"I'm Thin, So I'm Fine"? The Misconception of Generation X, Which Had No Time to Look After Itself

[Financial News] For Generation X entering middle age, diabetes and obesity are major concerns. However, experts warn that health management should not be viewed simply as a matter of losing weight. Diabetes can develop even at a normal weight, while abdominal obesity and fatty liver may signal the need to examine heart and kidney health as well.
Junyeop Lee, a professor in the Division of Endocrinology and Metabolism at The Catholic University of Korea, Seoul St. Mary's Hospital, explained, "The key to managing metabolic health in middle age is to move beyond viewing individual measurements separately and identify and manage the risks of interconnected diseases at an early stage."

East Asians, including Koreans, can develop type 2 diabetes even at a relatively low body mass index. What matters is not only how effectively insulin works in the body, but also whether the body can secrete enough insulin when needed. The cells that produce insulin are the beta cells in the pancreas. As insulin resistance increases, beta cells must produce more insulin. If they cannot secrete enough to meet the body's needs, blood glucose levels rise. This is why people cannot consider themselves free from diabetes risk simply because they are not overweight.
Lee explained that health screenings use fasting blood glucose and glycated hemoglobin, or HbA1c, to assess diabetes risk. If diabetes is suspected or a person is considered high-risk, insulin secretion capacity should also be evaluated based on the individual's condition. He emphasized that once diabetes is diagnosed, treatment strategies should be established from the outset to reduce the burden on beta cells and preserve their function.

The effects of abdominal obesity and insulin resistance extend beyond blood glucose. Increased visceral fat and chronic inflammation can place stress on the heart and kidneys, particularly in combination with high blood pressure and dyslipidemia. Fat accumulation in the liver is also closely linked to these metabolic abnormalities.
The American Heart Association (AHA) and other organizations have proposed the concept of cardiovascular-kidney-metabolic (CKM) syndrome, which views metabolic diseases such as obesity and diabetes, cardiovascular disease, and chronic kidney disease as interconnected problems. More recently, an expanded concept called cardiovascular-kidney-metabolic-liver (CKML) syndrome, which also includes liver health, has been proposed. The key is to manage risks affecting multiple organs together. Diseases do not necessarily develop in a fixed order, but because they influence one another, prevention and treatment should also be pursued together.
Fatty liver associated with metabolic abnormalities such as obesity and diabetes is not limited to the liver. In some cases, it can progress through steatohepatitis and fibrosis to cirrhosis, and it is also associated with an increased risk of cardiovascular disease and chronic kidney disease. If fatty liver is detected during a health screening, it should not be dismissed as minor; overall metabolic health should be evaluated.

It is important to check weight, waist circumference, blood glucose, blood pressure, and cholesterol together. People with abdominal obesity or a family history of diabetes should regularly check their fasting blood glucose and HbA1c even if they have no symptoms. Those with diabetes or high blood pressure should consult a medical professional about checking kidney function through blood tests and looking for signs of kidney damage with a urine albumin test. For people with fatty liver, normal liver enzyme levels alone should not be considered reassuring. The risk of liver fibrosis should be assessed, followed by additional testing when appropriate.
The goal of lifestyle management should be to create sustainable changes rather than achieve substantial short-term weight loss. The basics include reducing overeating, sugar intake, late-night meals, and alcohol while maintaining a balanced diet. It is also important to combine aerobic and strength training to preserve muscle mass.
If treatment for obesity or diabetes is needed, medication should be used appropriately alongside lifestyle improvements. Treatment should not stop at lowering weight or blood glucose levels. It should also take blood pressure, cholesterol, and the condition of the heart, kidneys, and liver into account in order to reduce the risk of complications.
The same principles apply during periods such as Chuseok, when people have more opportunities to eat and drink alcohol. It is important to enjoy holiday foods while avoiding overeating and excessive drinking and maintaining regular eating and exercise habits.
Generation X's health management should not stop at how many kilograms have been lost. People should pay attention to beta-cell function and diabetes risk, and when signs such as abdominal obesity or fatty liver appear, they should also examine their heart and kidney health. Managing metabolic diseases in middle age is about more than lowering individual measurements; it is a process of preventing long-term organ damage in the future.
 
[email protected] Myeong-jin Jeong, Medical Correspondent Reporter