Is Your Metabolism in Trouble? Let’s Talk Metabolic Syndrome

Jennifer Hardy
10 hours ago
10 min read

You’ve probably heard the term metabolic syndrome tossed around lately—on wellness podcasts, in doctors’ offices, even on TikTok. It sounds serious (it is), but also vague (it kind of is). Is it diabetes? A slow metabolism? Is it just another name for being overweight? Not exactly.

As someone who deals with obesity, high blood pressure, and chronic kidney disease, I've never once had a doctor mention metabolic syndrome. That’s a problem, because understanding metabolic syndrome isn’t just for people already on meds. It’s for anyone trying to make sense of their health or support someone they care about.

In this article, we'll explore what metabolic syndrome is, its risk factors, its criteria, and its treatment.

The Basics of Metabolic Syndrome

Metabolic syndrome, sometimes called insulin resistance syndrome or syndrome X, is basically a cluster of health issues that tend to show up together.

“Metabolic” refers to your metabolism, which is how your body processes energy — everything from how you break down food to how you store fat and regulate blood sugar.

“Syndrome” means a group of conditions that show up together.

Metabolic syndrome literally means: "A group of metabolic problems that tend to cluster in the same person"

Symptoms can include high blood pressure, high blood sugar, extra belly fat, and abnormal cholesterol levels.

It was first named in the late '80s and early '90s, when researchers started connecting the dots between these conditions and the risk for heart disease and type 2 diabetes.

Having just one of these isn’t metabolic syndrome, but when they gang up, it signals your body is out of balance. It’s a warning sign—like your body saying, “Hey, we need to talk.”

Metabolic Syndrome Criteria

To be diagnosed with metabolic syndrome, you typically need to meet at least three out of five of the following criteria (as defined by the National Cholesterol Education Program’s Adult Treatment Panel III):

Waist circumference: Over 40 inches for men, over 35 inches for women (this may vary by ethnicity).
Triglycerides:150 mg/dL or higher, or you're on medication for elevated triglycerides.
HDL cholesterol (the “good” kind): Less than 40 mg/dL for men, less than 50 mg/dL for women, or you're on meds to raise it.
Blood pressure: 130/85 mm Hg or higher, or you're on medication for high blood pressure.
Fasting blood sugar: 100 mg/dL or higher, or you're taking meds for elevated glucose.

Meeting three means you’re dealing with metabolic syndrome, which ups your risk for type 2 diabetes, heart disease, and stroke.

What Causes Metabolic Syndrome?

Metabolic syndrome doesn’t have one single cause—it’s more like a perfect storm of risk factors.

The biggest culprits are insulin resistance and chronic inflammation, often fueled by carrying extra weight (especially around the belly), being physically inactive, and eating a diet high in processed carbs and added sugars.

Genetics also plays a role—some people are just more predisposed to develop it. Aging ups your risk, too.

Basically, when your body stops responding well to insulin, your blood sugar, blood pressure, and cholesterol can all drift in the wrong direction, and that’s when the domino effect of metabolic syndrome starts kicking in.

How Does Obesity Play a Role in Metabolic Syndrome?

Obesity, particularly around the waist, is more than just a number on a scale—it’s a metabolic disruptor. Excess fat can throw off your body's balance and create the ideal environment for metabolic syndrome to develop.

Types of Body Fat, Ranked from Least to Most Harmful

Not all fat is created equal. Your body stores fat in different ways, and some types are a lot more dangerous than others.

Subcutaneous fat: This is the soft fat just under your skin—the stuff you can pinch. It’s the least harmful and even plays a role in insulation and hormone function.
Intramuscular fat: Found between muscle fibers (like the marbling in steak), this fat increases with age and inactivity. It’s not ideal, but not the biggest threat either.
Visceral fat: This is the one to watch. This dense, firmer version of fat builds up around your organs, pumping out inflammatory compounds and messing with insulin regulation.

The more visceral fat you carry, the higher your risk, even if your weight doesn’t look alarming on paper. That’s why waist circumference is such a big deal in metabolic health.

On the flip side, when you lose weight (such as when using GLP-1 agonists), you're most likely to lose visceral fat first.

Visceral Fat Isn’t Just Extra Weight

Visceral fat is belly-based, organ-hugging fat, not the kind that spreads all over your body. You might hear your doctor say that visceral fat is "metabolically active." Here's what that means: The fat cells are constantly sending out signals, hormones, and chemicals that affect how your body works.

So instead of just storing extra energy, metabolically active fat actually talks to your body—it can influence hunger, blood sugar, inflammation, and even how your body responds to insulin.

By the time visceral fat shows up, it’s not just sitting there—it’s actively working against your health. This deep belly fat surrounds your internal organs and releases inflammatory chemicals and hormones that disrupt how your body processes insulin, sugar, and fat.

You may not see it from the outside, but your waistline (or a belly that pokes out) can be a major clue. That’s why measuring abdominal circumference—not just weight or BMI—matters.

