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Normal body weight but high metabolic risk: Doctor explains why you should look beyond BMI to assess your health
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A normal BMI may not always mean good health. Dr Niraj Kumar explains why abdominal fat, waist circumference and metabolic markers matter beyond body weight.
A normal BMI is often considered a sign of good health, but the number on the weighing scale may not always tell the complete story. Some people with a seemingly healthy body weight may still have underlying health risks that go unnoticed. This raises an important question: how much can body weight alone tell us about our overall health?
In an interview with HT Lifestyle, Dr Niraj Kumar, Senior Consultant, Internal Medicine, Shardacare – Healthcity, sheds light on why it is important to look beyond BMI and understand the factors that can influence long-term health. (Also read: Small lifestyle changes, better brain health: Neurologists share practical ways to reduce stroke risk and improve overall well-being )
“BMI is a useful screening tool, but it does not provide a complete picture of a person’s metabolic health. Someone with a normal BMI may still have excess abdominal fat, particularly visceral fat, which can increase the risk of insulin resistance, type 2 diabetes and cardiovascular disease,” says Dr Kumar.
Understanding the two types of abdominal fat
Abdominal fat is broadly classified into two types: subcutaneous fat and visceral fat. Subcutaneous fat lies just beneath the skin, while visceral fat is located deeper within the abdomen, surrounding organs such as the liver, pancreas and intestines.
Visceral fat is metabolically active and releases fatty acids and inflammatory substances that can interfere with the body’s response to insulin. Over time, excess visceral fat is associated with abnormal cholesterol levels, high blood pressure, fatty liver disease and an increased risk of type 2 diabetes and heart disease.
“Not all abdominal fat behaves in the same way. Visceral fat is particularly concerning because of its association with inflammation and insulin resistance. This is why assessing metabolic risk requires more than simply looking at body weight,” Dr Kumar explains.
Why a normal BMI may not tell the whole story
The ICMR-INDIAB national study, published in the Indian Journal of Medical Research, analysed data from 1,13,043 adults across 31 States and Union Territories. It found that 43.3% of participants had metabolic obesity despite having a BMI below 25 kg/m².
Researchers defined metabolic obesity as the presence of at least two risk factors, including increased waist circumference, high blood pressure, elevated blood glucose, high triglycerides or low levels of high-density lipoprotein (HDL) cholesterol.
“The findings highlight an important point: a normal reading on the weighing scale does not necessarily mean that a person is metabolically healthy. In the Indian population, waist circumference, family history, blood pressure, blood sugar and cholesterol levels should all be considered while assessing an individual’s risk,” says Dr Kumar.
How can metabolic risk be assessed?
Rather than relying on BMI alone, healthcare professionals may consider waist circumference, waist-to-height ratio, blood pressure, blood glucose and lipid levels to develop a more comprehensive assessment.
The UK’s National Institute for Health and Care Excellence (NICE) recommends keeping waist circumference below half of one’s height as a practical guide for adults with a BMI below 35 kg/m².
Indian consensus guidelines commonly define abdominal obesity as a waist circumference of 90 cm or more in men and 80 cm or more in women. These measurements are screening indicators and should be interpreted alongside other clinical factors.
“Waist circumference is a simple and practical measurement that can help identify people who may otherwise be overlooked when BMI is used in isolation. When indicated, blood tests for glucose and cholesterol, together with blood pressure monitoring, can help identify metabolic abnormalities at an early stage,” Dr Kumar says.
Lifestyle changes can improve metabolic health
Reducing metabolic risk does not necessarily mean focusing exclusively on weight loss. Improving body composition, maintaining regular physical activity and adopting sustainable dietary habits can support better metabolic health, even when body weight changes very little.
According to Dr Kumar, a combination of aerobic activity and strength training can improve insulin sensitivity and help reduce visceral fat. A balanced diet that includes vegetables, whole grains, pulses, fruits and adequate protein, while limiting excess sugar and highly processed foods, can also contribute to better metabolic outcomes.
Sleep and stress management are equally important. Inadequate sleep and chronic stress can influence appetite, activity levels and metabolic regulation, making healthy routines more difficult to maintain.
“The objective should be to improve overall metabolic health rather than focusing only on the number on the weighing scale. Regular physical activity, balanced nutrition, adequate sleep and stress management are important components of prevention. Consistency is more valuable than pursuing quick results,” Dr Kumar notes.
When should you seek medical advice?
Abdominal fat alone does not necessarily indicate a metabolic disorder. However, people with a larger waist circumference, a family history of diabetes, a sedentary lifestyle or previously abnormal blood sugar or cholesterol levels may benefit from a medical assessment.
Identifying risk factors early can help individuals and their healthcare providers take appropriate steps before metabolic abnormalities progress to more serious conditions.
“People should not assume that they are free from metabolic risk simply because their BMI falls within the normal range. If there are additional risk factors, a medical check-up that includes waist measurement, blood pressure and relevant blood tests can provide valuable information and help guide preventive care,” Dr Kumar concludes.
Ultimately, maintaining good health requires looking beyond body weight. Understanding where fat is stored and monitoring key metabolic indicators can help identify potential risks early and support long-term health.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
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