“Metabolic health” is a wellness catchphrase that is hard to escape. Health Secretary Robert F. Kennedy Jr. has made it a pillar of his “Make America Health Again” agenda. Dr. Casey Means, the nominee for surgeon general, wrote a best seller explaining how to achieve it. Influencers claim it’s the key to longevity.
But what does metabolic health … really mean?
The term is difficult to define, in part because it typically refers to the absence of metabolic syndrome, a cluster of interrelated health problems that reflect issues with metabolism, or how your body uses and stores energy. Metabolic syndrome is defined as having at least three of the following: high waist circumference, high triglycerides, low levels of “good” cholesterol, high blood pressure and high blood sugar. These conditions increase the risk for heart disease, stroke and Type 2 diabetes.
Many people are not considered to be in good metabolic health: The American Heart Association has estimated that 90 percent of American adults have some degree of cardiovascular-kidney-metabolic syndrome, an umbrella term the organization defined in 2023 as a health disorder caused by connections among obesity, diabetes, chronic kidney disease and cardiovascular disease.
Too much fat is a major culprit.
Adiposity, the accumulation of excess body fat, particularly in the abdomen, is a significant component of metabolic dysfunction, said Dr. Latha Palaniappan, the associate dean for research at Stanford Medicine. Three-quarters of American adults are overweight or obese.
Fat cells store energy in the form of triglycerides. When we chronically consume more calories than we expend, and exceed what our fat cells can store, those triglycerides begin to go where they don’t belong, like the liver and muscles, said Dr. Paul Cohen, an associate professor at Rockefeller University whose lab studies obesity and metabolic disease.
The fat cells release inflammatory molecules, which make it harder for insulin to work; insulin resistance in turn contributes to obesity.
“It’s a circular loop,” Dr. Cohen said.
Obesity is not just a product of what we eat and how much we exercise; much of it is driven by genetics. So is body shape. People with an apple shape, who store excess fat in the abdomen, are more likely to experience metabolic issues than those who are pear-shaped, storing their excess fat in the hips and thighs, Dr. Cohen said.
One reason, he said, is that subcutaneous fat (the kind that sits just under the skin) and visceral fat (the kind that surrounds your internal organs) are molecularly different, expressing genes differently and affecting inflammation differently.
Excess fat is often accompanied by other abnormalities.
Dr. Palaniappan compared adiposity to the “check engine” light in a car: It can be a warning sign of other metabolic risk factors, health issues that increase the risk of heart disease.
“When you have excess adiposity, it’s important to check your cholesterol, glucose and blood pressure,” she said. “That will signal where the next step is in your metabolic health.”
Not everyone with adiposity will immediately develop these other risk factors, said Dr. Sadiya Khan, a preventive cardiologist at the Feinberg School of Medicine at Northwestern University. At first, high blood pressure might be the primary issue for one person, while cholesterol or Type 2 diabetes is for another. But as metabolic dysfunction progresses, people often develop more than one condition, she said.
It’s important to pay attention to change over time. For example, say your blood pressure isn’t yet very high, but it has crept up between doctor’s visits.
“If it’s heading in the wrong direction, that can be a sign,” Dr. Khan said.
Metabolic dysfunction can lead to chronic diseases.
Over time, these metabolic risk factors can wreak havoc on the body. High blood pressure, for example, damages the arteries and makes them stiffen, increasing plaque buildup that can lead to a heart attack or stroke. High blood pressure also puts more strain on the heart and kidneys, increasing the chance of heart failure and kidney disease.
Diabetes damages the arteries and filtering units in the kidneys. Insulin resistance and fat buildup in the liver can lead to metabolic dysfunction-associated steatotic liver disease, or MASLD, a condition which can result in inflammation and irreversible liver scarring.
At least 13 types of cancer, including breast, colon, endometrial, liver and pancreatic cancer, are more common among people who are overweight or obese, and higher levels of insulin can accelerate tumor growth, Dr. Cohen said.
The best treatment is prevention.
Getting to a healthy weight is a key first step in preventing metabolic dysfunction, said Dr. Joshua Joseph, associate professor of endocrinology, diabetes and metabolism at the Ohio State University College of Medicine.
Doctors typically recommend starting with lifestyle interventions — quitting smoking, getting more exercise, following a heart-healthy diet like the Mediterranean or DASH diet and getting adequate sleep.
If that sounds like a long list of to-dos, put quitting tobacco first, Dr. Khan said. Smoking is associated with more visceral fat, damages the arteries and may increase insulin resistance.
Otherwise, talk to your doctor to identify which area of your metabolic health might need the most attention — whether it’s blood pressure, cholesterol or blood sugar.
Dr. Joseph, who also directs the Healthy Community Center in Columbus, said he emphasizes incorporating lifestyle changes into daily habits. For example, he encourages people to cook at home, rather than eat out, to reduce sodium and calorie intake.
Exercise can help people lose weight; it also reduces insulin resistance. The American Heart Association recommends people get at least 150 minutes of moderate aerobic exercise per week, ideally with strength training twice a week, but only about one in four American adults gets the recommended amount. Adding a walk or jog at lunchtime, taking the stairs at the office or parking a little farther from the supermarket can make a difference, Dr. Joseph said.
But it can be difficult to lose weight with lifestyle changes alone. GLP-1 medications can be highly effective at reversing obesity and reducing the risk of downstream consequences like metabolic syndrome, diabetes and heart disease.
“The early stages are a great opportunity to focus on reversal or stopping progression,” Dr. Khan said.
Nina Agrawal is a Times health reporter.
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