Metabolic Syndrome

What is metabolic syndrome?

Metabolic syndrome is when you have 3 or more health problems that put you at higher risk for diabetes, heart disease, and stroke. It is also known as insulin resistance syndrome. It’s also called syndrome X. If you have metabolic syndrome, it means you have 3 or more of these:

  • Abdominal obesity. This means having a waist size of more than 35 inches for women and more than 40 inches for men. A larger waist size is most strongly tied to metabolic syndrome.

  • High blood pressure. This means blood pressure of 130/85 mm Hg or higher. Normal blood pressure is less than 120/80 mm Hg. High blood pressure is strongly tied to obesity. It is often found in people with insulin resistance.

  • High fasting blood glucose. This means a fasting level of 100 mg/dL or higher before treatment. A hemoglobin A1c over 5.7% would also indicate high blood glucose.

  • High triglyceride level. This means a level of more than 150 mg/dL before treatment. Triglycerides are a type of fat in the blood.

  • Low HDL (good) cholesterol. This means less than 40 mg/dL for men and less than 50 mg/dL for women.

Each of these still count as a risk factor, even if you are being treated for it.

What causes metabolic syndrome?

Experts don't fully know what causes metabolic syndrome. Several factors are connected. Obesity plus an inactive lifestyle adds to risk factors for metabolic syndrome. These include high cholesterol, insulin resistance, and high blood pressure. These risk factors may lead to cardiovascular disease and type 2 diabetes.

Metabolic syndrome is more likely the older you are. It may become the main risk factor for cardiovascular disease, even more than cigarette smoking. Higher rates of obesity may be related to higher rates of metabolic syndrome.

Insulin resistance may be a cause of metabolic syndrome. But experts have not found a direct link between the 2 conditions. Hormone changes caused by chronic stress may lead to abdominal obesity, insulin resistance, and higher blood lipids (triglycerides and cholesterol).

Other factors that may lead to metabolic syndrome include:

  • Genetic changes in a person's ability to break down fats (lipids) in the blood

  • Inflammation from substances released from fat cells

  • Older age

  • Problems in how fat is distributed in the body

Who is at risk for metabolic syndrome?

Knowing your risk factors for any disease can help guide you to take helpful actions. This includes changing habits and being checked by your healthcare provider for the disease.

Risk factors most closely tied to metabolic syndrome include:

  • Older age

  • Being African American or Mexican American

  • Being African American and female

  • A body mass index (BMI) higher than 25

  • Diabetes during pregnancy (gestational diabetes) 

  • Having a family member with type 2 diabetes 

  • Smoking

  • History of heavy drinking

  • Stress

  • Being past menopause

  • High-fat diet

  • Inactive lifestyle

What are the symptoms of metabolic syndrome?

In general, people do not have symptoms. But high blood pressure, high triglycerides, and being overweight may be signs of metabolic syndrome. People with insulin resistance may have acanthosis nigricans. This is darkened skin areas on the back of the neck, in the armpits, and under the breasts.

How is metabolic syndrome diagnosed?

You may be diagnosed with metabolic syndrome if you have:

  • Abdominal obesity

  • BMI above 25

  • High triglycerides

  • Low HDL cholesterol

  • High blood pressure or are using medicine to lower blood pressure

  • High fasting blood glucose

  • Increased blood clotting

  • Insulin resistance

How is metabolic syndrome treated?

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are

  • Your overall health and past health

  • How sick you are

  • How well you can handle specific medicines, procedures, and therapies

  • Your opinion or preference

Below are the types of treatment for metabolic syndrome.

Weight loss

Losing weight increases HDL (good) cholesterol and lowers LDL (bad) cholesterol and triglycerides. Losing weight can also reduce the risk for type 2 diabetes.

Losing even a small amount of weight can lower blood pressure and increase sensitivity to insulin. It can also reduce the amount of fat around your middle. Diet, behavioral counseling, and exercise lower risk factors more than diet alone.

Lifestyle changes

You will need to stop using tobacco and cut back on the amount of alcohol you drink. Talk with your healthcare team about ways to get help for these.

Diet changes

Changes in diet are important in treating metabolic syndrome. Treating insulin resistance is the key to changing other risk factors. The best way to treat insulin resistance is by losing weight and getting more physical activity. Here are healthy ways to change your diet:

  • Include a variety of foods in your diet.

  • Use healthy fats. Polyunsaturated and monounsaturated fats may help keep your heart healthy. These healthy fats are found in nuts, seeds, and some types of oils, such as olive, safflower, and canola.

