Intended for healthcare professionals

Rapid response to:

Head To Head

Should we dump the metabolic syndrome? No

BMJ 2008; 336 doi: (Published 20 March 2008) Cite this as: BMJ 2008;336:641

Rapid Response:

Metabolic Syndrome – Dubious Value from a Public Health Perspective

As a public health physician, I recognize syndromic approaches as essential when we don't know what we are dealing with e.g., SARS. In other instances, when etiology is understood, some syndromes remain useful in prevention, diagnosis, treatment and health promotion e.g., AIDS. However, is it really likely that we could develop better public health strategies around “metabolic syndrome” than to address underlying determinants such as overweight, obesity and physical inactivity? Although useful papers have been published on its prevalence in various populations, for most actual public health applications, the answer to this question would be “no”. Just as Gale states for the clinical context, where “energetic screening and treatment for obesity, hypertension, and dyslipidaemia already form the basis of managing diabetes”, so too in public health, it is more practical to focus on the prevalence of its underlying determinants: overweight, obesity, physical inactivity, and poor nutrition practices, and then move further upstream to examine activity, nutrition and food marketing polices and practices.

Measurement of these determinants and domains is more relevant in tracking the health of communities and in assessing the impact of health promotion initiatives. It is dubious to state that “the syndrome provides a simple public health strategy to define those at higher risk” (Alberti and Zimmet). We can already determine the prevalence of any such constellation of measurable risk factors without resorting to this syndrome as named.

There is also a public health parallel to Coceani’s comments on the confusion this might give rise to in a startled patient: while keeping mechanisms in mind, most public health professionals would avoid using such a complex and medically loaded term when designing a health promotion strategy. Instead, it would be better practice to focus primarily on the determinants, and try to deal more directly with those realities through healthy public policy and community programming.

Competing interests: None declared

Competing interests: No competing interests

23 March 2008
Franklin White MD, FRCPC, FFPH
President, Pacific Health & Development Sciences Inc.
3164 Balfour Avenue, Victoria BC, CANADA V9A1S1