Jessica Andrews, 40, has been overweight since puberty, but she says that for years doctors didn’t take much notice of her. There was some advice about maintaining a healthy weight but otherwise she felt that they left her alone. Then, two new diagnoses in the last few years suddenly made her the focus of medical attention.
During the pandemic, Andrews, who lives in Surrey, discovered she had developed type 2 diabetes. And in May this year, she was found to also need treatment for high blood pressure. Suddenly Andrews was prescribed a range of medications to keep her blood sugars and blood pressure under control. She had come under the umbrella of ‘metabolic syndrome’.
Metabolic syndrome is the medical term for when diabetes, hypertension (high blood pressure) and obesity occur together in a patient. The NHS says it “puts you at greater risk of getting coronary heart disease, stroke and other conditions that affect the blood vessels. On their own, diabetes, high blood pressure, and obesity can damage your vessels, but having all three together is particularly dangerous”.
But metabolic syndrome isn’t uncommon. The NHS says it affects one in three adults aged 50 or over in the UK. For the rest of the population, it is one in four.
Although Andrews had an increase in thirst related to her high blood sugar, she hadn’t otherwise noticed a change in her health. This made stark warnings from doctors harder to digest. “They kind of picked up the badgering,” she says. “There is a general assumption because of my weight that I don’t do exercise and that I have a really crap diet, neither of which is the case. I took myself up Mount Kilimanjaro 10 years ago.”
But doctors are insistent because metabolic syndrome is a particularly risky combination of diagnoses. It can be reversed, but the combination of factors involved makes this very tricky – especially for people who have a genetic disposition for insulin resistance or blood pressure that is hard to control.
Since her diagnosis, Andrews has been trying a combination of medications to reduce the risk of heart disease. She also works from home – as a brand consultant for her agency, Rabbit and Other Stories – and is managing her diet. “My health seems to improve when I have something of an Oriental diet – Japanese and Thai. I also have ulcerative colitis and the diet I require to control that is the polar opposite of navigating diabetes,” she explains. “But I have a really good relationship with my nurse and she’s open to the idea that I exercise and I care about my size.”
For Andrews, managing the condition will now involve a lifelong balancing of risks. Medics are doing the same for their wider patient population. One in six people admitted to hospital now has diabetes, even if that’s not the reason they presented to clinicians for care, and there were 128,000 stroke admissions to NHS wards last year. About 10 per cent of all deaths are related to heart disease. Metabolic syndrome plays a significant role in these statistics.
Dr David Oliver, a consultant in emergency medicine sees the effects of metabolic syndrome inside the A&E department every day. “In terms of the pressure on acute care, large and increasing numbers of people with diabetes, with ischaemic heart disease, with stroke or peripheral vascular disease and in turn heart failure resulting from this syndrome, present to acute hospitals and are admitted to wards,” he says. “Underlying obesity, diabetes, hypertension and cardiovascular complications often also complicate other conditions they are being treated for.”
Dr Oliver describes the rise in the number of patients diagnosed with metabolic syndrome as gradual, rather than a seismic shift. “As population prevalence of obesity has gone up then we see more problems related to the syndrome and not helped by the rise in ultra-processed food (UPFs), more sedentary lifestyles and the growing health inequalities.”
For doctors, managing issues related to metabolic syndrome can be a long-term process. Patients can live for decades with complications related to heart disease, stroke and type 1 or 2 diabetes, but often become more frail earlier in life meaning they need lifelong care and support.
In north-west London, Christine*, a 48-year-old school secretary, has been categorised as having metabolic syndrome for the last two years, after a diagnosis of diabetes and high blood pressure. Doctors were quick to prescribe medication to bring her blood sugar and blood pressure readings under control.
Although her medics did not use the term “metabolic syndrome” when discussing her treatment, Christine says they were clear to outline the risks of tackling these three issues together. “One GP said there was a higher risk of heart disease due to the diabetes. I try not to eat as much sugar or carbs, or “bad” fats and I’m trying to incorporate exercise more. It hasn’t affected my life much apart from a few side effects from the meds that have now gone. I feel ok. I do get quite tired. Mentally can get a bit down but I’m not really that way inclined so try to keep upbeat.”
Christine, who also has multiple sclerosis, has been advised to lose weight and was offered a free admission to Slimmer’s World classes. But some doctors worry that there is too much of an emphasis on “lifestyle” rather than population trends.
GP Stephanie deGiorgio says that the term “metabolic syndrome” was created for the effects of visceral obesity – where excess weight is held around to describe middle of the body – on the body before clinicians really understood the way fat storage can affect the functioning of organs. Now it has become a major feature of NHS work.
“Obesity is here and isn’t going to go down anytime soon, so the health service needs to adapt,” she says. “It needs to fund treatments long term, for what is a long term problem, not continue to pretend that you can cure obesity.”
DeGiorgio is particularly critical of those who attempt to offer “lifestyle” changes to patients developing metabolic syndrome instead of immediate medical intervention. “Lifestyle is a lazy term that medics and others use and it implies choice that many people don’t have. Lifestyle is your ability to go on a skiing holiday and shop in Waitrose, not what food you can afford and how many jobs you have to do to feed your family,” deGiorgio says.
For any patient with a BMI of over 35, losing over 15 per cent of their body weight and keeping it off long term will need assistance through surgery or pharmaceuticals, Dr deGiorgio adds.
But there is one change of habit that deGiorgio does recommend to help treat or avoid developing metabolic syndrome in the first place – “the baseline for everyone is: give up smoking”.
*Name has been changed
