be able to lower triglycerides, improve their HDL, reverse the insulin resistance, improve their blood pressure, all of which were talked about that basically are describing MetS. By the prevention of diabetes, MetS is being challenged, to the point of that other risk factors will not be present. The DPP program emphasizes on the importance of (diet), what we eat and how to selectively decide what types of food choices will help one reverse pre-diabetes and of course prevent diabetes. To reduce carbohydrate consumption, monitor fat intake, incorporating more protein and fiber to reduce the amount of blood sugar. Secondly, it focuses and targets weight loss (losing about 7% of current weight), how to engage family support, also to focus on mental health symptoms (stress/anxiety/depression), basically all essential tools to adapt new lifestyle and being consistent with changes. This program supported to have 58% success reduced risk for diabetes after three years, among the 3,234 participants, regardless of sex, race, age, and socioeconomic differences.

This program clearly identifies on strengthening behavioral strategies by delivering skills to adapt in one’s life and make modifications that can be tailored to one’s health condition (Burns & Sirisena, 2016, pp. 603). Switching focus to a successful treatment for severe obesity or “obesity-related comorbidity and mortality”, Bariatric surgery is supported to be effective and “durable’, this could be supported by clinical trials showing evidence of “induce sustained weight loss, and/or improve/ normalize obesity related comorbidities, of which highlights one of MetS’s important preventive condition, diabetes (type two) (Ahima & Park, 2016, pp. 814). Comparing to DPP, Bariatric Surgery is recommended for the patient to at least meet a minimum BMI of “40 kg/m2 or at least 35 kg/m2 and obesity-associated comorbidity” (Ahima & Park, 2016, pp. 814) to serve as a baseline to identify if surgery is effective or not. After the surgery has been performed, maintenance is the key to keeping the weight off. The cohort study of participants that have undergone the surgery, and the result are impressive, yet still delivers a few challenges. Simply, due to the size of the cohort “relatively small”, the outcome resulted that after two years of Bariatric surgery, control/management of blood sugars did not improve or kept the same (Ahima & Park, 2016, pp. 815). Many factors could contribute to the data sample, for example requirement for selection of surgery, age, health conditions (other complications of disease), etc.

The purpose of this surgery is to follow and analyze change and improvement throughout years, exclusively within 10 years of surgery. Bariatric surgery had a significant effect in Metabolic syndrome (on the risk factors), as concluded, Bariatric surgery decreased rates of elevated high blood pressure, high triglycerides, HDL ranges improved, waist circumference, and of course elevated sugar levels (Ahima & Park, 2016, pp. 815). Within the data, losing weight is closely evaluated, where about 5% of weight was lost for patients at baseline, compared to 30% of patients having had the Bariatric surgery. It was also stated that hospitalizations were also common, reasons could be due to complications of surgery or how the body adjusts to the change of stomach and other organs involved in the surgery. A potential opportunity for improvement would be to continue delivering non-invasive interventions. Of course it cannot be generalized to all potential candidates, because they all have underlining conditions that would make one more eligible than the other (Ahima & Park, 2016, pp. 815).

Future Directions

A proposed intervention would be a, “Family Based Intervention”, defining the intervention as being delivered by parents, to target their child’s health and the prevention of obesity and chronic diseases. This opportunity could be funded by programs like Supplemental Nutrition Assistance Program (SNAP) or Women, Infant, and Children (WIC). This type of certification could be used as a tool to collect data, or interpret data and analyze if the assistance is being used as a preventive method that reduces the inability to afford food. It could be considered as an eligibility requirement for parents to be able to receive governmental assistance. So, once parents apply for food assistance they must first complete the training, to be certified to deliver family based interventions. This way it will also be eliminating barriers, the intervention will deliver by parent to the child (i. e younger than 12 years of age) at home, there will be no need to pay or invest in a third party, or even having to commute. So not only will this opportunity provide a safe environment for children, but also to be able to expand the opportunity for parents to build autonomy and a stronger relationship with their child. If parents do not need monetary assistance, it could even be considered a hospital discharge procedure, just like having a car seat already installed upon discharge of mother after delivery, becoming certified to deliver an intervention that could potentially improve the quality of life of a child and reduce the risk of developing chronic diseases.

As stated, American Diabetes Association and the CDC had already encouraged implementation of family based interventions (Roy, Rustico & Kublaoui, 2016, pp. 829-834). If lifestyle interventions can delay the onset of many preventable diseases, why not continue delivering these programs to additionally share the focus on earlier interventions, to be able target pregnant women and children. Perinatal care and education, is a building block for the foundation of prevention of chronic diseases in children and women. This is the stage in life where prevention can build its roots, and increase awareness of breastfeeding. Breastfeeding not only strengthens a baby’s immune system, but also provides all the necessary nutrients for the baby to grow and maintain a healthy weight (Roy, Rustico & Kublaoui, 2016, pp. 829). This is the beginning of obesity prevention. Data are as follows, preconception evaluation of women being obese showed there was an effect in childhood obesity by 6. 5 more times (if mother and father are obese), compared to those women of whom were not obese. It is also included that the type of mode of delivery also affects the chances/risk of the baby being obese or having a higher BMI in childhood.

There is a higher risk of the child to become obese in their childhood if delivered by cesarean section, when compared to vaginal delivery (Roy, Rustico & Kublaoui 2016, pp. 829-830). In addition to understanding data on children and obesity, it is also important to know that women that are pregnant and are diagnosed with gestational diabetes, 50% of those cases will eventually develop to type 2 diabetes in the future if left unintended (CDC, 2017). In addition to the proposed intervention, education on Metabolic syndrome could be incorporated in perinatal classes, or even in wellness classes in general. The reason would be to increase awareness of what Metabolic syndrome is, to learn to interpret indicating risk factors, and most importantly to learn on how could it be prevented. This approach will allow mothers to become more knowledgeable and be able to identify the signs and symptoms of metabolic syndrome. Now, if we begin incorporating the education portion with intervention, we could reduce the prevalence of obesity (CDC, 2017).

Conclusion

Public health is continuing to become more well known, and popular among healthcare. To address social determinants of health, healthcare and Public Health must continue to work together to be able to address and care for the whole person. Meaning, treating the persons’ condition, delivering health education classes, increasing awareness, reaching out to the community, linking them to housing services, assessing their access to food, a safe home, transportation, and being able to follow up on their overall health. If the person is only taken care partially, there will be reoccurring events that will impact the quality of care.

For example, reoccurring emergency visits, reoccurring symptoms of any chronic condition, this will affect the recuperation of the person and the quality of life. As included in the videos we were assigned during class, healthcare without public health emphasis, is like placing a “band-aid” on people and are send back to the community, the environment where they live, that is the reason why it matters where you live and grow (Unnatural Causes, 2008).