Report on Cardiometabolic Risk in Normal-BMI Individuals and Implications for Sustainable Development Goal 3

Introduction: Addressing Non-Communicable Diseases (NCDs)

Recent research highlights a significant gap in the global strategy to combat non-communicable diseases (NCDs), a key component of Sustainable Development Goal 3 (Good Health and Well-being). Two studies indicate that a substantial portion of the population with a normal Body Mass Index (BMI) exhibits abdominal obesity, placing them at an elevated cardiometabolic risk. This oversight in diagnostics challenges the achievement of SDG Target 3.4, which aims to reduce premature mortality from NCDs through prevention and treatment. This report synthesizes the findings and their implications for global health policy.

Global Cross-Sectional Study: Uncovering Hidden Risk

Prevalence of Abdominal Obesity in Normal-BMI Populations

A global study published in JAMA Network Open on October 17, 2025, analyzed data from 91 countries, revealing a critical public health issue that impedes progress toward SDG 3.

• Global Prevalence: The overall prevalence of abdominal obesity was 45.4%.
• Normal-BMI Cohort: More than one in five adults (21.7%) with a normal BMI (18.5-24.9) had abdominal obesity.
• Regional Disparities: Prevalence in the normal-BMI group varied significantly, from 15.3% in the Western Pacific region to 32.6% in the Eastern Mediterranean, highlighting inequalities in health outcomes relevant to SDG 10 (Reduced Inequalities).

Association with Cardiometabolic Risk Factors

The study established a consistent association between abdominal obesity in normal-BMI individuals and major NCDs, underscoring the inadequacy of BMI as a sole screening tool.

1. Hypertension: A 1.29-fold increase in the odds of hypertension.
2. Diabetes: A 1.81-fold increase in the odds of diabetes.
3. Elevated Total Cholesterol: A 1.39-fold increase in the odds of high cholesterol.
4. Elevated Triglycerides: A 1.56-fold increase in the odds of high triglycerides.

These findings suggest that millions are at risk of developing NCDs but may be missed by current screening protocols, thereby hindering efforts to meet SDG Target 3.4.

Policy Implications for Achieving SDG 3

The authors advocate for the integration of waist circumference measurement into routine clinical practice. This aligns with the principles of universal health coverage (SDG Target 3.8) by providing a more accurate and complete assessment of cardiometabolic risk, enabling timely and appropriate interventions for at-risk populations.

US-Based Cohort Study: Defining “Anthropomorphic-Only Obesity”

Prevalence and Demographics

A second study, also in JAMA Network Open (October 15, 2025), utilized data from the All of Us (AoU) cohort to examine a phenomenon termed “anthropomorphic-only obesity.”

• Prevalence: Over 25% of the cohort had normal BMI but exhibited at least two elevated anthropomorphic measurements (waist circumference, waist-to-hip ratio, or waist-to-height ratio).
• Demographic Factors: This condition was more prevalent in males (32.5%) than females (21.7%) and increased significantly with age, affecting 78.3% of individuals older than 70 years.

Link to Morbidity and Mortality

The study confirmed that this condition is associated with significant morbidity, reinforcing the urgency of addressing NCDs to achieve SDG 3.

1. Type 2 Diabetes: Individuals with anthropomorphic-only obesity had a 2.12-fold higher risk for incident type 2 diabetes compared to those with neither condition.
2. Cardiovascular Events: The risk for cardiovascular events was elevated, with an adjusted hazard ratio of 1.55.
3. All-Cause Mortality: The risk for all-cause mortality was also significantly increased (adjusted hazard ratio of 1.20).

Conclusion: A Call for Enhanced Health Screening Protocols

Strengthening NCD Prevention to Meet SDG Targets

Both studies conclude that reliance on BMI alone is insufficient for identifying individuals at high risk for NCDs. To advance global health and meet the targets outlined in SDG 3, a paradigm shift in clinical assessment is required.

Recommendations

• Integrate Anthropometric Measurements: Health systems worldwide should adopt waist circumference and other anthropometric measurements as standard vital signs alongside BMI to improve risk stratification.
• Update Clinical Guidelines: Public health organizations and medical bodies must update diagnostic and screening guidelines to reflect the risks associated with abdominal obesity, regardless of BMI.
• Targeted Interventions: The development of interventions aimed specifically at reducing visceral adiposity could provide a new therapeutic pathway for this distinct at-risk population, contributing directly to the reduction of premature NCD mortality as mandated by SDG 3.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article directly addresses health issues by focusing on obesity, specifically abdominal obesity, and its strong association with noncommunicable diseases (NCDs) such as hypertension, diabetes, and cardiovascular disease. The research discussed aims to improve the diagnosis and identification of at-risk populations to ensure better health outcomes and promote well-being, which is the core objective of SDG 3.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

  The article’s central theme is the prevention and better identification of cardiometabolic risks associated with abdominal obesity. The studies highlight that individuals with normal BMI but abdominal obesity are often “overlooked for appropriate interventions.” By recommending the inclusion of waist circumference as a vital sign, the research aims to improve early detection and prevention of NCDs like diabetes and cardiovascular disease, directly contributing to the goal of reducing premature mortality from these conditions.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease.

  The article provides several metrics that are directly or indirectly related to this indicator. It explicitly discusses the increased risk for “incident type 2 diabetes,” “cardiovascular events,” and “all-cause mortality” in individuals with abdominal obesity. The studies measure the prevalence of key risk factors and associated diseases, including:

  • Prevalence of abdominal obesity (defined by waist circumference).
  • Prevalence of hypertension.
  • Prevalence of diabetes.
  • Levels of elevated total cholesterol and triglycerides.
  • Adjusted hazard ratios for cardiovascular events and all-cause mortality.

  Tracking these metrics, as done in the WHO survey mentioned in the article, is essential for monitoring progress toward reducing mortality from NCDs.

Table of SDGs, Targets, and Indicators

Source: medscape.com