Although there are many factors to consider in determining the state of our health, a major aspect is our weight and many of us are aware that being overweight can increase our risk of developing many life-threatening diseases. For this reason, it’s easy to assume that those who are slim are immediately healthier than those carrying excess fat, but the truth is that many people at a ‘healthy’ weight are not metabolically healthy. In fact, statistics show that as many as 1 in 3 slim Americans have pre-diabetes, a condition usually solely associated with obesity.

Pre-DiabetesThe link between inactivity and pre-diabetes

A study published in the American Journal of Preventative Medicine in January 2017 found that in adults of a healthy weight, low physical activity levels are strongly associated with abnormal blood glucose levels, which is an indicator of pre-diabetes or undiagnosed diabetes. 25% of the study participants who were inactive were found to be either pre-diabetic or diabetic. When age was considered, 40% of inactive participants aged 40 and above were diagnosed as pre-diabetic or diabetic.

The study established that those who live predominantly sedentary lifestyles had a higher proportion of fat to lean muscle than the more active participants. Thus, they were described as having ‘normal-weight obesity’. The key message is that even if the number on the scale seems healthy, there’s no room to become complacent about your health. By increasing your activity you increase your ratio of lean muscle and reduce the risk of insulin resistance.

There are more unhealthy thin people than unhealthy fat people in the US

Professor of pediatric endocrinology at the University of California, San Francisco, Dr. Robert Lustwig, has discussed in great detail the rates of sickness in both obese and healthy weight individuals.

Currently, around 30% of the US population is obese, and 80% of this proportion suffers from insulin resistance, which can show itself not only in pre-diabetes and diabetes, but a myriad of other serious conditions such as heart disease, hypertension and cancer. Of the 70% of Americans that are of a normal weight, 40% also suffer from insulin resistance and the same kinds of conditions.

Although these statistics prove that obesity increases the risk of insulin resistance, they also demonstrate that there are a higher number of slim people with insulin resistance and metabolic diseases than there are fat people with the same ill-health. It’s clear than that slim people cannot rest on their laurels and assume they’re in good health simply for being of a normal weight.

The reason why exercise is important for more than just weight loss

A study from 2015 in the Annals of Internal Medicine found that sitting for more than eight hours each day increases the risk of type 2 diabetes by an astounding 90%. Exercise is commonly recommended by doctors to help overweight patients lose weight and thus reduce symptoms of diabetes or reduce the risk of a diagnosis, but the benefits of being more active go far beyond fat loss.

Exercise promotes muscle gain and stimulates mitochondrial biogenesis, which further tones muscles and improves insulin sensitivity. Plus, it helps to reduce visceral fat – that which gathers around the internal organs – which also improves metabolic health.

Determining your own pre-diabetes risk

We’ve established that pre-diabetes is a risk for people of healthy weight as well as in those that are obese, and for this reason we recommend that everyone undergo annual blood tests to establish their fasting insulin and glucose levels. You can incorporate these tests into your annual health examination.

A normal and healthy fasting blood insulin level is below 5, but ideally below 3. Your fasting glucose level should be below 100 mg/dl; anything between 100 and 125 is an indicator of pre-diabetes.

You could also measure your waist-to-hip ratio (WHR) as an indicator of pre-diabetes. Measure the circumference of your waist, and then the circumference of your hips around the widest part of your buttocks. Divide the waist measurement by the hip measurement, and you’ve established your WHR. Here’s a breakdown of WHR norms:

0.95 – At risk of pre-diabetes and cardiovascular disease

0.86 – At risk of pre-diabetes and cardiovascular disease

For many people, but particularly those of a healthy weight, WHR is a far more effective method of evaluating a weight problem than body mass index (BMI) which only takes into account height and weight, and not the proportion of fat to lean mass or the amount of visceral fat that can increase the risk of insulin resistance. A simple BMI reading could indicate that an individual is of normal weight, but if their WHR is particularly high, they will be at an increased risk of pre-diabetes.

Insulin resistance can be reduced in as little as two weeks

If you know you’re at an increased risk of pre-diabetes or have even been diagnosed, you’ll be pleased to know that you can reverse insulin resistance once you get your diet under control and incorporate some exercise into your lifestyle.

A study published in Medicine and Science in Sports and Exercise in 2011 found that with three sessions of interval training for just two weeks, participants with type 2 diabetes were able to improve their insulin sensitivity and blood glucose levels in just two weeks. Although all types of exercise are beneficial, interval training, which involves exercising in very short, high intensity bursts, was found to be most effective in improving insulin sensitivity compared to longer periods of exercise at a slower pace.

HIIT – high intensity interval training – is an incredibly popular and effective method that will not only improve blood glucose levels, but also help those with excess fat to lose weight. It’s also an effective way to improve overall fitness levels when performed regularly. A typical HIIT workout will involve 30 second intervals of very intense activity with maximum effort exerted, interspersed with 90 second intervals of rest in order to bring the heart down and let the body recuperate.

Spend less time sitting for even more health benefits

Aside from incorporating regular exercise into your routine, you should also work on being more active in general. Long periods of sitting have been linked in various studies to diabetes and other chronic diseases. It is believed that doing so caused increased aging on a cellular level.

Telomeres, which are structures found at the end of chromosomes (part of a cell which contains our genetic makeup), become shorter each time a cell divides, and are therefore used to measure biological aging. Short telomeres have been linked to diabetes, heart disease, diabetes and cancer.

A study published in January this year in the American Journal of Epidemiology found that women (aged between 64 and 95) who sat for more than 10 hours and participated in less than 40 minutes of moderate exercise each day, were found to have shorter telomeres than their more active counterparts. This suggests that inactivity leads to premature biological aging. In fact, those who were less active were biologically 8 years older than the more active women on average.

The impact of inactivity on insulin levels are so severe that they can even be affected after just one day of sitting, as it causes the pancreas to produce increased amounts of insulin. Not only that, but Diabetologia journal found that those who spend the longest periods at time sitting are twice as likely to have diabetes or heart disease compared to those who spend the least amount of time sitting each day.

If you live a very sedentary lifestyle, it’s important that you try to reduce the amount of time you spend sitting down as much as possible. If lifestyle factors such as your job cause you to have to sit for long periods, try to make a habit of standing up and taking a short walk every hour or so to increase your activity levels, and outside of work make a concerted effort to walk more frequently.

The next step to improving your health

The key point to take home is that even if you’re at a healthy weight, you still need to take precautions to minimize the risk of developing pre-diabetes or diabetes; you should have frequent blood tests, keep check of your waist-to-hip ratio, and ensure you remain active both in terms of doing regular exercise and spending less time sedentary on a daily basis.

For those who have already had a diagnosis of pre-diabetes or diabetes, it’s never too late to work on managing and improving your condition. Although you may have been prescribed medications to help manage the disease, the Diabetes Prevention Program Research Group have found that lifestyle interventions, such as dietary changes and increases in exercise, were more effective in delaying the development of diabetes in people at high risk of the disease.

An all round healthy lifestyle is key to avoiding insulin resistance, so no matter your weight or size, it’s important to be active and eat a balanced diet to keep your risk low. If you’re of a normal BMI, be aware that your current lifestyle could still put you at risk of diabetes. Those at an unhealthy weight can certainly reduce their risk by losing weight, but improving diet and increasing exercise will also go a long way in fighting off diabetes.