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The scale pairs with your mobile device and gives a breakdown of many elements, including visceral fat (listed as a ranking from 1-59) vs. subcutaneous fat (listed in percentages).

Since I started Zepbound, my visceral fat score went from 30 to 21. Once I hit 15, I will be in a lower risk group. My subcutaneous fat dropped by 11% during this timeframe, but I still have a ways to go before I am in the "average range."

summer sitting by my scale — My RENPHO Scale (and my golden retriever, Summerella). You can purchase this scale through my Amazon affiliate link. While I earn a commission on all purchases at no extra cost to you, I only promote products I find useful. Golden retriever is NOT for sale 😍

Inflammation and Hormone Imbalance

Let’s break this down further, because this is where obesity stops being just about extra weight and starts behaving more like a metabolic disruptor.

When fat cells—especially in the visceral fat depot—expand beyond what your body can comfortably handle, they become stressed. Picture an overstuffed closet where everything starts spilling out and jamming the door. Stressed fat cells begin releasing pro-inflammatory cytokines, which are chemical messengers that essentially tell your immune system, “We’ve got a problem.”

These cytokines create a state of chronic, low-grade inflammation—not the kind that gives you a fever or a swollen ankle, but the kind that silently messes with nearly every system in your body over time.

Here’s how that plays out:

Arteries: Inflammation damages the inner lining of blood vessels (the endothelium), making them stiffer and more prone to plaque buildup. This raises blood pressure and increases the risk of heart disease.
Glucose metabolism: Inflammation interferes with how your cells respond to insulin, the hormone that helps move sugar out of your blood and into your cells for energy. That resistance raises blood sugar, which is how type 2 diabetes starts creeping in.
Fat processing: Inflammatory signals alter how your liver and fat cells handle cholesterol and triglycerides, leading to higher LDL (bad) cholesterol and lower HDL (good) cholesterol.

So while weight gain itself doesn’t directly “cause” metabolic syndrome, the environment obesity creates—especially the inflammation—is what flips the metabolic switch.

This is why reducing visceral fat through even modest weight loss, healthier eating, or medications like GLP-1s can lower inflammation and reverse some of the damage. You're not just shrinking fat—you’re calming down an entire dysfunctional system.

before and after — Within three months, the inflammation and edema from chronic kidney disease and arthritis reduced substantially, thanks to the loss of visceral fat and extra weight.

How Obesity Disrupts Insulin—and How Insulin Resistance Feeds Obesity

Obesity and insulin resistance don’t just coexist—they fuel each other in a vicious cycle that underpins metabolic syndrome.

Here’s how it starts:

When you carry excess fat, especially visceral fat, your fat cells become overloaded and inflamed.
That inflammation interferes with how your cells respond to insulin, the hormone that helps move glucose from your bloodstream into your cells for energy.
The more resistant your cells become, the more insulin your pancreas has to pump out to get the job done.

But high insulin levels aren’t harmless. Chronically elevated insulin signals your body to store more fat, especially around the abdomen. It also makes it harder to burn existing fat for energy, essentially putting your metabolism into storage mode.

At the same time, glucose builds up in your blood, triggering cravings and crashes that make you more likely to overeat—especially carbs, which spike insulin even further.

So, obesity makes your insulin stop working as well. And poor insulin sensitivity makes it easier to gain—and harder to lose—fat. This metabolic tug-of-war is why breaking the cycle can radically shift your insulin dynamics and overall health.

Not All Obesity Is Equal

Two people can have the same BMI and look completely different on the inside. That matters a lot when it comes to metabolic syndrome risks. Where and how your body stores fat has a bigger impact on your health than just how much you weigh.

Here’s what makes the difference:

Fat distribution matters: Carrying more fat around your hips and thighs (called “pear-shaped”) is generally less risky than fat stored around your abdomen (“apple-shaped”). Belly fat often means more visceral fat, which is more metabolically harmful.
BMI doesn’t tell the whole story: Someone with a “normal” BMI could still have high visceral fat and be at risk for metabolic syndrome. Back when “skinny fat” was the buzzword, this is exactly what people were trying to describe—normal weight on paper, but unhealthy under the surface.
Metabolically healthy obesity exists—but it’s rare: Some people are technically obese but have normal blood pressure, cholesterol, and blood sugar. Still, research shows many of them eventually develop metabolic issues over time, especially if visceral fat increases.
Muscle mass changes the equation: A person with more muscle may weigh more but be healthier metabolically than someone with less muscle and more fat at the same weight.

So the scale and BMI can be starting points—but waist circumference, body composition, and lab results tell the real story.

Metabolic Syndrome and Diabetes: Which Comes First?

Think of metabolic syndrome as the warning light on the dashboard, and type 2 diabetes as the engine trouble that happens when you ignore it for too long.

