Metabolic health refers to how efficiently and effectively your body uses energy sources to fuel bodily processes. Most Americans are not as metabolically healthy as they think they are (or as they could be). According to data from the National Health and Nutrition Examination Survey, only 12% of Americans meet the criteria for being metabolically healthy.1 To better define metabolic health, experts have identified metabolic indicators that are consistent with having good health and a low risk of cardiovascular disease.
Metabolic health means having optimal levels of all risk factors without the use of medications. Many people equate metabolic health with being at a healthy weight, but less than one-third of people at a healthy weight are metabolically healthy. If possible, access your most recent lab results and grab a tape measure to assess your metabolic health. If your markers are not at optimal levels, talk to your doctor about your risk of metabolic syndrome.
In the past, body mass index and body weight were considered the best indicators of cardiovascular risk. However, the distribution of body fat is more important than the amount of body fat you carry.2,3 Belly fat (abdominal fat) is more dangerous to your health than subcutaneous fat (fat under your skin). Measuring your waist circumference and waist-to-hip ratio can help you better understand your risk for insulin resistance and type 2 diabetes.
<p class="pro-tip"><strong>Read more about </strong> <a href="/blog/bmi">the limitations of body mass index (BMI)</a>.</p>
Genetic predisposition, hormone changes, and lifestyle factors all contribute to increased belly fat, but the biggest contributing factor is an increase in overall body fat.4,5
Ideal Waist Circumference Measurements
Measure your waist circumference in a standing position. Wrap the tape measure snugly around your waist, just above your hip bones. Ensure the tape measure is horizontal and take a measurement just after you breathe out.
Waist Circumference Ideal Numbers6
- Men: less than 40 inches (102 cm)
- Nonpregnant women: less than 35 inches (89 cm)
To measure your hip circumference, stand up straight and wrap the tape measure around the widest part of your hips. Make sure it is snug and horizontal before taking a measurement.
To calculate the waist-to-hip ratio: divide your waist circumference by your hip circumference in either inches or centimeters (the units don't matter as long as both measurements have the same units).
World Health Organization Waist-to-Hip Ratio Ideals:7
- Men: less than or equal to 0.9
- Women: less than or equal to 0.85
Tips for Meeting the Waist Circumference Recommendation
If your waist circumference exceeds the recommended guidelines, you will need to reduce your overall body fat to improve this measurement. You can't reduce body fat in specific areas, instead you need to lose total body fat.8Losing just 5% to 10% of your body weight can significantly improve your health and reduce your risk of chronic disease.
Monitor your progress by measuring your waist circumference every few weeks. Many people achieve diet or exercise-induced reductions in their waist circumference without experiencing weight loss.4
<p class="pro-tip"><strong>Read more about </strong> <a href="/blog/lower-belly-fat">burning off lower belly fat</a>.</p>
Blood Glucose Levels
Blood glucose is kept in a very narrow range because it is the primary energy source for every cell in the body. There are two main hormones responsible for regulating blood sugar, insulin and glucagon. Insulin lowers blood glucose, and glucagon raises it. Over time, some people develop insulin resistance. Their body cells become resistant to the effects of insulin, which forces the pancreas to pump out more. When the pancreas can no longer keep up with insulin demand, blood glucose levels rise.
Risk factors for insulin resistance or abnormal glucose levels include: 9
- Overweight or having obesity
- Increased inflammation
- Physiological stress
- Family history of diabetes
- Over age 45
- Physical inactivity
- History of gestational diabetes
- Polycystic ovary syndrome
- High blood pressure
- Abnormal cholesterol and triglyceride levels
<p class="pro-tip"><strong>Learn about </strong> <a href="/blog/ways-to-reduce-inflammation">how to reduce inflammation</a>.</p>
Blood Glucose Levels
These blood glucose levels are the Centers for Disease Control and Prevention standards and are used to define prediabetes and diabetes. If you don’t have prediabetes or diabetes, lower blood sugar levels are likely going to be more optimal for you.
