Does Metabolic Syndrome hamper weight loss efforts?

BUMP:  This post is over four years old (original publish date:  11/17/10).  It came to mind a day or so ago when someone linked me to Sam Feltham's latest DISinfographic and accompanying video.

If what Feltham is saying (and I can't for the life of me understand how he "borrows" this from Bailor w/o any complaint from Bailor ... even his book title is similar to Bailor's former one!), the results in this study shouldn't have occured.

So the original (short) post, unedited, and some commentary afterwards in how some things have changed in my knowledge, understanding and thinking about all of this.

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ORIGINAL CONTENT

This study would indicate that, if anything, it helps (??Say what!!??)

Does the Presence of Metabolic Syndome Influence Weight Loss in Obese and Overweight Women? (PDF full text free until end of the month)

Background: It is known that weight loss is benefi cial for obese and overweight subjects with metabolic syndrome. Very few data exist, however, about whether the presence of metabolic syndrome and insulin resistance (IR) infl uence the response of these subjects to weight-reducing interventions. The current study intends to examine whether the presence of metabolic syndrome and its components could infl uence weight loss in obese and overweight women during a short-term, dietary-based intervention program.

Methods: A total of 107 women aged 49.1 ± 13.5 years old, with a body mass index (BMI) greater than 25 were studied. The subjects were prescribed a low-fat diet plus weight-reducing drugs when necessary.

Results: After 3 months, the subjects with metabolic syndrome lost more weight than those without (6.62% vs. 4.50%; P < 0.05). There was a positive correlation between the percentage of weight loss and the number of the components of metabolic syndrome present at baseline (Spearman ρ = 0.329; P < 0.01). Furthermore, patients in the quartile with the highest homeostasis model assessment index (HOMA-index) lost more weight than the remaining subjects (8.17% ± 3.34 vs. 5.59% ± 3.87; P < 0.05). These results were signifi cant, even after adjustment for the medical treatment prescribed.

Conclusions: Obese and overweight patients with metabolic syndrome showed a greater reduction of their body weight, compared to the patients without metabolic syndrome. The components of the metabolic syndrome present at baseline correlated positively with the percentage of the weight loss. Finally, the patients with the highest levels of HOMA-index at baseline lost significantly more weight than those with lower levels of this parameter.

I find this somewhat surprising.  It would seemingly go counter to what one expects given the effectiveness of low carb diets and how an even higher fat lower carb/protein version (e.g. fat fast, Silver Cloud Diet) is usually advocated for the more hyperinsulinemic.  This study looked at a low fat diet.  One would also think that if insulin resistance (which is the underlying factor in metabolic syndrome) causes obesity then the obese/overweight with IR should have greater difficulty losing weight.  

Things that make you go hmmmmmm.

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EDIT ADDITIONAL COMMENTARY 3/22/2015:

For those who are newer to the blog, and/or perhaps the low carb community, etc., the atmosphere in 2010 was still dominated by vocal proponents of what I call TWICHOO:  Taubes Wrong Insulin-Carbohydrate Hypothesis Of Obesity.  Ketomania was yet to be launched, but the "up the fat" if you were stalled was common advice, as was the notion that fat couldn't make you fat so long as you didn't eat carbs with it.  People were still convinced that calories didn't count at all (most at least acknowledge that they do, at least when pushed in debate) .

But most importantly, the Taubes part of TWICHOO which was the progression of insulin resistance dominated.   There is overwhelming scientific evidence that peripheral (muscle cells) insulin resistance may not even exist!  Whatever slight impairments in glucose transport are attributable to a reduction in GLUT4 transporters, and glucose clearance is not impaired in type 2 diabetics.  If you haven't already read this blog post, may I suggest it as future reading?   The Cause of Hyperglycemia in Type 2 Diabetes.

Taubes progression:

carb ingestion → insulin secretion ... high carb ingestion → more insulin secretion → chronic hyperinsulinemia → peripheral insulin resistance → fat accumulation → eventual adipose insulin resistance

is not supported by either observation or pretty much any interventional evidence.

Probably for at least the past year, I've used the term insulin resistance much less frequently.  Unfortunately the whole hormonal resistance idea is so ingrained in the lexicon that it cannot be replaced.  If this is so, then it needs to be re-defined to correspond to the scientific evidence.  What is often perceived as IR -- and makes "common sense" = a back-up of glucose into circulation -- is actually due to a loss of initial insulin secretion and glucagon suppression leading to unchecked glucose production in the liver.

Where this ties in with this study, is that low carb proponents still cling to this idea and claim this is why "low fat high carb diets don't work".   This is simply not the case.  When you become obese, your metabolic milieu certainly changes.  Some of this may be irreversible, or at least persist for years following loss of the weight.  But it appears that -- barring an underlying serious endocrine/genetic disorder -- the "damaged metabolism" of this nature does NOT stand in the way of weight loss.  And just to be clear, I don't put a whole lot into any greater weight loss observed in this study in the more metabolically deranged, but it is an outcome that flies in the face of the "alternate hypothesis".