Larissa was 25 years old, and was seeing a new doctor because she'd recently moved to a different city, and needed to refill her birth control prescription. A nurse weighed her, measured her blood pressure, and sent her into an exam room to wait for the doctor.
Dr. Zamora introduced herself, asked a few personal questions about Larissa, and then raised a concern. "Did you know that your BMI is in the obese range? And your blood pressure is 130/85 mm Hg; that's in the pre-hypertensive range."
Larissa felt blood rush to her face. She'd always been overweight, and she knew with the recent stress of her move and new job that her diet and exercise habits hadn't been the best lately. "Um, no, but I can't say I'm surprised."
"You should join a gym...maybe do Weight Watchers. My sister in law did Weight Watchers after she had her baby and she lost 50 pounds."
Larissa just nodded, but she felt embarrassed and angry. Dr. Zamora was probably one of those naturally skinny people. "Yeah, I've done all that stuff before," said Larissa, "but even when I'm doing everything I'm supposed to, I've never been skinny. Everyone in my family is big-boned."
Dr. Zamora looked annoyed. "If you eat less and move more, you will lose the weight. You're so young. I'm worried that you might have something called metabolic syndrome. Obesity can lead to serious health problems. I'm going to have you go for some bloodwork. You'll have to fast for at least 12 hours before coming in to have it done."
Although Larissa was upset about the way Dr. Zamora had handled the issue, she was also concerned about her health, so she went and had the bloodwork Dr. Zamora had requested. Her results are in the table below.
See attached file for data.
1. How is metabolic syndrome defined? Does Larissa have metabolic syndrome?
2. Dr. Zamora feels that Larissa can achieve a BMI in the normal range if she changes her habits; Larissa feels that changing her behavior can only get her so far. Who is right?
3. If Larissa's leptin levels were checked, would you expect her to have high, normal, or low leptin?
4. What would you tell Larissa if she were your patient? Is there anything you would do differently from Dr. Zamora?
1. Metabolic syndrome is defined by several criteria, but according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) to be officially diagnosed as having the syndrome you have to have at least 3 out of 5 criteria: fasting blood glucose more than or equal to 100 mg/dL or being treated for hyperglycemia, blood pressure more than or equal to 130/85 mmHg or being treated for hypertension, blood triglyceride of more than or equal to 150 mg/dL or being treated for hypertriglyceridemia, high-density lipoprotein cholesterol (HDL-C, known as the "good" cholesterol) less than 40 mg/dL in men or 50 mg/dL in women or being treated for low HDL-C and finally a waist circumference of more than or equal to 40 inches in men or 35 in women. Waist ...
We discuss a case of metabolic syndrome in a young woman, along with pathogenesis and treatment. We also discuss the importance of communication between doctor and patient.