Why your weight isn't the only number that matters: Laparoscopic surgeon shares 5 signs your metabolism is struggling

Metabolic health is more than weight, as Dr Gautam explains; signs like waist circumference, blood sugar variations, and lipid profiles are vital indicators.

Often, we consider the numbers on the weighing scale to be the ultimate mark of our health. If the scale goes up, you are unhealthy; if it goes down, you are okay. But defining your health depends on more than just your weight on the scale.

According to Dr Ashish Gautam, principal director, robotic and laparoscopic surgery, Max Super Speciality Hospital, Patparganj, New Delhi, a weighing scale can tell how much a person weighs, but it cannot tell how the body is handling that weight.

In an interview with HT Lifestyle, Dr Gautam explained that metabolic health depends on how the body uses and stores energy, regulates blood sugar, processes fats, and responds to hormones. Moreover, a person can have a ‘stable weight’ and still develop ‘insulin resistance, abnormal cholesterol, fatty liver or other metabolic problems.’

35 crore Indians above the age of 20 have abdominal obesity. (Freepik)

Dr Gautam listed five signs that can provide useful clues that metabolic health needs attention, even when the weighing scale tells a different story:

1. Your waist is increasing even when your weight is stable

According to Dr Gautam, a gradual increase in waist circumference can be more informative than a small change in body weight. He explained, “Abdominal fat includes visceral fat, which surrounds internal organs. It is metabolically active and is associated with insulin resistance, abnormal blood lipids and cardiovascular disease.”

This is one reason a person can remain within a normal BMI range and still develop metabolic problems. BMI does not show where fat is stored. “A growing waistline, therefore, deserves attention even when the weighing scale has barely moved,” he added.

2. Blood sugar starts rising

“Blood sugar does not usually become abnormal overnight,” Dr Gautam highlighted. In many people, insulin resistance develops gradually, he cautioned.

“Insulin helps to move glucose from the blood into cells where it can be used for energy. As cells become less responsive to insulin, the pancreas produces more insulin to keep blood glucose levels normal. Eventually, this compensation may fail, and blood sugar rises,” he explained.

Regular screening may be helpful for those gaining weight around their waist.

Therefore, having a normal fasting glucose does not always tell the whole story. HbA1c, which measures average blood glucose over roughly three months, can add information. Moreover, he stressed that regular screening may be helpful for those gaining weight around their waist, with a family history of diabetes, inactive lifestyles or past abnormal blood sugar readings.

3. Cholesterol and triglycerides are changing

Metabolic health also shows up in the lipid profile. Dr Gautam noted that high triglycerides, elevated LDL cholesterol, and low HDL cholesterol can occur alongside insulin resistance and abdominal fat accumulation.

“Such changes increase the risk for cardiovascular disease even when body weight appears stable. A lipid profile is therefore useful during routine health assessment, particularly for people with diabetes, hypertension, abdominal obesity or a family history of cardiovascular disease. The number on the weighing scale cannot provide this information,” he opined.

4. You are losing muscle while gaining fat

Body weight can remain unchanged while body composition changes considerably. Explaining this, Dr Gautam stated, “Muscle mass tends to decline with age and physical inactivity. If this is accompanied by an increase in body fat, particularly around the abdomen, the weighing scale may show little difference.”

Moreover, he emphasised that muscle plays an important role in glucose metabolism. “It removes glucose from the bloodstream and uses it for energy. Regular resistance exercise helps to maintain muscle and promotes insulin sensitivity. That gives exercise a purpose for people who aren’t trying to lose weight,” Dr Gautam shared.

Muscle mass tends to decline with age and physical inactivity. You need to strength-train to preserve muscle mass.

Moreover, he quoted the World Health Organisation's estimates that state that about half of Indians do not meet recommended levels of physical activity. “Long periods of sitting, limited walking, and insufficient strength training can gradually affect muscle mass and metabolic function,” he stated.

5. Energy, sleep and appetite have changed

Changes in energy and appetite can also provide clues whether your metabolism is struggling, although they are not specific to metabolic disease.

“Persistent tiredness may have many causes, including inadequate sleep, anaemia, thyroid disorders, stress or other medical conditions. A lack of sleep can also disturb the regulation of appetite and glucose metabolism,” Dr Gautam shared.

He added that sleep deprivation can lead to increased hunger and a preference for high-calorie foods, and hormonal changes due to chronic stress can change eating habits and lead to abdominal fat accumulation.

Moreover, such effects are exacerbated by a sedentary lifestyle; reduced movement lowers daily energy expenditure and can contribute to a gradual loss of muscle mass.

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.