Metabolic syndrome is often the precursor. It signals that your body is struggling to manage blood sugar, fat storage, and blood pressure all at once. Over time, this metabolic stress wears down your body’s ability to respond to insulin, pushing you closer to insulin resistance and eventually, diabetes.

Here’s how it usually unfolds:

First comes metabolic syndrome with high blood sugar, high blood pressure, abnormal cholesterol, and belly fat creeping in.
Then comes insulin resistance where your body stops responding properly to insulin, so your pancreas has to work overtime.
And finally, diabetes. Once your pancreas can’t keep up, blood sugar levels stay high, and type 2 diabetes is diagnosed.

Not everyone with metabolic syndrome will develop diabetes, but the risk is high. The good news? Catching it early (or reversing it with weight loss, exercise, or GLP-1 meds) can stop the cycle before diabetes sets in.

Why Not All Diabetics Can Reverse the Damage

Even though weight loss and improved insulin sensitivity can lead to major improvements—or even remission—in type 2 diabetes, it’s not always possible to undo the damage. A lot depends on how long the disease has been active and how much internal stress the body has already absorbed.

Here’s what’s happening under the surface:

Beta cell burnout

Your pancreas relies on beta cells to produce insulin. In the early stages of insulin resistance, those cells work overtime to keep blood sugar in check. But over time, they get worn out and start dying off.

Once beta cells are lost, they don’t come back—so even if you improve your diet or lose weight, your body might not be able to produce enough insulin on its own anymore.

Permanent organ damage

Chronic high blood sugar silently damages nerves, blood vessels, kidneys, and eyes. Even if glucose levels improve later, some of that damage can’t be reversed—it can only be slowed or managed.

People with prediabetes or early-stage diabetes have the best chance of reversing the disease. That’s why early diagnosis and intervention (including GLP-1 medications like Ozempic or Mounjaro paired with lifestyle changes) make a huge difference.

Can Metabolic Syndrome Be Reversed?

Because the diagnosis of metabolic syndrome is based on meeting at least three out of five criteria, the reverse is also true: If lifestyle changes, weight loss, medications, or other interventions bring you down to fewer than three of those criteria, you no longer meet the clinical definition.

Here’s how that might look in practice:

You reduce your waist circumference through fat loss, especially visceral fat.
Your triglycerides come down with better eating habits or medication.
Your HDL improves with exercise or weight loss.
Blood pressure lowers through diet, activity, or medication.
Your fasting blood sugar drops below 100 mg/dL consistently.

Doctors may not formally “remove” a diagnosis the way they would with, say, an infection—but they will document that you no longer meet the criteria. More importantly, your risk of developing diabetes or heart disease drops significantly, even if you once carried the label.

How GLP-1 Agonists Help Tackle Metabolic Syndrome

GLP-1 medications like Ozempic, Wegovy, and Zepbound weren’t originally designed to treat metabolic syndrome, but they’re remarkably effective at targeting the core issues that define it.

Here’s how they work:

Lower blood sugar: GLP-1s boost insulin when you need it and cut back glucagon (the hormone that raises blood sugar), helping keep glucose levels stable, especially after meals.
Promote weight loss: These meds reduce appetite and slow digestion, which leads to fewer cravings and smaller portions. As weight drops, especially around the belly, so does visceral fat—the main driver of inflammation and insulin resistance.
Improve cholesterol and triglycerides: Studies show GLP-1s can lower triglycerides and modestly raise HDL, both of which help undo part of the metabolic syndrome checklist.
Lower blood pressure: Weight loss and better metabolic control also help bring down blood pressure, often without needing separate medications.

In short, GLP-1s don’t just treat symptoms—they attack the root causes. They’re not a magic fix, but for people living with metabolic syndrome, they can be a powerful tool to break the cycle and move out of the danger zone.

Are You Worried About Metabolic Syndrome?

Metabolic syndrome doesn’t always come with flashing warning signs. Most people don’t feel sick—they just have slowly rising numbers on a chart.

It’s most common in people over 40, those with a family history of metabolic issues, and communities facing barriers to healthcare, nutrition, and physical activity. It’s also a big reason why health outcomes differ so much across income and race.

And it’s not just about diabetes—metabolic syndrome doubles your risk of heart attack or stroke. It’s a whole-body, long-haul issue. Yet many people are diagnosed with “prediabetes,” “fatty liver,” or “high blood pressure” without ever hearing the unifying term that ties it all together.

Metabolic syndrome may sound like a technical label, but understanding it can change the trajectory of your health. Because if you catch it early—before the system fully breaks—you can actually reverse it. And that’s a rare opportunity in medicine.

Disclaimer: I’m not a doctor, and this article isn’t medical advice; it's information. If you think you might have metabolic syndrome—or you're dealing with any of the risk factors mentioned—talk to a qualified healthcare provider. They can run the right tests, help you interpret your results, and guide you toward next steps based on your personal health needs.