Fasting blood glucose (sugar) ranges:10
- Normal: 99 mg/dL or lower
- Prediabetes: 100 to 125 mg/dL
- Diabetes: 126 mg/dL or higher
Hemoglobin A1C measures your average blood glucose over 2 to 3 months.10
- Normal HgA1C: below 5.7%
- Prediabetes: between 5.7 and 6.4%
- Diabetes: 6.5% or higher
Glucose tolerance tests measure your blood glucose after drinking a sugary drink.10
- Normal: 140 mg/dL or below
- Prediabetes: 140 – 199 mg/dL
- Diabetes: 200 mg/dL or above
<p class="pro-tip"><strong>Learn about </strong> <a href="/blog/age-glucose-levels">how aging changes blood sugar levels</a>.</p>
Tips for Meeting the Blood Glucose Recommendation
Small changes in your lifestyle can pay off with better glucose levels and a reduced risk for type 2 diabetes.
Tips to improve your glucose levels:
- Lose excess body weight Drink water
- Increase physical activity
- Manage stress
- Get 7 to 9 hours of high-quality sleep
<p class="pro-tip"><strong>Read about </strong> <a href="/blog/lower-blood-sugar-fast">11 natural ways to lower blood sugar fast</a>.</p>
Just over one-fourth of American adults have high triglyceride levels.11Triglycerides are a source of energy that is often used when in a fasting state. Humans store excess fat in their adipose tissue and liver, and in their bloodstream as triglycerides.12Triglycerides, along with low-density lipoprotein (LDL) cholesterol, build up on the inner walls of blood vessels, which increases the risk of cardiovascular disease.
Risk factors for high triglycerides include:13
- A family history of high cholesterol or high triglycerides
- Excessive alcohol consumption
- Liver or kidney disease
- Medications such as corticosteroids
- Uncontrolled diabetes
- Thyroid disease
National Heart, Lung, and Blood Institute recommendations for triglyceride levels:14
- Acceptable: Less than 150
- Borderline: 150 to 199
- High: 200 or higher
Tips for Meeting the Triglyceride Recommendations
To lower your triglyceride levels:15,16
- Consume a heart-healthy diet, such as the DASHdiet
- Prioritize daily exercise
- Quit smoking
- Lose 5% to 10% of your body weight if you are carrying excess weight
- Get 7 to 9 hours of high-quality sleep each night
- Increase fiber in your diet
<p class="pro-tip"><strong>Learn why </strong> <a href="/blog/fiber-for-metabolic-health">fiber is so beneficial for metabolic health</a>.</p>
Low-density Lipoprotein (LDL)/ High-density Lipoprotein (HDL) Cholesterol Levels
Over 38% of American adults have high cholesterol.17Total cholesterol includes LDL cholesterol, triglycerides, and HDL cholesterol. Cholesterol is a waxy substance that is produced by the liver and consumed in the diet. It is used by the body to make cell membranes and make hormones.
High total and LDL cholesterol increase your risk of cardiovascular disease. Excess cholesterol can contribute to thick deposits inside your blood vessel walls. These deposits raise your blood pressure and increase your risk of heart attacks or strokes.
LDL cholesterol (bad cholesterol) makes up about 60% to 70% of total cholesterol.18It contributes to cardiovascular disease and atherosclerosis.
- Reduces nitric oxide, a molecule that dilates blood vessels and increases blood flow
- Increases inflammation
- Increases fatty deposits on the lining of blood vessels
- Increases the risk of blood clots
HDL cholesterol makes up about 20% to 30% of total cholesterol.18 It is considered good cholesterol because it travels through the bloodstream, picks up cholesterol from the lining of blood vessels, and carries it back to the liver. A high HDL cholesterol reduces your risk of heart disease and may block some of the adverse effects of LDL cholesterol.19
Factors contributing to high LDL and total cholesterol include:20
- A diet high in saturated and trans fats
- Increasing age
- Lack of physical activity
- Being overweight
- Excess alcohol intake
- Genetic predisposition
- Medications such as steroids
- Medical conditions such as thyroid disease, diabetes, liver disease, and kidney disease
Ideal Cholesterol Levels
Healthy Cholesterol Levels
- Total cholesterol: 125 -200 mg/dL
- LDL cholesterol: Less than 100 mg/ dL (optimal), 100 to 129 mg/dL (near optimal)
- HDL cholesterol: More than 60 mg/dL(ideal), otherwise above 40 mg/dL for men and above 50 mg/dl for women
Borderline Cholesterol Levels
- Total cholesterol: 200 to 239 mg/dL
- LDL cholesterol: 130 to 159 mg/ dL
High Cholesterol Levels
- Total cholesterol: 240 mg/dL or higher
- LDL cholesterol: 160 to 189 mg/ dL
Tips for Meeting the Cholesterol Recommendation
Lifestyle changes that can lower LDL and total cholesterol include:21
- Consuming a diet high in fruits, vegetables, and whole grains
- Consuming low-fat dairy products, fish, poultry, legumes, and nuts
- Reducing calories from saturated and trans fats
- Limiting sweets, high sugar beverages, and red meats
- Increasing physical activity, aiming for at least 150 minutes per week of moderate-to-vigorous intensity exercise
<p class="pro-tip"><strong>Learn more about </strong> <a href="/blog/mediterranean-diet">the Mediterranean Diet</a>.</p>
Blood pressure measures the force exerted by your blood against the walls of your blood vessels. Systolic blood pressure (the top number) is the pressure on your blood vessels just after your heart pumps blood. Diastolic blood pressure (the bottom number) is the pressure in your blood vessels as your heart relaxes.
