Written by Dr Todd On, Associate Consultant, Family Physician, MBBS, GDFM, MMED (FM), MCFP (S)
Perhaps, when you hear the words “metabolic health”, you think about diabetes and obesity. But by the time diabetes or the health issues associated with weight gain develops, metabolic dysfunction has often been building silently for years.
Long before blood sugar crosses the threshold for a diabetes diagnosis, the body may already be showing signs of insulin resistance, excess visceral fat, chronic inflammation, elevated blood pressure, abnormal cholesterol levels, and fatty liver disease. These changes increase the risk not only of type 2 diabetes, but also heart disease, stroke, chronic kidney disease, certain cancers and even cognitive decline.
This is why metabolic health deserves far more attention than it receives today.
Rather than asking, “Do I have diabetes?”, the better question is: “How healthy is my metabolism?”
What is metabolic health?
The body’s ability in processing, storing and utilizing energy and nutrients forms the baseline of metabolic health.
In a state of optimal metabolic health, our body will be able to process the nutrients and energy from our food well, and maintain a good balance in storing and utilizing these nutrients and energy levels. For example, relating to blood glucose, our body will be able to process carbohydrates eaten into blood glucose, and this blood glucose rise tells our pancreas to release insulin, which signals cells to draw glucose from the bloodstream, immediately turning it into energy or reserving it for future utilization as glycogen and fat.
Furthermore, a well-functioning metabolism manages dietary fats effectively to prevent elevated triglyceride levels. It promotes the generation of HDL cholesterol (the “good” form that shields against heart attacks) while keeping LDL cholesterol (the “bad” form associated with heart attack risks) in check.
Recommended Reading: What is Metabolic Health?
The problem is that metabolic disease develops quietly
One of the greatest challenges with metabolic disease is that it rarely causes symptoms in its early stages. You may feel perfectly well while significant changes are already occurring inside the body causing a deterioration of your metabolic health. Visceral fat accumulates around internal organs gradually, leading to increasing insulin resistance, so the pancreas has to work harder to produce more insulin to lower blood sugar. Increased body fat and bad cholesterols increases inflammation throughout the body, leading to accumulated damage to the blood vessels.
Without testing, many people only discover a problem after complications appear.
This explains why prevention has become such an important focus in modern medicine.
According to the American Diabetes Association’s 2026 Standards of Care, identifying people at high metabolic risk and intervening early through structured lifestyle and medical programs can significantly prevent or delay progression to type 2 diabetes, and improve other cardiometabolic risk factors such as blood pressure, lipids and markers of inflammation.
Metabolic health is about much more than weight
Many people assume that being slim automatically means they are healthy. Unfortunately, this is not always true.
Research shows that some individuals with a “normal” body weight and BMI can still have poor metabolic health due to excess visceral fat, insulin resistance, or abnormal lipid profiles (referred to as Metabolically Unhealthy Normal Weight (MUHNW)). Conversely, not everyone living with obesity has the same metabolic risk (Metabolically Healthy Obesity (MHO)).
This is why doctors are moving beyond BMI alone.
Moving beyond the WHO definition of obesity based on BMI, in 2025 the Lancet Diabetes and Endocrinology Commission now recommend confirming excess adiposity (fat) with at least one additional measure, such as waist circumference, waist-to-hip ratio, or direct body fat measurement, to diagnose obesity more clearly. This helps to reduce overdiagnosis and underdiagnosis of obesity, and helps distinguish “preclinical” obesity (excess fat without organ dysfunction) from “clinical” obesity (a disease in its own right due to excess fat already causing a negative health effect).
Thus, your metabolic health cannot be judged by the number on the scale.
Why metabolic health matters even before diabetes
Type 2 diabetes does not appear overnight. It develops over many years. During this time, blood vessels, nerves, kidneys and the heart may already be experiencing damage.
People with poor metabolic health are at increased risk of:
- Type 2 diabetes
- Heart attack and stroke
- Fatty liver disease
- Chronic kidney disease
- Sleep apnea
- Polycystic Ovarian Syndrome (PCOS), now known as Polyendocrine Metabolic Ovarian Syndrome (PMOS)
- Cognitive decline
- Reduced healthy lifespan
Globally, according to WHO data in 2021, conditions associated with poor metabolic health such as ischaemic heart disease, stroke, Alzheimer’s and other dementias, diabetes mellitus, and kidney diseases rank amongst the top 10 global causes of death and causes of disability-adjusted life years (DALYs).
Thus the earlier metabolic dysfunction is identified, the greater the opportunity to reverse or slow its progression, so that our lifespan and healthspan (healthy lifespan) can be improved.
Prevention is no longer enough; people need personalized management
Traditional healthcare often relies on annual health screenings. The problem is that receiving abnormal results does not automatically lead to meaningful change.
Many people leave with a report, good intentions and little ongoing support, but behavior change can be difficult. Managing a metabolic disease such as diabetes or prediabetes is even harder.
Sustained improvements require continuous care, regular monitoring, personalized nutrition, physical activity guidance and behavioral support, not simply one-off advice.
Metabolic health is not improved in a single consultation, it improves through consistent action over time.
What should you monitor?
For individuals concerned about their metabolic health, doctors commonly assess multiple indicators rather than relying on glucose alone.
These may include:
- HbA1c
- Fasting glucose
- Continuous glucose monitoring (CGM), where appropriate
- Blood pressure
- Lipid profile
- Liver function
- Kidney function
- Waist circumference
However, during the initial phases of insulin resistance, typical screenings like fasting glucose and HbA1c usually fail to detect abnormalities. The body manages this by generating surplus insulin to offset the tissues’ diminished responsiveness, thereby maintaining normal blood sugar levels even as metabolic health declines. It is only further along in the progression, when the body can no longer produce sufficient insulin to counteract the resistance, that these test results finally become abnormal.
A test called HOMA-IR can be used to look for early insulin resistance, allowing you to get a more comprehensive picture of your metabolic health.
Performing more detailed measurements such as doing a bio-impedance body composition or DEXA body composition scan would also help to give more information than BMI, and let us know important metrics such as body fat percentage, visceral fat level, and muscle mass which contribute to metabolic health.
The future of healthcare is proactive
Healthcare is gradually shifting from treating disease after complications occur to identifying risk much earlier. This shift reflects decades of scientific evidence showing that early intervention leads to better long-term outcomes. The goal is not simply to live longer, but to spend more years living free from chronic disease.
Learn more about NOVI’s Longevity programs.
Take control before complications begin
If you have prediabetes, type 2 diabetes, excess weight, high blood pressure, abnormal cholesterol or a family history of metabolic disease, waiting until symptoms appear may mean waiting too long.
Improving metabolic health is possible, but it requires more than a single consultation or annual screening.
At NOVI Health, our physician-led NOVI Magnum Diabetes Care program combines medical care with continuous coaching to help people improve blood sugar control, and metabolic health, and reduce long-term metabolic risk.
The programme includes:
- Specialist doctor consultations
- Personalized diabetes management plans
- Registered dietitian support
- Continuous glucose monitoring (where appropriate)
- Ongoing health coaching through the NOVI App
- Regular monitoring of metabolic markers and treatment progress
Rather than simply managing diabetes after complications develop, NOVI Magnum focuses on helping you take control of your metabolic health earlier, with personalized care designed to deliver lasting improvements.
About the Author
Dr. Todd On, an Associate Consultant and Family Physician with 16 years of experience in tertiary and community care, specializes in person-centered treatment for acute and chronic conditions. He has led quality initiatives in smoking cessation and diabetic care and is an award-winning clinical tutor at the College of Family Physicians Singapore.