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Lifestyle Medicine: Nutrition and the Metabolic Syndrome

Course Description | Faculty | Accreditation | General Information

Course Description

This course reviews the case of a 54-year-old gentleman who has full Metabolic Syndrome (i.e., impaired fasting glucose, pre-hypertension, low HDL, high triglycerides, and abdominal obesity). At his first visit to you this patient, who is new to town, will voice concern about his elevated blood glucose as well as his poor eating behavior and pattern.

Through the course of seven questions, you will learn how to counsel this patient about nutrition and behavior management using evidence based guidelines and expert opinion with a focus on lifestyle modification techniques. Updated criteria for Metabolic Syndrome diagnoses from the International Diabetes Federation (IDF) and updated American Diabetes Association (ADA) criteria for diagnosis of Type 2 Diabetes using HgA1c, as well as off label use of metformin in Metabolic Syndrome, will be addressed.

Original Release: 10/14/2010
Most Recent Update: 1/20/2015
Termination Date: 1/20/2018

NUMBER OF CREDIT HOURS: The Harvard Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 1 hours to complete.

COST: COST: $25.00

After completing this course, participants will:

  1. Be able to identify Metabolic Syndrome per 2001 NCEP and recent 2005 IDF guidelines.
  2. Be able to perform basic nutritional assessment for a patient with Metabolic Syndrome.
  3. Learn to identify individualized goals including utilizing the patient’s stage of readiness to change.
  4. Understand the use of appropriate follow-up and accountability for successful nutritional behavior change.

Participants will learn to:

  1. Review basic nutritional guidelines within the weight control concept of timed eating.
  2. Describe the concept and practical application of calorie density and its role in metabolic nutrition.
  3. Understand the importance of and learn how to utilize environmental and portion control with respect to nutritional behavior change.
  4. Employ ancillary specialists to enhance nutritional adherence


Registrants participate in the learning process by answering interactive multiple choice questions that are dispersed throughout the case presentation. You must answer a question correctly in order to continue through the course. If you answer a question incorrectly, you will be prompted to try again.

In order to earn credit, physicians must complete the entire educational activity before the termination date (see above). Non-physicians may register for the course but are not eligible for AMA PRA Category 1 Credits™. Instead, non-physicians will earn a certificate of participation after successfully completing the course before its termination date.


This internet enduring material is a case-based, interactive presentation comprised mainly of text, interactive questions, and images. A variety of media, including video clips, audio clips, and Flash animation, may be presented. Links to any necessary plugins are provided when necessary, but no plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.

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Course Co-Director
Elizabeth Pegg Frates, MD, is a Clinical Assistant Professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School and Assistant Director of Medical Education of the Institute of Lifestyle Medicine. Dr. Frates received her BA degree from Harvard University and medical degree from Stanford University School of Medicine. Her focus is on the academic side of medicine, teaching the Human Central Nervous System, Musculoskeletal System, and Introduction to the Professions at Harvard Medical School. She is also a writer, stroke educator and researcher. Beth completed her internship in Internal Medicine at Massachusetts General Hospital and her residency in Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital, where she served as Chief Resident.

Dr. Frates educates the public about stroke basics including risk factors, warning signs, what to do if someone is having a stroke and how to prevent a second stroke. Much of the prevention requires behavior modification. She is the co-author of the book Life After Stroke: The Guide to Recovery and Preventing Another Stroke published by Johns Hopkins University Press. In residency, Dr. Frates worked on a study examining the exercise habits of physicians and comparing that to their counseling. She found that physicians who exercise themselves are more likely to counsel patients about exercise.

Dr. Frates is an avid runner, completing her first race, a 10-mile course on Nantucket Island, when she was in 7th grade. More recently, in May 2006, she completed the Vermont Half Marathon as a member of the Train to End Stroke team with the American Heart Association.

Founder, Wellness Synergy, LLC (wellness coaching and private practice)

