I hope you’ve been enjoying the good weather this weekend? I’m not much of a gardener, but those weeds won’t remove themselves, and I’ve planted a lot of vegetables which needed attention. How much we get to eat of it remains to be seen, as the snails are queuing up outside! Vegetables may be a good place to start week 3 of my series on prevention, where I’m looking at some of the major health conditions and what we can realistically do to reduce risk. This week I want to tackle diabetes, obesity and metabolic syndrome — a topic that sits at the centre of so many modern health problems.
Why diabetes, obesity and metabolic syndrome matter
This is not simply about weight, and it is certainly not about blame. Type 2 diabetes, obesity and metabolic syndrome are among the major drivers of preventable illness: heart disease, stroke, heart failure, kidney disease, fatty liver disease, sleep apnoea, some cancers, dementia risk, osteoarthritis and loss of independence.
Metabolic syndrome is the term used when several risks tend to cluster together: increased waist circumference, raised blood pressure, abnormal cholesterol or triglycerides, and impaired glucose handling. In simple terms, it is a sign that the body’s metabolism is under strain.
It often saddens me walking around the hospital and seeing the consequences of just how common overweight, obesity and metabolic disease have become, among both patients and staff. As a society we have sleepwalked into a health emergency that is placing enormous strain on individuals, families and health services, and it is only getting worse. This is not to lay the blame on anyone. It is simply to recognise the scale of the problem.
What we cannot control
It is far too simplistic to say this is all about willpower. Genetics, early-life environment, hormones, menopause, sleep, stress, medication, work patterns, food availability and the modern environment all matter. This last point is so important. Many people are trying to manage their health in a world that makes weight gain easy and weight loss difficult, with many food companies incentivised to produce food contrary to what we really require.
That matters because shame is not a useful medical strategy, and in fact often has the opposite effect. Understanding biology is. A well-informed patient is much more able to make better decisions.
What we can influence
Firstly, in a huge number of cases, metabolic syndrome and diabetes can be either reversed, or dramatically improved, so all is certainly not lost.
The goal is not simply to “lose weight”. That is what we might see with our eyes, but the importance is often hidden. The goal is to improve metabolic health: reduce visceral fat (fat around our organs), preserve or build muscle, improve blood pressure, improve glucose control, improve cholesterol and reduce long-term risk.
The practical areas that matter most are diet quality, regular movement, resistance training, aerobic fitness, sleep, alcohol intake, blood pressure, glucose levels, lipids, waist circumference and, where appropriate, medical treatment.
A particularly important point is muscle, and one that is very often overlooked and under-appreciated.. Weight loss can be very beneficial, but losing muscle alongside fat is not what we want, especially as we age. This is why protein intake, resistance training and strength matter so much. In addition, muscle acts as a store for glucose, so increasing the amount of muscle we have can improve insulin sensitivity.
On the nutrition side, I would avoid making this too complicated. Most people would do better by eating more protein, more fibre, more minimally processed food, and fewer ultra-processed foods, snacks and liquid calories (including alcohol). That does not mean perfection, and it does not mean never enjoying food. It means improving the default pattern. No-one is perfect, least of all me (I’ve literally just had an ice-cream in the back garden!) but making consistently better choices adds up.
Screening and early detection: why it is complicated
Many people have insulin resistance for years before type 2 diabetes is diagnosed. HbA1c is the usual blood test to help make a diagnosis. It is a measure of how well our bodies have controlled sugar levels over the preceding 3 months. It is useful, but it is not the whole story. Waist circumference, blood pressure, triglycerides, HDL cholesterol, evidence of fatty liver, family history and body composition can all give clues. Remember also that HbA1c is a spectrum. Although doctors use cut-offs to diagnose pre-diabetes and diabetes, a person’s blood results over time give us far more useful information.
This is also why “normal weight” does not always mean low risk, and “overweight” does not tell the whole story. Where fat is stored, how much muscle someone has, and how the body is handling glucose and fat are all important.
Key takeaways
Type 2 diabetes and metabolic syndrome are major drivers of preventable disease.
Obesity is biology plus environment, not simply willpower.
Visceral fat and insulin resistance matter more than weight alone.
Resistance training, aerobic exercise, nutrition, sleep and alcohol all matter.
Even modest weight loss can significantly improve metabolic health.
Medication can be helpful and appropriate, but it should sit alongside nutrition, movement and muscle preservation.
Prevention is not about shame. It is about recognising risk early and acting intelligently.
For those who want to go deeper
This is where things become very interesting. We are increasingly able to look beyond weight alone and assess body composition, visceral fat, blood pressure, HbA1c, lipids, ApoB, fatty liver risk, fitness, strength and sleep. In some people, newer treatments such as GLP-1 or GIP-based therapies may have an important role, but they need to be used thoughtfully. I’ve written lots on this before and it can all be accessed in the members area.
Looking ahead, this is exactly the sort of area where preventive health and healthspan medicine can add value: not just reacting once diabetes, heart disease or fatty liver has developed, but identifying risk earlier and helping people preserve metabolic health, muscle, movement and independence for as long as possible.