Can thin people have Metabolic Syndrome?


Most people think about metabolic health in terms of leanness vs. obesity, thin vs. fat. But BMI and weight don’t tell the whole story, and it’s the internal biochemical processes that affect the risk of a wide array of chronic diseases, such as type 2 diabetes, heart and vascular disease.

How would we know if we’re metabolically healthy?

In yearly checkups physicians measure some important metabolic parameters, such as weight, BMI, sometimes waist circumference, and blood pressure. They inquire about habits that influence metabolic health, such as physical activity and smoking avoidance.

And they can also order blood work that includes other important markers known to raise the risk of disease: Impaired sugar metabolism is identified by high blood glucose or high HbA1c (a test that gauges the average level of blood sugar over the past 3 months) measurements, and the lipid panel will look at triglycerides and cholesterol, which when elevated need some attention, liver enzymes may suggest fatty liver.

The metabolic state of the union

A new study in the journal Metabolic Diseases and Related Disorders looked at the metabolic health of a nationally representative sample of the American population. The researchers included almost 9000 people, whose metabolic health was assessed by measuring 5 parameters: blood pressure, waist circumference, fasting blood glucose, triglycerides and cholesterol. The participants also reported on their physical activity and smoking status.

Metabolic health was the exception rather than the norm. Only 1 in 8 people in this study had optimal levels of all 5 parameters.

Metabolic health often correlated with weight status among the participants, and the higher the BMI the greater the chance of metabolic abnormalities, but even among the people with normal weight, less than a third were metabolically optimal.

There were more metabolically healthy women than men, and metabolic health was more prevalent among people who exercised more, never smokers, and among the younger participants.

Lifestyle and medication

A risk factor is not yet a disease, but it’s a predictor of trouble down the road, and the longer a risk factor is present, and the more metabolic risk factors one has, the more likely it is that there will be consequences such as type 2 diabetes, heart disease and stroke.

So this does sound like bad news indeed. Fortunately, metabolic health is highly responsive to lifestyle interventions.

What’s the secret? Diet and exercise are the main measures that affect metabolic health.

Most people are able to achieve some control over these risk factors with these side-effect-free measures alone. And if these aren’t enough – there are also genes and many other factors beyond our control – there are medications.

Take home message

What we eat matters. The quality of our foods affects our wellbeing and health trajectory in a profound way.

We used to pay attention to food mostly in the context of weight control and the pursuit of skinny silhouettes. But as this study and many others show, people may look thin yet have the metabolic risk markers of an overweight person; and vice versa.

Eating poorly and disregarding physical activity can catch up with the skinniest of people.

So for this New Year, if you’re planning on a diet resolution, make it one that addresses the quality of your meals – not just its caloric content. Focus on whole foods, real food, and more plant-based, less highly processed and less added sugar.

Wishing you a healthy holiday season,

Dr. Ayala