The number on a scale or a “normal” Body Mass Index (BMI) can provide a false sense of security when it comes to heart health. A significant portion of the population, particularly those of South Asian ethnicity, can be “metabolically challenged” even with a BMI under 25, placing them at a hidden but substantial risk for cardiovascular disease driven by cholesterol abnormalities.
This condition, sometimes described as “normal weight obesity” or “metabolically obese normal weight,” means that an individual may have a high percentage of body fat, especially visceral fat around the organs, despite their total weight being in a healthy range. This type of fat is metabolically active and contributes directly to an unhealthy lipid profile.
People in this category often exhibit the classic signs of atherogenic dyslipidaemia: high triglycerides, low HDL (good cholesterol), and a high number of small, dense LDL particles. This harmful combination accelerates the process of atherosclerosis, increasing the risk of early-onset coronary artery disease even without the obvious red flag of being overweight.
For this reason, relying on BMI alone as a measure of health is insufficient. A more thorough assessment, including a full lipid panel and possibly a measurement of waist circumference, is needed to identify this hidden risk. Understanding that you can be lean on the outside but unhealthy on the inside is a critical first step toward prevention.
The management strategy for this group emphasizes lifestyle changes that target metabolic health, not just weight. This includes a diet low in refined carbohydrates and high in fiber, along with a consistent exercise routine that combines both cardio and strength training. Even a modest reduction in body fat, without a major change in total weight, can lead to significant improvements in cholesterol markers and provide powerful, outsized cardiovascular benefits.