Health‐care providers are in a unique position to encourage people to make healthy lifestyle choices. However, lifestyle modification counseling is a complex task, made even more so by the cultural and socioeconomic diversity of patient populations. The objective of this study is to evaluate the prevalence and predictors of attending and physician‐in‐training weight control counseling in an urban academic internal medicine clinic serving a unique low‐income multiethnic high‐risk population. In 2006, patients (n = 256) from the Associates in Internal Medicine clinic (Division of General Medicine at the New York Presbyterian Hospital, Columbia University Medical Center, New York, NY) were recruited and completed a questionnaire, which assessed demographic variables, health conditions, access to health‐care services, physician weight control counseling, and weight loss attempts. Seventy‐nine percent of subjects were either overweight or obese. Only 65% of obese subjects were advised to lose weight. Attending physicians were more likely than physicians‐in‐training to counsel subjects on weight control (P < 0.01). Factors that were significantly (P < 0.05) associated with different types of weight control counseling included obesity, cardiovascular disease (CVD) risk factors, female gender, nonblack race, college education, married status, and attending physician. Subjects advised to lose weight were more likely to report an attempt to lose weight (P < 0.01). Rates of weight control counseling among physicians are suboptimal, particularly among physicians‐in‐training. Training programs need to promote effective clinical obesity prevention and treatment strategies that address socioeconomic, linguistic, and cultural factors.

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EditorialVascular biomarkers in the metabolic syndrome Expert. Rev. Mol. Diagn. 9(3), 209-215 (2009) "Insulin resistance, a key mechanism contributing to the metabolic syndrome, is tightly associated with endothelial dysfunction, which partly explains the increased risk for cardiovascular disease seen with the metabolic syndrome."The metabolic syndrome (MetS) is associated with approximately a twofold increased risk of developing cardiovascular disease. Insulin resistance, a key mechanism contributing to the MetS, is tightly associated with endothelial dysfunction, which partly explains the increased risk for cardiovascular disease seen with the MetS. Therefore, vascular markers of endothelial dysfunction have the potential to be used as surrogates for cardiovascular outcomes when evaluating various interventions in individuals with the MetS. Individual biomarkers or a combination of biomarkers may also provide independent information regarding the risk for cardiovascular disease and thus identify a subset of individuals with the MetS who may benefit from more aggressive preventive strategies.The MetS is a clinical entity characterized by a group of risk factors that, in aggregate, are associated with an increased risk of cardiovascular disease and diabetes [1]. It has been argued that the MetS does not identify individuals who have an increased cardiovascular risk beyond the individual components that define the MetS, and there is no underlying pathophysiological mechanism for this phenotype [2]. Regardless, the concept of the MetS has been widely embraced by clinicians and it serves as a useful construct for categorizing individuals at high cardiometabolic risk [1,3]. In this editorial, we will review the contribution of several vascular biomarkers that have been associated with higher cardiovascular event rates in metabolic syndromes. Defining the metabolic syndromeDefinitions of the MetS, or the insulin resistance syndrome, have been proposed by the WHO [4], the Third Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (ATP III) [5], the International Diabetes Federation (IDF) [6] and the American Association of Clinical Endocrinologists (AACE) [7]. All definitions include the same core criteria: abdominal obesity, impaired glucose tolerance, dyslipidemia (high triglycerides and low high-density lipoprotein [HDL]-cholesterol levels) and high blood pressure with varying emphasis on different components of the syndrome. For instance, ATP III emphasizes abdominal obesity and the WHO makes insulin resistance a required component of the MetS. ATP III also emphasizes a prothrombotic and proinflammatory state as an emerging risk factor associated with the MetS [8].Discrepancies in various definitions of the MetS are based on controversy surrounding pathophysiological mechanisms. The two most commonly proposed mechanisms include increased activity of visceral adipocytes and insulin resistance. However, any attempt to identi...