Why metabolic health matters in South Africa
Metabolic problems are common, and they are often silent. According to the South African Demographic and Health Survey (2016):
- almost half of adults aged 15 and older had high blood pressure;
- about two in three women and one in three men were living with overweight or obesity;
- about 13% of women and 8% of men had diabetes.
Many people with these conditions feel completely well. That is why measuring matters.
The five markers doctors look at
Doctors commonly use an internationally agreed ("harmonised") definition of metabolic syndrome. You meet the definition if any three of these five are present:
| Marker | Outside the healthy range |
|---|---|
| Waist circumference | 94 cm or more (men), 80 cm or more (women)* |
| Blood pressure | 130/85 mmHg or higher, or on treatment |
| Fasting blood sugar | 5.6 mmol/L or higher, or on treatment |
| Triglycerides | 1.7 mmol/L or higher, or on treatment |
| HDL cholesterol | below 1.0 mmol/L (men) or 1.3 mmol/L (women), or on treatment |
*These waist cut-offs are recommended for European and sub-Saharan African populations. Lower cut-offs are used for some groups, including people of South Asian descent (90 cm for men).
Why waist size, not just weight?
Fat stored around the abdominal organs (visceral fat) is more closely linked to insulin resistance, fatty liver and heart disease than total body weight. Two people with the same weight can have very different metabolic risk. Measure around your middle, level with your belly button, after breathing out normally.
Other tests your doctor may consider
Depending on your history, a doctor may also look at:
- HbA1c, an average of your blood sugar over the past two to three months;
- a full lipid profile, including LDL cholesterol;
- liver tests, since fatty liver is closely tied to metabolic health;
- kidney function and urine tests, especially if blood pressure or sugar is raised.
Which tests make sense depends on your age, family history and symptoms. More tests are not always better.
How to improve your metabolic health
The evidence consistently points to the same foundations:
- Move more. The World Health Organization recommends 150 to 300 minutes of moderate activity a week (such as brisk walking), plus regular muscle-strengthening activity, and less time sitting.
- Eat mostly whole foods. More vegetables, legumes, whole grains, fruit, nuts and lean proteins; fewer sugary drinks and highly processed foods.
- Sleep enough. Adults should aim for seven or more hours a night on a regular basis.
- Limit alcohol and avoid smoking.
- Aim for gradual, sustained weight loss if you are carrying excess weight. In a landmark trial, a lifestyle programme aiming for about 7% weight loss and 150 minutes of activity a week reduced the development of type 2 diabetes by 58% over about three years.
When to see a doctor
Consider a check-up if you:
- have a waist above the cut-offs above;
- have a family history of diabetes or early heart disease;
- have had diabetes in pregnancy or have PMOS (polyendocrine metabolic ovarian syndrome, the new name for PCOS);
- have never had your blood pressure, blood sugar or cholesterol measured as an adult.
Frequently asked questions
Can I be slim and metabolically unhealthy?
Yes. Some people at a "normal" weight have raised blood sugar, blood pressure or blood fats, often linked to fat stored around the organs. Measurements, not appearance, tell the story.
Is metabolic syndrome a disease?
It is a cluster of risk factors rather than a single disease. Its value is as a warning sign that your risk of diabetes and heart disease is higher.
Can metabolic syndrome be reversed?
Many people improve one or more markers, sometimes enough to no longer meet the definition, through activity, nutrition, sleep and weight changes. Some people also need medicines. Your doctor can help you decide.
How often should I check?
It depends on your results and risks. Your doctor can advise a sensible interval for you.
References
- National Department of Health (NDoH), Stats SA, SAMRC and ICF. South Africa Demographic and Health Survey 2016: Key Findings. DHS Program. https://www.dhsprogram.com/pubs/pdf/DM142/DM142.pdf
- Alberti KGMM et al. Harmonizing the metabolic syndrome. Circulation. 2009. Summary: https://www.metabolicum.com/learn/research/metsyn-alberti-2009
- Seedat YK et al. South African hypertension practice guideline 2014. Cardiovascular Journal of Africa. 2014.
- World Health Organization. Guidelines on physical activity and sedentary behaviour. 2020.
- American Academy of Sleep Medicine and Sleep Research Society. Recommended amount of sleep for a healthy adult. https://sleepeducation.org/get-involved/campaigns/7-and-up-the-healthy-sleep-duration-for-adults/
- Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine. 2002.
This article is for general educational purposes only, like a health newsletter. It is not medical advice, diagnosis or treatment, and reading it does not create a doctor and patient relationship. Please speak to your own doctor about your situation. In an emergency, call 10177 or 112, or go to your nearest emergency unit.