Syndrome W

Midriff weight gain in mid-life could be the sign of a serious metabolic problem. Ilene Cohen couldn't figure out what was wrong, and neither could her doctors. "I was always tired," she recalls, "working full-time and running a home, on my day off I didn't want to do anything. "I felt I was missing a lot because I only wanted to rest." Cohen, now 42, is just shy of five feet tall. She had been gaining weight too, and was up to 167 pounds. Over the years, she had sought help.

"I had different doctors, and I always complained about being very lethargic, and I went for more thyroid and glucose tolerance tests, and they all came back negative. 'Everything's fine, maybe you're working too much' they said."

Cohen remained baffled and miserable until a friend recommended one more doctor for her to try. An endocrinologist at New York Medical College in Valhalla, Dr. Harriette Mogul had been screening hundreds of women since the college started their Menopause Health Program in 1994. She had quickly begun noticing a cluster of symptoms in a certain type of patient who came in to be evaluated for hormone replacement therapy.

"Among these patients-a narrow range of health-conscious, non-smoking, physically-active women approaching menopause-there were many complaints of weight gain, usually around the waist, after years at a constant weight. When we began seeing these symptoms clustered together with elevated blood pressure and insulin levels, we decided there was a pattern," Dr. Mogul recalls.

Finding the Root

"Ilene came to see me because she had been experiencing weight gain, and she had a particular pattern of weight gain in her waist, and she had been exercising and attempting to diet, and really wasn't able to decrease her weight," Dr. Mogul explains. "In addition, she had some blood pressure changes, she had some abnormalities in the balance of her cholesterol, so she was starting to develop some early risk factors for heart disease."

Dr. Mogul coined the term "Syndrome W" to reflect the weight gain, particularly what she calls "waist gain," and intermittent-or "white-coat"-hypertension, she'd been seeing over and over in patients like Ilene. "Women with the Syndrome also report a detectable increase in appetite, food cravings, and inability to lose weight despite exercise and attempts to diet," she adds.

The key, however, was the women's elevated insulin levels despite normal blood glucose. Dr. Mogul was sure insulin was the root cause of all the other symptoms and realized that Syndrome W was really the manifestation of a potentially lethal phenomenon known as "insulin resistance." Therefore, the name "W" seemed all the more apt because it would likely lead, as it does alphabetically, to the better known Syndrome X.

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