Course Co-Director
Dr Tom Rifai is an expert in the areas of lifestyle based management and prevention of type 2 diabetes, dyslipidemia, hypertension and weight control. His evidence based training and clinical approach is one of "lifestyle first, medications only if necessary". Dr. Rifai serves as Regional Medical Director of Metabolic Health and Weight Management for the world renown Henry Ford Health System of Metro Detroit, Michigan and has been elected a Fellow of the American College of Physicians for his leadership in education of physicians and medical students in lifestyle medicine and type 2 diabetes prevention. Dr Rifai served two terms on the board of directors for the National Board of Physician Nutrition Specialists and was unanimously elected its president during his final term. After graduating with “Highest Honor” from Michigan State University with a Bachelors of Science in Psychology and Pre-Med, he then received his M.D. from Wayne State University School of Medicine – one of the few medical schools in the US with a significant medical nutrition education component. During his senior Internal Medicine residency year Beaumont Hospital in Royal Oak, Michigan, Rifai served as the chief resident coordinator for the hospital's Nutrition and Preventive Medicine (now known as Weight Control) Center – one of the United States first hospital based, multidisciplinary weight management programs. Since completing his Internal Medicine residency program in 2003, Dr Rifai has been appointed Clinical Assistant Professor of Medicine at Wayne State University School of Medicine. Dr. Rifai has been invited on multiple occasions to provide lectures to medical students on lifestyle and nutrition based interventions for Metabolic Syndrome and weight management, as well as provide senior medical students real-world clinical experience in his metabolic practice, including pre and post operative medical and nutritional management of bariatric surgery patients. From January through November of 2008 Dr Rifai served as the Associate Medical Director for the world renown Pritikin Longevity Center in Miami, Florida, helping revamp their nutrition, lab testing and educational programs – particularly as it applied to weight management and type 2 diabetes. He was consistently assessed as one the most dynamic, compelling and enjoyable lecturers while at Pritikin. He continues a relationship with Pritikin as a member of their Science Advisory Board and as part of their national, Medicare approved, Pritikin Intensive Cardiac Rehabilitation (ICR) video education series, providing the lead educator role on dietary fats and weight management. Dr. Rifai is a highly sought after public speaker and appearing via TV and radio media in Detroit, but also New York, Miami, Las Vegas and others. Print appearances have included the honor of being given a full page spread and article in the 2010 HOUR Detroit Magazine “TOP DOCS” issue, as well as being featured in the 2013 issue on the topic of the type 2 diabetes epidemic in Michigan. Dr Rifai's appearance in the Michigan Emmy Award nominated documentary film "The Embrace of Aging - The Male Perspective" while in Sardinia, Italy was touted as one of the most memorable parts of the film (EmbraceOfAging.com). Dr Rifai has also served the public by donating his time as a gratis consultant to two Michigan public school systems in Warren and Birmingham and as nutrition advisor to Blue Cross Blue Shield of Michigan publications. In 2009 Dr Rifai co-designed a comprehensive a healthy gourmet menu for the largest Michigan based Italian restaurant chain, Andiamo Italia restaurants called "Andiamo Lean!". Working with executive chef Jim Oppat, the menu was designed to allow metabolic patients (lipid, blood pressure, diabetes and weight control) and fine dining, healthy culinary experienc

The commercial entities with which I have relationships do not produce health-care related products or services relevant to the content I am planning, developing or presenting for this activity. Dr Rifai is founder and president of Reality Meets Science LLC, a health and wellness education company.

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David M. Eisenberg is the Director of the Osher Research Center at Harvard Medical School and the Division for Research and Education in Complementary and Integrative Medical Therapies and the Director of the Program in Integrative Medicine at the Brigham & Women’s Hospital. He is also the Bernard Osher Associate Professor of Medicine at Harvard Medical School. Dr. Eisenberg is a graduate of Harvard College and Harvard Medical School. He completed his fellowship training in general internal medicine and primary care and is Board Certified in Internal Medicine. In 1979, under the auspices of the National Academy of Sciences Dr. Eisenberg served as the first US medical exchange student to the People’s Republic of China. In 1993, he was the medical advisor to the PBS Series, “Healing and the Mind” with Bill Moyers. More recently, Dr. Eisenberg served as an advisor to the National Institutes of Health, the Food and Drug Administration and the Federation of State Medical Boards with regard to complementary, alternative and integrative medicine research, education and policy. From 2003-2005 Dr. Eisenberg served on a National Academy of Sciences Committee responsible for the Institute of Medicine Report entitled, “The Use of Complementary and Alternative Medicine by the American Public.” Dr. Eisenberg has authored numerous scientific articles involving complementary and integrative medical therapies and currently oversees Harvard Medical School’s research, educational and clinical programs in this area.

Reported no relevant financial relationships with commercial entities.

