Metabolic health is not just about body weight or BMI. The research underscores the importance of fat distribution—particularly in the abdomen—and its relationship to insulin resistance and chronic hyperinsulinemia. This means that weight alone cannot accurately capture one’s metabolic health. Instead, specific biomarkers provide a more comprehensive view. Key indicators include waist circumference (WC), waist-to-height ratio (WHtR), triglycerides (TG), HDL cholesterol (HDL-C), and the TG/HDL ratio.
These markers allow us to distinguish between Metabolically Healthy Obese (MHO) individuals, who carry excess weight yet maintain a healthier metabolic profile, and Metabolically Unhealthy Obese (MUO) individuals, who face increased risks for cardiovascular disease and diabetes. Additionally, some may appear “thin on the outside, fat on the inside” (TOFI)—people with a normal BMI but high visceral fat and insulin resistance, for whom weight alone does not reveal key health risks.
By focusing on biomarkers like fasting glucose, insulin levels, HOMA-IR (a measure of insulin resistance), triglycerides, and HDL—rather than BMI alone—we gain a clearer, more actionable understanding of metabolic health.
Fernández-Verdejo et al., 2020; Neeland et al., 2024; Wang et al., 2022
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