Cardiometabolic Risk: Why Your Weight Is Only Part of the Picture

Cardiometabolic risk refers to the combined likelihood of developing cardiovascular disease (including heart attack and stroke) and metabolic conditions (including type 2 diabetes and metabolic syndrome). It is determined by a cluster of interacting factors — many of which are closely linked to excess body weight, but none of which can be fully captured by BMI alone.

What is metabolic syndrome?

Metabolic syndrome is a cluster of five risk factors that frequently occur together and dramatically increase the risk of cardiovascular disease and type 2 diabetes. According to the International Diabetes Federation definition, metabolic syndrome is present when central obesity (waist circumference above 94cm in European men or 80cm in European women) is accompanied by two or more of the following:

• Elevated triglycerides (≥1.7 mmol/L) or treatment for elevated triglycerides
• Reduced HDL cholesterol (<1.03 mmol/L in men, <1.29 mmol/L in women)
• Elevated blood pressure (systolic ≥130 mmHg or diastolic ≥85 mmHg) or treatment for hypertension
• Elevated fasting glucose (≥5.6 mmol/L) or previously diagnosed type 2 diabetes

Metabolic syndrome affects approximately 25–30% of UK adults and is strongly associated with visceral adiposity.

What is the difference between metabolically healthy and metabolically unhealthy obesity?

Not all people with obesity have the same cardiometabolic risk profile. A subset — estimated at 10–30% of people with obesity — are described as "metabolically healthy obese" (MHO): they have excess body fat but normal blood pressure, blood glucose, and lipid levels. However, research suggests that MHO is not a stable state. A 2018 study in the Journal of the American College of Cardiology following over 90,000 participants found that people who were metabolically healthy obese at baseline had a 50% higher risk of cardiovascular events over 12 years than metabolically healthy normal-weight individuals, and many transitioned to metabolically unhealthy obesity over time.

What tests assess cardiometabolic risk?

• Fasting lipid profile — total cholesterol, LDL, HDL, and triglycerides
• Fasting glucose and HbA1c — to detect impaired fasting glucose and type 2 diabetes
• Blood pressure — both systolic and diastolic
• Waist circumference — a more sensitive marker of visceral fat than BMI
• Liver function tests — to screen for non-alcoholic fatty liver disease
• High-sensitivity CRP — a marker of systemic inflammation and independent cardiovascular risk factor

How does weight loss affect cardiometabolic risk?

Weight loss of 5–10% of body weight produces clinically meaningful improvements across all components of metabolic syndrome. A 2016 meta-analysis in Obesity Reviews found that this level of weight loss reduced triglycerides by 20%, raised HDL cholesterol by 8%, reduced systolic blood pressure by 3–8 mmHg, and reduced fasting glucose by 0.5–1.0 mmol/L. Greater weight loss produces proportionally greater improvements.

A thorough cardiometabolic assessment is part of every consultation at Weight Loss Wales. Book your appointment today.