Metabolic health is foundational to overall well-being, yet most people are unaware of its importance and how to assess overall metabolic health. Recent estimates indicate less than 10% of American adults are metabolically healthy, defined as having optimal levels of blood sugar, blood lipids, blood pressure, and abdominal fat without the use of medications for these indications (1, 2). 

Here, we take a deeper look at the 4 key metrics used to assess metabolic health, how to support clients in obtaining their measures of metabolic health, and a guide to high-level interpretation of results. 

Why Coaches Should Understand Metabolic Health Metrics

Understanding how to assess and discuss metabolic health with your clients is an important step to improving their long-term health and lowering risk of chronic diseases. Identifying key areas for client support allows coaches to tailor evidence-based lifestyle interventions and to track client progress over time – key differentiators from one-size-fits-all solutions. 

Measuring Metabolic Health

In a previous article, I introduced the 4 key metrics used to assess metabolic health, their connection to risk of diseases, and optimal levels. To assess an individual’s overall metabolic health, you need to have the following measures: 

1. Blood sugar – either as fasting plasma glucose or HbA1c, but ideally both;
2. A blood lipid profile either including triglycerides and high-density lipoprotein (HDL) cholesterol, or the Total cholesterol: HDL cholesterol ratio can also be used; 
3. Blood pressure; and
4. Waist circumference 

The first three metrics are often measured at an annual physical, so many clients may already have these results. If not, you can encourage them to go for an annual physical – ensuring they ask for these standard tests if covered by their health plan. 

Alternatives to physician-ordered testing

If a client does not have access to a healthcare provider for these tests, there are many walk-in labs (e.g. LabCorp, Quest, walkinlab.com) or at-home testing kit services that can test blood sugar (usually as HbA1c) and lipids. While the at-home test kits like this one can be convenient and affordable, the process can be confusing for first-time users. If you suggest one of these options for your clients, going through the process yourself will ensure you provide the best support for your clients. You will also want to ensure the test covers fasting glucose or HbA1c, HDL-cholesterol, and either triglycerides, total cholesterol, or both.

Considerations for At-home Health Tests

The most common at-home test kits for blood sugar and lipids will use a finger prick blood collection. This process can be tedious, and there are many tips to ensure a better experience and viable sample. Heating the arm and hand prior to the finger prick, being hydrated, pricking on the side of finger rather than the center of the fingertip, holding the hand below the heart, and not excessively squeezing the finger to get blood are all actions that can improve consumer experience and the quality of the lab sample. Ensuring clients watch demonstration videos and read instructions thoroughly is also important. 

However, these tests only cover metrics 1 and 2, the blood-based testing. You will have to find alternate ways to obtain blood pressure and waist circumference measures.

How to Assess Blood Pressure 

Some pharmacies still offer walk-in blood pressure readings, but it is best to check with individual stores for more information. This is also a service you can offer clients if you have training in measuring blood pressure. Whether a client has the reading performed by you or another party, communicate the following to ensure an accurate reading:

• Sit quietly and relax for at least 5 minutes before taking the measure
• Avoid strenuous activity, caffeine, and nicotine for at least 30 minutes prior
• Sit with feet flat on the floor, and avoid crossing legs and talking or moving during the measure
• Rest the arm on a flat surface at about heart level, and use a bare arm when possible
• Take at least 2 readings, 1-2 minutes apart and record the average

Following these steps will provide a more accurate reflection of blood pressure, as conditions like “White coat syndrome” and other anxieties can sometimes result in higher readings that may not reflect typical blood pressure.

How to Assess Waist Circumference

Waist circumference is a simple but effective proxy for abdominal fat you can offer your clients, but procedure should be followed for accuracy and consistency:

• Have the individual stand straight, with feet shoulder-width apart and a relaxed abdomen (don’t hold breath or suck in stomach)
• Find the top of the hip bones (iliac crest), and use a measuring tape to assess waist circumference at the level of the top of the hip bones, making sure the tape is snug but not compressing the skin
• Measure at the end of a normal exhale

Interpreting Key Metabolic Health Metrics

The following table summarizes optimal, intermediate, and poor ranges for each metric (1,2). The goal is to shift all measures towards the optimal category. These values can help you assess a client’s status in each key area for a full picture of metabolic health.

Abbreviations: BMI, body mass index; DBP, diastolic blood pressure; F, female; FPG, fasting plasma glucose; HDL, high-density lipoprotein cholesterol; M, male; NA, not applicable; TG, triglyceride; SBP, systolic blood pressure; WC, waist circumference
*Without use of related medications to achieve optimal range.

What If the Numbers Are Out of Range?

While you should not provide medical advice to individuals unless you are a qualified healthcare provider, you may likely be the first person to discuss the importance of metabolic health with your client, and to explain what their levels mean in terms of overall metabolic health. If you use an external lab or at-home test and results are out of range, clients should discuss the results with a qualified healthcare professional. 

Final Thoughts

Assessing metabolic health is the first step toward improving it – and most people don’t know their metabolic health status. By monitoring the 4 key metrics reviewed, coaches can identify early signs of metabolic dysfunction. This will be extremely valuable for your clients on their journey to improve their health, and it will guide you to design a personalized approach based on their needs.

References:

(1) Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009-2016. Metab Syndr Relat Disord. 2019 Feb;17(1):46-52. doi: 10.1089/met.2018.0105. Epub 2018 Nov 27. PMID: 30484738.

(2) O’Hearn M, Lauren BN, Wong JB, Kim DD, Mozaffarian D. Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018. J Am Coll Cardiol. 2022 Jul 12;80(2):138-151. doi: 10.1016/j.jacc.2022.04.046. PMID: 35798448.

About Erin Glynn, PhD

Dr. Glynn is an expert in metabolism, exercise physiology, weight management, and metabolic disease, with over 30 published research articles in these fields. After a decade conducting academic research in these areas, Erin transitioned to researching and developing dietary supplements and health programs – leading a global R&D team of nutrition scientists. In 2023, she left the corporate world to found Nuchi Health – a company with a mission to provide credible, no-hype nutrition, health, and wellness education for consumers and health practitioners. Dr. Glynn hosts the Nuchi Health Podcast and serves in leadership and advisory roles for the American Society for Nutrition (ASN) and Unicity International.