George Grunberger, MD,is the founder and chairman of GDI. Dr. Grunberger, an experienced diabetologist, is a Clinical Professor of Internal Medicine and of Molecular Medicine & Genetics at Wayne State University School of Medicine. Before establishing GDI, Dr. Grunberger was Director of the Diabetes Program at the Detroit Medical Center for sixteen years as well as the Medical Director of Wayne State University’s Morris J. Hood Comprehensive Diabetes Center. Dr. Grunberger held tenured Full Professor appointments at the University in Department of Internal Medicine and in the Center for Molecular Medicine and Genetics since 1986. Between 1997 and 2001 he was Henry L. Brasza Director of the Center for Molecular Medicine and Genetics. Prior to that (1995-1996) Dr. Grunberger served as interim Chairman of the Department of Internal Medicine and Physician-in-Chief of the Detroit Medical Center. Dr. Grunberger was originally recruited to Detroit from the Diabetes Branch of the National Institute of Diabetes, Digestive and Kidney Diseases of the National Institutes of Health in Bethesda, MD where he worked as a basic and clinical researcher for six years. Dr. Grunberger has received his internal medicine training at the University Hospitals of Cleveland at Case Western Reserve University, his medical (M.D.) training at the New York University School of Medicine and his bachelor’s degree (in biochemistry) at Columbia College of Columbia University, also in New York City. Dr. Grunberger’s clinical and basic research endeavors have been well recognized. He has published over hundred original peer-reviewed manuscripts, in addition to review articles, abstracts, book chapters, and letters to journals. His research interests have spanned the spectrum of subjects related to diabetes and its complications, from very basic studies on molecular underpinning of insulin action and insulin resistance to clinical research studies on many aspects of diabetes and its management. In 20

Reported no relevant financial relationships with commercial entities.

The Department of Continuing Education at HMS welcomes Graham McMahon M.D., M.M.Sc. Associate Professor of Medicine and member of the Academy at Harvard Medical School, as its new Associate Dean. Dr. McMahon is an Associate Professor of Medicine and member of the Academy at Harvard Medical School. He is the fellowship Program Director and member of the faculty in the division of endocrinology, diabetes and hypertension at the Brigham & Women’s Hospital in Boston where he completed his postgraduate training.
Dr. McMahon received his medical education at the Royal College of Surgeons in Ireland, a Master’s Degree in clinical research from Harvard Medical School, and his doctorate in education from the National University of Ireland. He is the Chief Editor for medical education at the New England Journal of Medicine and executive editor for NEJM Knowledge + a novel, adaptive and personalized learning system for physicians. Dr. McMahon is the co-director of center for expertise in medical education. Additionally, he directs the endocrinology course at Harvard Medical School and the tutorial program for “Introduction to the Profession.” Dr. McMahon has also directed a new integrated teaching unit at the Faulkner Hospital. He has received local and national awards for his teaching and his work in medical education and diabetes research.
His work has been published in the New England Journal of Medicine, Diabetes Care, the Archives of Internal Medicine, the Journal of General Internal Medicine, and Medical Education. His research interests include systems of care for patients with diabetes, cardiovascular disease in diabetes, and medical education.

Reported no relevant financial relationships with commercial entities.

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Course Planners
Dr. Sanjiv Chopra is Professor of Medicine at Harvard Medical School. He is also the the James Tullis Firm Chief in the Department of Medicine and a Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston. He served as Faculty Dean for Continuing Education at HMS for 12 years. Dr. Chopra has more than 150 publications and seven books to his credit. Dr. Chopra is Editor-in-Chief of the Hepatology Section of UpToDate, the most widely used electronic textbook in the world subscribed to by more than 850,000 physicians in 149 countries. He is also the recipient of numerous awards and accolades. For a complete bio, click here.

Reported no relevant financial relationships with commercial entities

Andi Long directs the Department of Continuing Education’s Distance Learning group, which offers a variety of online continuing medical education programs to health care professionals around the world. Andi develops strategies for new pilot programs and systematically rolls out new distance learning initiatives and has a leadership role in IT planning and other online processes for HMS DCE. She oversees the day-to-day operations of each distance learning activity and ensures ACCME compliance across all enduring programs. She has had the privilege of working with hundreds of Harvard Medical School Faculty members to develop high-quality, engaging online programs that physicians in more than 170 countries have taken part in. Andi earned her Ed.M. in Technology, Innovation, and Education from Harvard Graduate School of Education and graduated from Bridgewater State College with a degree in English. Her professional interests focus on teaching and learning with new technologies and online course development.

Reported no relevant financial relationships with commercial entities

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The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Harvard Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 1 hours to complete.

Within 2 weeks of completing the course, you will receive your certificate via email.

Click the image to view a sample of the certificate

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General Information


Any computer running Windows, Mac OS, or Unix machines are supported.

Internet Connection
Your computer should be configured to access the Internet. A high speed internet connection may be required to view some of the large multimedia files.

Firefox or Internet Explorer 5.5 or higher are recommended. JavaScript and cookies must be enabled.

Some of the multimedia resources in this course require Apple Quicktime, RealMedia, or a Flash player. You will be prompted to download the appropriate plugin when necessary. No plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.


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