When your blood vessels are narrowed due to fatty deposits or stiffened because excess blood glucose binds to proteins lining blood vessels, your heart must apply a greater pumping force to overcome resistance, and your blood pressure increases.
In most cases, there are no symptoms associated with high blood pressure. It is important to check your blood pressure regularly. However, there are risk factors for high blood pressure, including:22
- Age over 65
- A genetic predisposition
- Diabetes or metabolic syndrome
- Sleep apnea
- Kidney disease
- Thyroid disease
- Adrenal gland problems
Ideal Blood Pressure Measurements
The American Heart Association categorizes normal and high blood pressure according to these parameters.
Normal blood pressure (must have both)
- Systolic blood pressure less than 120 mm Hg
- Diastolic blood pressure less than 80 mm Hg
Elevated blood pressure (must have both)
- Systolic blood pressure between 120 and 129 mm Hg
- Diastolic blood pressure less than 80 mm Hg
High blood pressure, stage 1 (can have either)
- Systolic blood pressure between 130 and 139 mm Hg
- Diastolic blood pressure between 80 and 89 mm Hg
High blood pressure, stage 2 (can have either)
- Systolic blood pressure 140 mm Hg or higher
- Diastolic blood pressure 90 mm Hg or higher
Hypertensive crisis (can have either)
- Systolic blood pressure higher than 180 mm Hg
- Diastolic blood pressure higher than 120 mm Hg
A hypertensive crisis is a medical emergency.
The higher your blood pressure, the higher your risk of cardiovascular disease, heart attacks, heart failure, stroke, and kidney disease.23 There is a strong association between high blood pressure and high blood sugar. Increased blood sugar causes changes in blood vessels and the kidneys, which can cause high blood pressure.24 Increased blood vessel stiffness, a cause of high blood pressure, can also worsen insulin resistance and increase fasting blood sugar.25
Tips for Meeting the Blood Pressure Recommendation
Adopting a healthy diet, such as the dietary approaches to stop hypertension (DASH) diet, may reduce systolic blood pressure by 8 to 14 mm Hg.23 Other lifestyle changes that can help you lower your blood pressure include:
- Reduce salt intake
- Increase potassium intake
- Increase magnesium intake
- Get 7 to 9 hours of high-quality sleep
- Make time for relaxing activities that lower stress
- Quit smoking
- Exercise regularly
- Lose excess pounds
- Limit alcohol use
<p class="pro-tip"><strong>Read more about </strong> <a href="/blog/blood-sugar-high-blood-pressure">how stable blood sugar can reduce your risk of high blood pressure</a>.</p>
Uric acid is a by-product of purine metabolism. It is known for its association with gout and kidney stones. However, high uric acid levels may also increase the risk of high blood pressure, metabolic syndrome, diabetes, fatty liver disease, and chronic kidney disease.12
Risk factors for increased uric acid include:
- Immune suppressing medications
- Kidney disease
- Genetic predisposition
- Purine-rich diet
- High fructose consumption
Uric acid can be increased after consuming these high-purine foods and drinks:
- Red meat
- Game meat
- Organ meat
- Beer and other alcoholic beverages
- Seafood and shellfish
Ideal Uric Acid Levels
Normal values for uric acid:26
- Between 3.5 and 7.2 milligrams per deciliter (mg/dL)
Tips for Meeting the Uric Acid Recommendation
To lower your uric acid to more healthy levels27
- Limit purine-rich foods in your diet
- Avoid medications that may increase uric acid
- Maintain a healthy body weight
- Maintain a stable blood sugar
- Increase fiber in your diet
- Avoid alcoholic and sugary drinks
- Limit fructose in your diet
<p class="pro-tip"><strong>Read more about </strong> <a href="/blog/what-is-sucrose">types of sugars, including fructose</a>.</p>
What Explains the Low Rates of Metabolic Health in Americans?
