HomeHealth TopicCardiovascular

How Metabolic Syndrome, High Cholesterol, and Obesity Are Connected

Khama Ennis, MD, MPH, FACEP
Published on March 3, 2021

Key takeaways:

  • Metabolic syndrome is a collection of health conditions that puts people at a higher risk of cardiovascular disease and diabetes. 

  • It’s reversible with healthy life choices such as losing weight and exercise.

  • Good primary care is the key to screening for and addressing this early.


What is metabolic syndrome?

A syndrome is a collection of symptoms or findings. When clustered together, they show that something might be going wrong with our health. Metabolic syndrome is having a cluster of health conditions that affects our metabolism. Our metabolism is how we use the calories we take in. Together, this cluster of health conditions can be a sign that we are at risk for worse health outcomes. In other words, metabolic syndrome is really a collection of problematic conditions, rather than being a disease on its own.

Is metabolic syndrome common?

Metabolic syndrome is very common. In fact, 34% of adults in the U.S. have it and the numbers have been rising around the world. This change seems to be linked with people around the world becoming less active and having more access to fast food.

How do I know if I have metabolic syndrome? 

Metabolic syndrome means that you have at least three of the following five health issues.

Waist size 

One of the criteria for metabolic syndrome is a waist that measures more than 40 inches in men and 35 inches in women. While overweight and obesity are risk factors for many health conditions, carrying extra weight in the belly itself is bad. It has been linked to high cholesterol, heart problems, and problems controlling blood sugar. 


The body takes extra calories and converts them into triglycerides, which are stored in fat cells. This particular type of fat has been associated with a higher risk of heart disease and diabetes. Your triglyceride levels are worrying in terms of metabolic syndrome when they are greater than 150 mg/dL. 

A triglyceride level is included when you get your cholesterol checked. The Centers for Disease Control and Prevention (CDC) recommends cholesterol testing for all adults starting at 20 years old. 


HDL, or high-density lipoprotein, is a kind of “good” cholesterol. It has the following benefits:

  • Reduces your risk of heart attacks and strokes

  • Helps the body get rid of excess LDL, or low-density lipoprotein, known as the “bad” cholesterol 

Cholesterol is essential to many processes in the body. But it’s important to maintain a healthy balance. If our body doesn’t have enough HDL (good cholesterol), then the extra LDL (bad) can build up in the arteries and cause problems with blood flow to vital parts of our bodies. HDL less than 40 mg/dL in men and 50 mg/dL in women could make cholesterol part of the worrisome cluster involved with a diagnosis of metabolic syndrome.

High blood pressure

Blood pressure is usually read out as two numbers in a fraction: 

  • Systolic (top number): how much pressure is in the arteries when the heart contracts to move blood out to the rest of the body

  • Diastolic (bottom number): how much pressure is in the arteries when the heart is relaxed

Healthy blood pressure is when systolic is less than 120 mmHg and diastolic is less than 80 mmHg (120/80). Here are the numbers when you should be concerned in terms of metabolic syndrome:

  • Systolic: greater than 130 mmHg

  • Diastolic: greater than 85 mmHg 

The problems caused by high blood pressure are most often a result of having it for too long. A single reading that is high is not really dangerous. But over time, the arteries become stiff if they have to handle that much strain all the time. That stiffness eventually makes them more fragile and less able to get blood and oxygen where your body needs it. 

Fasting glucose 

This is a blood sugar check done at least 8 hours after the last time you had anything to eat. A high fasting blood sugar level may be an early warning sign of diabetes. This would show up on your medical record as a fasting glucose of more than 100 mg/dL.

What are the health risks associated with metabolic syndrome?

People with metabolic syndrome are 5 times more likely to have type 2 diabetes than people without it. Diabetes is a serious condition. It affects how the body uses insulin to control blood sugar. As a result, it needs to be managed well to avoid long-term health problems.

Metabolic syndrome can also double the risk of heart disease and stroke, both of which can be disabling or even fatal. 

What are the physical side effects of metabolic syndrome?

Metabolic syndrome doesn’t have specific physical side effects. That’s part of why it’s so important to have regular checkups with a primary care provider to screen for it. This involves checking your weight, vital signs, and ordering important blood tests. 

Can you have metabolic syndrome without having obesity?

In short, yes. If you have three of the five conditions above, you have metabolic syndrome. Obesity is not on the list, but it is somewhat likely that if you have metabolic syndrome, you will also be obese. And if you have obesity, you have double the risk of having metabolic syndrome.

The CDC defines obesity according to a number known as body mass index (BMI). It’s calculated using your height and weight. That number can help you figure out if your weight is healthy, too high, or too low. Find your BMI with this online calculator.

Can you have metabolic syndrome without high total cholesterol?

Yes. A person only needs to have three of the five findings above to be diagnosed with metabolic syndrome. The finding on the list related to cholesterol is for low HDL, the good cholesterol, since it helps protect against heart disease and stroke. 

Can you be obese but not have high cholesterol?

Yes. There are many people who are obese (with a BMI greater than 30, based on the CDC’s definition) but who don’t have high cholesterol. However, obesity does increase your risk of high cholesterol. It also increases your risk of:

  • High blood pressure

  • Heart disease

  • Stroke

  • Metabolic syndrome

What are the best treatments for metabolic syndrome?

The good news is that metabolic syndrome is considered reversible.

Weight loss through increased physical activity and calorie control can turn the tide on metabolic syndrome. Remember, it is a syndrome based on our metabolism, or how we use the calories we take into our bodies. So you can address the syndrome by tackling both sides of the equation. In other words, cut down how many calories you take in and get more exercise to burn what you don’t need. It’s important to check in with your primary care provider before starting a new high-intensity program. But you can start moderate programs, like walking, anytime you’re ready.


Healthy eating starts with making smart food and beverage choices. Be sure to choose foods and drinks that fill you up with nutrients without adding extra calories. One simple change to reduce your calorie intake is choosing water over soda when you feel thirsty. Check out this post on common mistakes of healthy eating.


Burn more calories and give your metabolism a boost through increased physical activity. A good goal is 30 minutes of exercise at least 5 days per week. But every little bit helps. If going for a walk or riding a bike are not options, there are ways to exercise without leaving home, like dance, online fitness classes, and yoga. Even pushups or jumping jacks can make a difference. The point is to get up and move.

Medication options

If diet and exercise alone are not enough, don’t give up. There are medications available to treat high blood pressure, diabetes, and elevated triglycerides. Work with your primary care provider to come up with a plan that is best for you.


No surgery specifically treats metabolic syndrome. But surgical options that target weight loss can help address waist circumference that does not improve with diet, exercise, and medication. Surgical procedures include reversible options like gastric bands, which can reduce the size of the stomach. They also include gastric bypass surgery, which reroutes the way food moves through the body.

Surgery comes with some risks, though these procedures are safer than they have ever been in the past. It should only be considered after traditional options have failed. It’s important to speak with your healthcare provider about your options and what’s best for you, if surgery is needed.

The bottom line

Metabolic syndrome is a warning sign that you are at a higher risk of diabetes, heart disease, and stroke. However, it can be reversed with healthy diet choices and exercise. Medications are available to treat what signs and symptoms remain. 

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