The prevention and treatment of metabolic syndrome and high-risk obesity

Purpose of review The prevalence of obesity is increasing at an alarming rate, and the obesity epidemic is driving the epidemic in type 2 diabetes. High-risk obesity is characterized by abdominal obesity with evidence of abnormal glucose and lipid metabolism, and a state of heightened inflammation. Recent findings With increasing body weight, lipid accumulation occcurs not only in adipose tissue, but in other organs as well. This 'lipotoxity' in liver, muscle, islets, and elsewhere may account for many of the features of the metabolic syndrome. Adipose tissue produces many proteins, some of which are inflammatory cytokines, and others of which are antiinflammatory or which improve insulin sensitivity. Summary The treatment of obesity requires the identification of the high-risk patient, and the institution of lifestyle measures with a long term outlook, and an avoidance of heavily marketed fads. Current research will likely lead to improved medications in the future.