The entire metabolic syndrome is driven by hyperinsulinemia, and treatments should focus on lowering insulin levels rather than just symptomatic management.

“hyperinsulinemia too much insulin is really what is behind abdominal obesity high blood glucose high blood pressure low HDL and hypertriglyceridemia that's the metabolic syndrome the whole syndrome is not a syndrome of insulin resistance it's a syndrome of hyperinsulinemia”

Dr. Sinha believes that subcutaneous fat serves as a necessary safety buffer that protects against the adverse metabolic effects of visceral fat.

“as much as my female patients complain about subcutaneous fat I'm like this is actually a safety belt for me because we don't want this fat to get into the inner city as we get to the visceral fat”