Metabolic syndrome is defined as failing to meet optimal levels for at least three out of five of the traditional metabolic markers (excluding uric acid). Only one in eight Americans meets the criteria for metabolic health—having optimal levels of all five markers without the use of medications.1
A study that applied the seven lifestyle and risk factor criteria suggested by the American Heart Association found that virtually no American adults met all the ideal levels, which may explain why there are such low rates of metabolic health in Americans.1
The American Heart Association's lifestyle and risk factors:28
- Not smoking
- Having a healthy diet
- Sufficient physical activity
- Normal weight
- Normal total cholesterol
- Normal blood pressure
- Normal blood glucose
- Sleep 7 to 9 hours each night (added in 2022)
High body mass index, high fasting blood glucose, and smoking are the top three leading causes of years lived with disability and injuries (reduced healthspan). Smoking and high blood pressure are the leading causes of years of life lost (reduced lifespan).29
How to Begin Improving Your Markers of Metabolic Health
The statistics for the metabolic health of American adults are concerning, but the good news is that making even slight changes can have a big impact on your healthspan (years lived in good health) and lifespan.
To improve your markers of metabolic health, look at your diet and physical activity. Improving your diet and losing even 5% of your body weight can improve your waist circumference, fasting glucose, and blood pressure. Track your blood glucose with a Signos continuous glucose monitor (CGM) and app to see what foods and drinks are causing blood glucose spikes and use CGM data to help with weight loss.
<p class="pro-tip"><strong>Read more about </strong> <a href="/blog/body-positivity-weight-loss">body positivity and weight loss</a>.</p>
Increasing your physical activity can improve all five markers. Physical activity and exercise are not the same. Physical activity is movement of any type. It does not have to be planned or structured. Set physical activity goals for yourself, such as the number of steps per day or getting up and moving every hour. Each 1,000 steps per day increase is associated with a lower risk of metabolic syndrome (study in American men).29
<p class="pro-tip"><strong>Read more about </strong> <a href="/blog/walking-for-weight-loss">how walking can help with weight loss</a>.</p>
As you gain confidence, slowly increase your physical activity and duration until you can exercise for 150 minutes per week or more at a moderate-to-vigorous level. Small incremental steps that you can commit to as long-term lifestyle changes will pay off as you see your metabolic health improve.
Healthy behaviors to improve your metabolic health:28
- Schedule Daily Exercise: Aim for 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity each week, or a combination of both.
- Aim for a Healthy Diet: Choose a healthy eating pattern that includes whole foods, fruits and vegetables, lean protein, nuts, and seeds.
- Add Resistance exercise: aim for two to three resistance exercise sessions per week to increase muscle mass and strength.
- Prioritize Sleep: Aim for 7 to 9 hours of restful sleep each night.
- Manage Stress: Make time for relaxing and fun activities to reduce your cortisol levels.
- Quit Smoking: If you smoke, talk to your doctor to get help with quitting.
