Have you ever wondered why so many people around you seem to struggle with weight management and prediabetes? It’s not just a coincidence. We are in the midst of a metabolic health crisis that’s impacting millions. This is the cause of not only heart attacks and strokes, but the alarming rise of obesity to 73.6% of the U.S. population [1].
In recent years, various guidelines for identifying and managing cardiometabolic risk factors have been introduced. Despite these efforts, the current prevalence of metabolic health among U.S. adults has become alarmingly low, according to a study published in the journal Metabolic Syndrome and Related Disorders. The research, conducted by Joana Araújo, Jianwen Cai, and June Stevens, analyzes data from the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2016, reveals that only 12.2% of Americans have optimal metabolic health [2].
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This is especially alarming because we are seeing this rise in obesity and metabolic disease at the same time we’re coming out with more medications and interventions to fight these very issues!
SOURCES: National Center for Health Statistics, National Health Examination Survey and National Health and Nutrition Examination Surveys.
Key findings show we’re mostly unhealthy
The Araújo study estimates the proportion of American adults with optimal cardiometabolic health based on different guidelines. Using data from 8,721 participants, the researchers defined metabolic health as having optimal levels of waist circumference, glucose, blood pressure, triglycerides, and high-density lipoprotein cholesterol, and not taking any related medication.
- Overall Prevalence: Only 12.2% of American adults were found to have optimal metabolic health according to the most recent guidelines. This is a significant decrease from 19.9% when using the older ATP III (Adult Treatment Panel III) guidelines. This suggests that fewer Americans are meeting the increasingly stringent criteria for optimal metabolic health, highlighting a troubling trend.
- Groups with Better Metabolic Health: Metabolic health was more prevalent among women, younger individuals, those with higher education, non-smokers, those engaging in vigorous physical activity, and those with a lower body mass index (BMI).
- BMI Categories: Less than one-third of normal weight adults were metabolically healthy. The prevalence decreased dramatically to 8.0% in overweight individuals and a mere 0.5% in obese individuals.
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Notably, metabolic disorder is not equivalent to being overweight or obese, and vice versa. There are many people walking around in traditionally categorized “healthy” weights according to BMI yet with terrible metabolic disorder within. These “Thing on the Outside, Fat on the Inside - TOFI” or “Skinny Fat” people may appear healthy but a simple blood test can reveal a more devastating picture within. There are also a small percentage (8% of the overweight and 0.5% of the obese) who are metabolically well and yet suffer from the more superficial fate of appearing unhealthy according to societal standards.
So What?
The implications of these findings are profound. The low prevalence of metabolic health means that a vast majority of American adults are at a significantly increased risk for cardiometabolic diseases. It’s no wonder that the leading cause of death has remained atherosclerotic cardiovascular disease (ASCVD) not only in the U.S., but worldwide [3].
This not only has dire consequences for individual health but also places a tremendous burden on the healthcare system. Early identification and management of metabolic disorders can prevent the progression of diseases like diabetes, heart disease, and stroke, ultimately saving lives and reducing healthcare costs. We doctors are tired.
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Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;Mar 17
I include this flow chart simply to demonstrate the calculus happening in a doctor’s brain (or more likely, not happening because it’s overwhelming). This is a ridiculous chart. People with any abnormality simply need to quit smoking, exercise, eat real food, and if all else fails try a medication, no matter their age, sex, or other ludicrous overfitting criteria imposed on them.
Why is this happening and what can we do about it?
Our modern diet, rich in processed foods and sugars, coupled with sedentary lifestyles, is a recipe for metabolic disaster. Chronic stress and environmental toxins further exacerbate these issues, disrupting our metabolic processes.
- Diet: The modern American diet is high in processed foods, sugars, and unhealthy fats, all of which contribute to poor metabolic health.
- Lifehack: Drink water, skip alcohol, sodas, and juices.
- Lifehack: Buy foods with no nutrition labels (single ingredient).
- Lifehack: Cut out refined and added sugars.
- Sedentary Lifestyle: Increasingly sedentary lifestyles, characterized by prolonged sitting and reduced physical activity, are major contributors to metabolic disorders.
- Lifehack: Stand up and walk every hour.
- Lifehack: Get a desk treadmill and standing desk.
- Lifehack: Do a quick daily workout, even if it’s just sit-ups or jumping jacks.
- Stress: Chronic stress can lead to hormonal imbalances that negatively impact metabolic health.
- Lifehack: Keep your phone away; charge it in another room.
- Lifehack: Avoid the news.
- Lifehack: Schedule a daily relaxation routine.
- Environmental Factors: Exposure to environmental toxins and pollutants can disrupt metabolic processes.
- Lifehack: Use glass or steel containers, not plastic.
- Lifehack: Invest in a quality air purifier.
- Lifehack: Quit smoking and limit alcohol and drug use.
- Healthcare System: A focus on treating symptoms with medication rather than addressing root causes through lifestyle changes and preventive measures also plays a role.
- Lifehack: Use your phone or wearable to track steps and exercise.
- Lifehack: Keep a personal health record.
- Lifehack: Learn about preventive health—don’t rely solely on your doctor.
Finally, don’t get overwhelmed. It’s about making the healthier choice 80% of the time, not being perfect all the time.
It’s time to take control of our metabolic health. Regular screening, proactive lifestyle changes, and better dietary choices can make a significant difference. Don’t wait for a diagnosis – start making healthier choices now.
We need better screening, for more people, and more often
The findings of this study have serious implications for public health. The low prevalence of metabolic health, even among normal weight individuals, suggests that many adults are at an increased risk for cardiometabolic diseases and that we cannot rely on simple weight or BMI as a screening tool. The study underscores the need for more effective strategies to promote healthier lifestyles and manage risk factors across the entire population.
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In other words, every person living in a modern day society needs to be screened via both physical measurement (waist circumference) and blood testing for metabolic disorder. In all likelihood (88% of the time) you will have something worth tackling to prevent a too early death or worse, a life filled with illness.
References
- Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960–1962 through 2017–2018. NCHS Health E-Stats. 2020.
- Araújo, J., Cai, J., & Stevens, J. (2019). Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metabolic Syndrome and Related Disorders, 17(1). doi:10.1089/met.2018.0105.
- Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;Mar 17
Until next time - Cheers to your health!
Hillary Lin, MD
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