Central obesity and the metabolic syndrome: implications for primary care providers.

PURPOSE: To describe screening measures that will determine which clients are at risk for the metabolic syndrome, common manifestations of the syndrome, preventive diagnostic considerations, and management and treatment options that primary care providers can implement. DATA SOURCES: Review of the clinical and research literature, supplemented with specific diagnostic criteria.
CONCLUSIONS: Central obesity is the cornerstone of the metabolic syndrome, which may lead to type 2 diabetes and cardiovascular disease. Generalized obesity is defined as body weight that is considerably greater than the ideal weight and that is distributed on all parts of the body. Generalized obesity has long been considered a significant risk factor for developing type 2 diabetes and cardiovascular disease. Those clients of ideal body weight have been considered at less risk for developing these conditions. However, this perception may not always be accurate. Weight distribution plays a major role in acquiring the metabolic syndrome. Because waist circumference is as important as overall body weight, central obesity is key to determining the risk. IMPLICATIONS FOR PRACTICE: The metabolic syndrome has now been given a CPT code (277.7). It is more likely that clients at risk for or with the metabolic syndrome may first be seen by a primary care provider. Primary care providers need to be able to diagnose, treat, and provide preventive interventions for the metabolic syndrome. Clients at risk will likely be identified during routine health screening. Early detection of and interventions focused on the metabolic syndrome may reduce the occurrence of type 2 diabetes and cardiovascular disease. Use of a tape measure to determine waist circumference may help the provider to identify at-risk clients who are of normal weight, and thus not previously believed to be at risk, as well as those more obviously at risk. It is necessary to determine not only patients' overall body weight but also their waist circumference. A measuring tape may be the key tool for establishing a patient's early risk for the metabolic syndrome and, ultimately, for prevention of type 2 diabetes and cardiovascular disease.