“Only 12% of American Adults Are Metabolically Healthy”
It was fascinating yesterday hearing former FDA Commissioner David Kessler close out a symposium on food noise, chatting about his views on healthy weight. He marvelled at the size of the problem and how, after years of studying it, people have difficulty with agreeing on a definition for “clinical obesity.” How hard can it be? After all, he said, “only 12% of American adults are metabolically healthy.”
This is a point he makes in his new book: Diet, Drugs and Dopamine – The New Science of Achieving a Healthy Weight. His real point is that dealing with obesity is not really about weight. It is about achieving good metabolic health.
On this we agree.
The Study
Kessler’s handy factoid comes from a 2018 study by Joana Araújo, Jianwen Cai, and June Stevens in Metabolic Syndrome and Related Disorders. They analyzed NHANES data from 2009 to 2016, looking for the prevalence of people who met criteria for optimal waist circumference, blood glucose, blood pressure, triglycerides, and HDL cholesterol. Only 12.2% met all of those criteria for good metabolic health.
How Hard Must This Be?
On the surface, it is a reasonable argument. It reminds us of the retort we received to a post about studies in Annals about slow progress in distinguishing different levels of obesity risk. Terry Maratos-Flier, an emerita professor of medicine at Harvard, wrote:
“On an individual basis a competent PCP should do this readily. Look at patient, age, sex distribution of adiposity, family history, A1c, lipid profile. It’s not hard. Any numbers would be valid on population basis, not necessarily individuals. Are we getting dumb?”
Nope. We’re not dumb. But we sure can be fussy.
Click here for the study by Araújo, Jianwen, and Stevens and here for reporting on it. For further perspective on our machinations regarding a definition for clinical obesity, click here and here.
The Mountain, painting by Emily Carr / WikiArt
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July 31, 2025
