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Easier warning of obesity’s nasty side-effects
If you can’t or won’t get to a diagnosis, now a diagnosis can get to you.
Let’s imagine you’ve seriously piled on excess pounds. Thanks to common sense and perhaps
a nudge from family or friends, you’re aware this is not exactly healthy. Then again, a lot of
large people seem to lead normal lives, and you haven’t noticed any grave consequences. How
bad can it be?
Unfortunately, answering this question can involve a fair amount of time, money, effort and
perhaps embarrassment. You’ll need to go to the trouble and cost of arranging an
appointment and visiting a doctor. There they’ll stick a needle into your arm. The 2 millilitres
of blood they withdraw will be sent out for laboratory testing. To learn the results you’ll have
to come back for another appointment, at earliest a day later. With all of these hurdles, surely
it’s tempting to skip the hassle and go along hoping that what you don’t know won’t hurt you.
On the other hand, maybe it will. Although obesity is not a ‘sure thing’ cause of disease, and it
can go for years before taking its toll, it is definitely linked to heart attacks, strokes and
diabetes as part of a set of symptoms known technically as ‘metabolic syndrome’. Clearly, if
this can be diagnosed more easily, the more likely – through lifestyle changes and medication
– its worst effects can be repelled.
Recently there has been progress on this front, with the introduction of an ‘easier’ testing kit.
Using Roche’s cobas b 101 can be as uncomplicated as walking into a chemist’s shop – no
appointment needed. No needles, only a finger-prick of blood (2 microlitres), is required; in
some cases the process is do-it-yourself, allowing complete anonymity. And the results, a
read-out of your ratings on the key risk factors, are available in about 15 minutes.
How bad can obesity be? Only testing will tell, but one thing is for sure: with easier diagnosis
of metabolic syndrome, there will be far less temptation for people at risk to avoid this
question.
What is metabolic syndrome?
Not that the query itself is easy. Since the concept was introduced generally in the late 1970s,
medical researchers long debated the validity of metabolic syndrome. Of course, massively
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excess body weight cannot be good, but can it really be linked conclusively to specific
diseases?
In recent years, the consensus opinion has moved from ‘maybe’ to a qualified yes. Qualified,
in that the existence of a super-sized waistline (>102 centimeters (40 inches) in men and >88
centimeters (35 inches) in women) is by itself not enough to set off a health alarm. For the
bells to start ringing, there must appear a combination of other symptoms, including: high
blood pressure, abnormally large concentrations of fat and sugar in the bloodstream, and
reduced levels of high-density lipoprotein, the so-called ‘good’ cholesterol.
Metabolic syndrome is not understood as a simple cause-and-effect mechanism. Rather, it is a
generalized warming that cardiovascular disease (heart attack and stroke) as well as type 2
diabetes may be on the cards. Compared to people without it, says the International Diabetes
Federation (IDF), those with metabolic syndrome are three times more likely to suffer the
former and five times more likely to develop the latter. Moreover, as pointed out by Professor
Scott Grundy at the University of Texas Southwestern Medical Center, the risks are
synergistic – i.e. the whole is more than the sum of its parts. Having, say, three of the
symptoms simultaneously, creates far more than three times the danger of having just one
symptom.
Just how much more dangerous, Grundy and others concede, is impossible to answer
precisely. Definitions of metabolic syndrome have been issued by not only the International
Diabetes Federation, but also the American Heart Association, the European Group for the
Study of Insulin Resistance, the US National Cholesterol Education Program and the World
Health Organization. While broadly similar, the characterizations are not uniform, and there
is little clarity as to if and when they will be.
Still, many experts have decided that it is better to act now rather than wait further for
complete scientific certainty. ‚The importance of identifying and treating a core set of risk
factors (pre-diabetes, hypertension, dyslipidemia, and obesity),‛ say the American Heart
Association and American Diabetes Association in a joint statement, ‚cannot be overstated.‛
The IDF has chimed in similarly, stating that the ‚importance of the early identification of
children who are at risk of developing the metabolic syndrome, type 2 diabetes and
cardiovascular disease in later life cannot be underestimated.‛
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Fatter chance: taking medicine downstream
Evidence that corpulence has exploded – obvious to anyone who has wandered the malls of
middle America – is far more than anecdotal. One-third of US adults are obese, according to
the Organization for Economic Cooperation and Development (OECD); a slightly higher
fraction of children are either overweight or obese. Their compatriots in the developed world
are not far behind. Since 1980, when fewer than one in ten people were obese, rates doubled
or tripled to the point that in 19 of 34 OECD countries, more than half the population is now
overweight or obese. By 2020, the OECD projects, that rate will creep up to two-thirds.
Behind this obvious gain in fat hides a thin wedge of burgeoning disease. Many people do not
realize the risk of carrying too much weight. Although some 700 million people globally
suffer from diabetes or excess fats in their bloodstream, the IDF estimates that half of these
cases are undiagnosed. A similar diagnosis deficit is suspected for obesity-related
cardiovascular disease. All told, metabolic syndrome’s attendant ailments threaten 20-25% of
the world’s adults.
So the aim of the cobas b 101 is, in a sense, quite modest. It is simply to lower the barriers to
testing. To make diagnosis easy enough, accessible enough, that more of the many millions of
so-far undetected threats are brought to light – and therefore treated. ‚We think that saving
time and money in testing for metabolic syndrome,‛ says Dr Stefan Foser of Roche
Professional Diagnostics, ‚can also end up saving a lot of lives.‛