Poor metabolic health increases your risk for heart disease, diabetes, and stroke.

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Here’s what to know about your metabolic health. Getty Images

If you think you’ve got good metabolic health just because you see a “normal” weight on the scale, think again.

New research shows that an “alarmingly low” number of American adults are achieving optimal metabolic health, leaving the majority of people at increased risk for serious diseases.

In a study published last month in the journal Metabolic Syndrome and Related Disorders, researchers from the University of North Carolina at Chapel Hill evaluated data from 8,721 adults from the 2009 to 2016 National Health and Nutrition Examination Survey (NHANES). They found that just 1 in 8 adults in the United States have optimal metabolic health.

They defined metabolic health as having ideal levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference, without using medications. These factors directly relate to a person’s risk for heart disease, diabetes, and stroke.

Participants who were obese fared the worst, with just 0.5 percent achieving optimal metabolic health. However, less than half of those who were underweight and less than a third of participants with normal weights had optimal metabolic health.

“We need to look at metabolism beyond just body weight,” said Dr. Rekha Kumar, endocrinologist at New York-Presbyterian and Weill Cornell Medicine. “There has been a push to address obesity through public health measures, but this study shows us that even people who are a normal weight seem to be developing diseases that we typically correlate with obesity.”

The report also showed that certain demographics and lifestyle factors affect metabolic health.

Those with the highest rates of metabolic health included women, people under the age of 40, nonsmokers, those who are physically active, and those who had at least some college education.

Non-Hispanic black participants and people 60 years old and older were least likely to be metabolically healthy.

“Lifestyle factors play into our health. We’re not isolated to just our numbers — we have to look at everything all together,” said Dr. Samantha Nazareth, a double board-certified gastroenterologist in New York City.

Explaining the low rates of metabolic health

There’s no standard definition in the medical community for metabolic health. As such, the estimated occurrence may change quite a bit depending on which factors are considered.

While this is the first study on metabolic health in the United States, other researchers have looked at similar data to determine that some 23 percent of adults have metabolic syndrome. This condition occurs when a person fails to meet at least three of five ideal measurements of things like blood pressure and glucose levels.

The latest report considers a person to be metabolically healthy only if they meet ideal levels of all five criteria.

What’s considered optimal has become stricter over the years as well. In the report, the researchers used “the most recent and restrictive” cutoffs from scientific societies and government agencies, which drove down the prevalence of metabolic health.

“These are the appropriate levels for the definitions of ‘normal’ for each factor,” said Dr. Rosemary Ku, a dual board-certified physician and founder of the digital health nonprofit Cure Chronic Disease.

“One of the biggest changes here was the blood pressure threshold. The standard for metabolic syndrome was 130/85, but in this study, they considered 120/80 to be optimal,” she said.

“It’s not that we use strict guidelines to label people with diseases that they don’t have. We want people to understand what their health risks are,” Kumar added.

Interestingly, the inclusion of waist circumference made a relatively large impact on the findings, bringing the portion of people with optimal metabolic health from 17.6 percent to 12.2 percent.

While the researchers determined the waist circumference of each participant using a consistent method, there’s no standardization for how doctors should measure their patients’ waists, Ku says.

Nevertheless, a large waist circumference is an important factor to note when evaluating a patient, Kumar says.

“Waist circumference can be considered a surrogate marker for someone’s metabolic health. It implies there’s visceral fat, a dangerous type of fat that gathers around the organs and increases a person’s risk for heart disease and heart attacks,” she explained.

How do you improve your metabolic health?

Having poor metabolic health means you have a higher chance of developing diabetes, heart disease, or stroke.

Understanding your risks starts by getting your annual physical.

“Ask your doctor about whether or not it would be appropriate to be screened for chronic disease risk,” Ku said. “They can easily order a routine lab screening that looks at those factors, like your cholesterol and blood sugar.”

Making diet and lifestyle changes can help improve your metabolic health. Ku, Nazareth, and Kumar emphasize the importance of quitting smoking, eating a healthy diet rich in vegetables, maintaining a healthy weight, and exercising regularly throughout the week.

Those habits not only work to improve your metabolic health, but also offer a range of other benefits for the body and mind.

“Sleep hygiene should also be incorporated into improving metabolic health. That has taken a hit on our modern society with technology and what often feels like a 24-hour workday for people,” Kumar said.

Shifting public health measures to target everyone (not just those with obesity) is also essential in helping improve the rate of optimal metabolic health throughout the country, Kumar adds.

“All those campaigns focused on increasing someone’s physical activity, reducing sugar intake and reducing saturated fats in the diet shouldn’t just be targeted at people with a weight problem, but to all people. We need to understand that even if you don’t have a weight problem, you might still have a metabolism problem,” she said.