  • Choose whole grains, such as brown rice and whole-wheat bread instead of white rice and white bread. Whole-grain foods are rich in nutrients compared with more processed foods. Whole grains are higher in fiber, so the body absorbs them more slowly. They do not cause a rapid spike in insulin, which can trigger hunger and cravings.

  • Eat more fruits and vegetables. Eat 2.5 cups of vegetables and 2 cups of fruit a day. This amount will vary depending on how many calories you need. Be sure to choose a variety of fruits and vegetables. Different fruits and vegetables have different amounts and types of nutrients.

  • When eating out, take part of your restaurant meal home. Ask for a take-home box and stay away from super-size selections when you order. Many restaurant portions are too large for 1 person, so think about sharing an entrée. Or order an appetizer instead of a main dish from the entrée menu.

  • Read food labels carefully. Pay close attention to the number of servings in the product and the serving size. If the label says a serving is 150 calories but the number of servings per container is 3 and you eat the entire container, you are getting 450 calories. Choose foods that are low in added sugar.


Exercise helps people who are overweight or obese. It helps to keep and add muscle tissue, while burning fat. It also helps you lose weight faster than just following a healthy diet. This is because muscle tissue burns calories faster.

Exercise lowers blood pressure and can help prevent type 2 diabetes. Exercise also helps you feel better emotionally, reduces appetite, improves sleep, improves flexibility, and lowers LDL cholesterol.

Talk with your healthcare provider before starting any exercise program. Walking is a great exercise for just about anyone. Start slowly by walking 30 minutes daily for a few days a week. Gradually add more time so that you are walking for longer periods most days of the week.


People who have metabolic syndrome or are at risk for it may need to take medicine as treatment. This is more likely if diet and other lifestyle changes have not helped. Your healthcare provider may prescribe medicine to:

  • Help lower blood pressure

  • Improve insulin metabolism

  • Lower LDL cholesterol and raise HDL cholesterol

  • Increase weight loss

Weight-loss surgery

Weight-loss surgery (bariatric surgery) is a treatment for morbid obesity in people who have not been able to lose weight through diet, exercise, or medicine. It may also help people who are less obese but who have severe complications from their obesity.

Weight-loss surgery can be done in several ways. The types of surgery are either malabsorptive, restrictive, or both. Malabsorptive procedures change the way the digestive system works. Restrictive procedures greatly reduce the size of the stomach. The stomach then holds less food. There is another weight-loss procedure that is still being studied (called bariatric arterial embolization). It reduces the number of cells lining the stomach that make a hormone that increases appetite.

What are possible complications of metabolic syndrome?

Most people who have metabolic syndrome have insulin resistance. The body makes insulin to move sugar (glucose) into cells for use as energy. Excess body weight makes it harder for cells in the body to respond to insulin. If the body can’t make enough insulin to override the resistance, the blood sugar level increases. This is type 2 diabetes. Metabolic syndrome may be a start of type 2 diabetes.

Metabolic syndrome greatly increases your risk for:

  • Heart disease

  • Stroke

Metabolic syndrome can also be linked to these conditions:

  • Type 2 diabetes

  • Polycystic ovarian syndrome (PCOS)

  • Fatty liver

  • Cholesterol gallstones

  • Asthma

  • Sleep problems

  • Some forms of cancer

What can I do to prevent metabolic syndrome?

The best way to prevent metabolic syndrome is to:

  • Keep a healthy weight

  • Eat a healthy diet

  • Be physically active

Your diet should be low in:

  • Salt

  • Sugar

  • Solid fats

  • Refined grains

Living with metabolic syndrome

Metabolic syndrome is a lifelong condition that will need changes in your lifestyle. If you already have heart disease or diabetes, follow your healthcare provider’s directions for managing these.

Lifestyle changes for managing metabolic syndrome include:

  • A healthy diet

  • Physical activity

  • Stopping smoking if you’re a smoker or use other tobacco products

  • Losing weight if you are overweight or obese

Key points about metabolic syndrome

  • Metabolic syndrome is when you have 3 or more health problems that put you at higher risk for diabetes, heart disease, and stroke.

  • Metabolic syndrome is more likely the older you are. It may become the main risk factor for cardiovascular disease, ahead of cigarette smoking. Higher rates of obesity may be related to higher rates of metabolic syndrome.

  • Knowing your risk factors for any disease can help guide you to take helpful actions.

  • Treatment may include weight loss, diet changes, exercise, and medicine.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

Online Medical Reviewer: Melinda Murray Ratini DO
Online Medical Reviewer: Raymond Kent Turley BSN MSN RN
Online Medical Reviewer: Robert Hurd MD
Date Last Reviewed: 2/1/2023
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