Conditions or ailments that are the cause of a problem that you see - your observation.

Your vet may diagnose

Equine Metabolic Syndrome, EMS

Synonyms: Insulin Resistance Syndrome, Peripheral Cushing's Disease or Syndrome, Prelaminitic Metabolic Syndrome


Historically, the veterinary profession considered fat, cresty-necked horses to be hypothyroid. Research in the last 10 years has shown that hypothyroidism is in fact very rare and usually not associated with these signs in the horse.

Insulin resistance is a reduced sensitivity to insulin that makes it more difficult for the body to transport glucose out of the bloodstream and store it as glycogen. Insulin resistance is very common in horses, and has been given the name Equine Metabolic Syndrome (EMS).

Attention has been paid to the condition primarily because horses that have the characteristics described (EMS) also get laminitis, a life-threatening, crippling condition. There are genetic and environmental factors that contribute to the development of the insulin resistant state. As with people that are insulin resistant, there is a wide range of signs from very mild to very serious.

The classic insulin resistant (EMS) horse is a very "easy keeper" being overweight even when fed very little. They often do have low grade laminitis smoldering along, so are often described as being mildly stiff. Classic EMS horses have a typical fat distribution, with hard, thick fat laid down on the crest of the neck and over the top-line and around the tail head.

This syndrome in horses is different than simple obesity from overfeeding and under-exercise. These horses have very high insulin levels in the face of high blood sugar levels detectable on laboratory tests. EMS most commonly occurs in the pony breeds, Morgans, Saddlebreds, Peruvian Pasos, Paso Finos, Arabians, Tennessee Walkers, Missouri Foxtrotters, and horses of similar type to these.

Horse owners should be aware of this state and how it contributes to the development of laminitis. Early intervention in the form of management changes might save the development of laminitis, a painful, debilitating and potentially fatal problem.

my vet's role


The prognosis for horses with EMS is good, with early recognition of the disorder and modified feeding and management.

my role


I might observe

You might make these observations when a horse has this condition.

Very Common
Less Common
more observations

Questions To Ask Your Vet:
  • Is this horse just obese, or does it really have EMS?
  • What is the advantage of testing, versus simply making the management changes to reduce weight?

Maintain horses at body condition score 5-6. Avoid feeds with excessive carbohydrate (especially simple sugars) when possible. Examples are certain sweet feeds. Do not allow horses to become obese at pasture, or turn obese horses out on pasture.

further reading & resources

Related References:

Frank N, Elliott SB, Boston RC. Effects of long-term oral administration of levothyroxine sodium on glucose dynamics in healthy adult horses. Am J Vet Res 2008 Jan;69(1):76-81.

Author: Doug Thal DVM Dipl. ABVP