<p class="pro-tip"><strong>For more tips, read: </strong> <a href="/blog/how-to-approach-metabolic-health">Easy Ways to Approach Your Metabolic Health</a>.</p>
Topics discussed in this article:
- Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metabolic Syndrome and Related Disorders. 2019/02/01 2018;17(1):46-52. doi:10.1089/met.2018.0105
- Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J. Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk--a review of the literature. Eur J Clin Nutr. Jan 2010;64(1):16-22. doi:10.1038/ejcn.2009.68
- Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TIL, Getz L. Body Configuration as a Predictor of Mortality: Comparison of Five Anthropometric Measures in a 12 Year Follow-Up of the Norwegian HUNT 2 Study. PLoS ONE. 2011;6(10):e26621. doi:10.1371/journal.pone.0026621
- Ross R, Neeland IJ, Yamashita S, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nature Reviews Endocrinology. 2020/03/01 2020;16(3):177-189. doi:10.1038/s41574-019-0310-7
- Williams R, Periasamy M. Genetic and Environmental Factors Contributing to Visceral Adiposity in Asian Populations. Endocrinol Metab (Seoul). Dec 2020;35(4):681-695. doi:10.3803/EnM.2020.772
- Huang PL. A comprehensive definition for metabolic syndrome. Dis Model Mech. May-Jun 2009;2(5-6):231-7. doi:10.1242/dmm.001180
- World Health Organization. Waist Circumference and Waist-Hip Ratio Report of a WHO Expert Consultation. http://apps.who.int/iris/bitstream/handle/10665/44583/9789241501491_eng.pdf;jsessionid=546D7D9F65CB1114D20723CCC3A130A0?sequence=1
- Vispute SS, Smith JD, LeCheminant JD, Hurley KS. The effect of abdominal exercise on abdominal fat. J Strength Cond Res. Sep 2011;25(9):2559-64. doi:10.1519/JSC.0b013e3181fb4a46
- American Diabetes Association. Understanding Insulin Resistance. https://www.diabetes.org/healthy-living/medication-treatments/insulin-resistance
- Centers for Disease Control and Prevention. Diabetes Tests. Accessed August 7, 2022. https://www.cdc.gov/diabetes/basics/getting-tested.html#:~
- Centers for Disease Control and Prevention. Trends in Elevated Triglyceride in Adults: United States, 2001–2012. https://www.cdc.gov/nchs/products/databriefs/db198.htm#
- Kanbay M, Jensen T, Solak Y, et al. Uric acid in metabolic syndrome: From an innocent bystander to a central player. Eur J Intern Med. Apr 2016;29:3-8. doi:10.1016/j.ejim.2015.11.026
- Clifton PM. Diet, exercise and weight loss and dyslipidaemia. Pathology. 2019;51(2):222-226. doi:10.1016/j.pathol.2018.10.013
- National Heart Lung and Blood Institute. High Blood Triglycerides. https://www.nhlbi.nih.gov/health/high-blood-triglycerides
- Macek P, Terek-Derszniak M, Biskup M, et al. A Two-Year Follow-Up Cohort Study-Improved Clinical Control over CVD Risk Factors through Weight Loss in Middle-Aged and Older Adults. J Clin Med. Sep 8 2020;9(9)doi:10.3390/jcm9092904
- Hannon BA, Thompson SV, Edwards CG, et al. Dietary Fiber Is Independently Related to Blood Triglycerides Among Adults with Overweight and Obesity. Curr Dev Nutr. Feb 2019;3(2):nzy094. doi:10.1093/cdn/nzy094
- Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association. Circulation. 2022;145(8):e153-e639. doi:doi:10.1161/CIR.0000000000001052
- Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? Bmj. Feb 5 1994;308(6925):367-72. doi:10.1136/bmj.308.6925.367
- Goldman L, & Schafer, A. I. Goldman-Cecil Medicine. 26 ed. Elsevier - Health Sciences Division.; 2019.
- Ma H. Cholesterol and Human Health. Nature Sci. 01/01 2004;2
- Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082-e1143. doi:doi:10.1161/CIR.0000000000000625
- Hegde S, Aeddula NR. Secondary Hypertension. StatPearls. StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.
- Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureThe JNC 7 Report. JAMA. 2003;289(19):2560-2571. doi:10.1001/jama.289.19.2560
- Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. The Lancet. 2012/08/11/ 2012;380(9841):601-610. doi:https://doi.org/10.1016/S0140-6736(12)60987-8
- Jia G, Sowers JR. Hypertension in Diabetes: An Update of Basic Mechanisms and Clinical Disease. Hypertension. Nov 2021;78(5):1197-1205. doi:10.1161/hypertensionaha.121.17981
- University of California San Francisco. Uric Acid Blood. https://www.ucsfhealth.org/medical-tests/uric-acid----blood-#
- Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Annals of the Rheumatic Diseases. 2017;76(1):29. doi:10.1136/annrheumdis-2016-209707
- American Heart Association. Life's Essential 8. Accessed August 7, 2022. https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8
- Virani SS, Alonso A, Aparicio HJ, et al. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. Feb 23 2021;143(8):e254-e743. doi:10.1161/cir.0000000000000950